Differentiation of Breast Cancer from Fibroadenoma with Dual-Echo Dynamic Contrast-Enhanced MRI

Abstract

Dynamic contrast-enhanced magnetic resonance imaging (DCE MRI) of the breast is a routinely used imaging method which is highly sensitive for detecting breast malignancy. Specificity, though, remains suboptimal. Dynamic susceptibility contrast magnetic resonance imaging (DSC MRI), an alternative dynamic contrast imaging technique, evaluates perfusion-related parameters unique from DCE MRI. Previous work has shown that the combination of DSC MRI with DCE MRI can improve diagnostic specificity, though an additional administration of intravenous contrast is required. Dual-echo MRI can measure both T1W DCE MRI and T2*W DSC MRI parameters with a single contrast bolus, but has not been previously implemented in breast imaging. We have developed a dual-echo gradient-echo sequence to perform such simultaneous measurements in the breast, and use it to calculate the semi-quantitative T1W and T2*W related parameters such as peak enhancement ratio, time of maximal enhancement, regional blood flow, and regional blood volume in 20 malignant lesions and 10 benign fibroadenomas in 38 patients. Imaging parameters were compared to surgical or biopsy obtained tissue samples. Receiver operating characteristic (ROC) curves and area under the ROC curves were calculated for each parameter and combination of parameters. The time of maximal enhancement derived from DCE MRI had a 90% sensitivity and 69% specificity for predicting malignancy. When combined with DSC MRI derived regional blood flow and volume parameters, sensitivity remained unchanged at 90% but specificity increased to 80%. In conclusion, we show that dual-echo MRI with a single administration of contrast agent can simultaneously measure both T1W and T2*W related perfusion and kinetic parameters in the breast and the combination of DCE MRI and DSC MRI parameters improves the diagnostic performance of breast MRI to differentiate breast cancer from benign fibroadenomas.

Diagnostic value of dynamic contrast-enhanced magnetic resonance imaging in rectal cancer and its correlation with tumor differentiation

“…These results are in agreement with previous studies performed with other types of solid tumors, including orbital (23), breast (24,25), head and neck (26) and pancreatic tumors (11). A previous study in colorectal cancer is consistent with the present study (27).…”

Single bolus split dynamic MRI: Is the combination of high spatial and dual-echo high temporal resolution interleaved sequences useful in the differential diagnosis of breast masses?

“…High diagnostic accuracy has also been obtained from qualitative assessment of signal loss in T 2 *‐weighted images using dynamic susceptibility contrast (DSC) MRI . Investigators have shown that using DSC MRI in conjunction with DCE MRI may help to distinguish malignant from benign breast lesion . The main limitation using this technique is the need for an additional contrast bolus to measure susceptibility‐induced signal loss with a dynamic T 2 / T 2 *‐weighted sequence.…”

Development of a Non-invasive Assessment of Hypoxia and Neovascularization with Magnetic Resonance Imaging in Benign and Malignant Breast Tumors: Initial Results

“…Wang, et al [48] developed a dual-echo GE sequence for simultaneous measurements of T1w DCE MRI and T2*w DSC MRI parameters in the breast that allowed the calculation of semi-quantitative parameters such as blood flow and blood volume. They showed that their approach .…”