Diagnostic performance of initial enhancement analysis using ultra-fast dynamic contrast-enhanced MRI for breast lesions

• Published in: European radiology Vol. 29; no. 3; pp. 1164 - 1174
• Main Authors: Goto, Mariko, Sakai, Koji, Yokota, Hajime, Kiba, Maki, Yoshida, Mariko, Imai, Hiroshi, Weiland, Elisabeth, Yokota, Isao, Yamada, Kei
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.03.2019; Springer Nature B.V
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Benign; Biopsy; Breast; Breast - pathology; Breast cancer; Breast Neoplasms - diagnosis; Contrast Media - pharmacology; Diagnosis, Differential; Diagnostic Radiology; Diagnostic systems; Female; Humans; Imaging; Informed consent; Internal Medicine; Interventional Radiology; Lesions; Magnetic Resonance Imaging; Medical diagnosis; Medicine; Medicine & Public Health; Middle Aged; Neuroradiology; Prospective Studies; Radiology; Sensitivity analysis; Ultrasound; Young Adult; Breast neoplasms; Kinetics; Magnetic resonance imaging; Contrast media; Classification
• ISSN: 0938-7994; 1432-1084; 1432-1084
• DOI: 10.1007/s00330-018-5643-4

Objectives To assess the diagnostic value and contribution to BI-RADS categorisation of initial enhancement on ultra-fast DCE-MRI for differentiating malignant and benign breast lesions. Methods The institutional review board approved this study, and written informed consent was obtained from each participant. Both ultra-fast DCE-MRI for initial enhancement analysis and conventional MRI were performed on 200 subjects with a total of 215 lesions (147 malignant and 68 benign). BI-RADS categorisation of enhancing lesions was performed using the conventional MRI. Two initial enhancement measures, time to enhancement (TTE) and maximum slope (MS), were derived from the ultra-fast DCE-MRI. Diagnostic performance and the additional diagnostic value of adding TTE and MS to BI-RADS were evaluated. Results Both TTE and MS showed significant differences between malignant and benign breast lesions in masses (TTE, p <.001; MS, p = .006) and non-mass enhancement (NME) (TTE, p <.001; MS, p <.001). For masses, the AUC of TTE+MS combined with BI-RADS (0.864) was better than BI-RADS alone (0.823, p = .065). For NME, the AUC of TTE+MS combined with BI-RADS (0.923) was significantly larger than BI-RADS alone (0.865, p = .036), and diagnostic specificity improved by 40.9% ( p = .005), without a significant decrease in the sensitivity ( p = .083). Conclusion Initial enhancement analysis using ultra-fast DCE-MRI is especially useful for increasing the diagnostic performance of NME in breast MRI. Key Points • Ultra-fast dynamic MRI effectively differentiates benign from malignant breast lesions. • Ultra-fast dynamic MRI contributes to BI-RADS categorisation in non-mass enhancement. • Management of non-mass breast lesions becomes more appropriate.