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

  • Breast
  • Published:
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Abstract

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.

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Abbreviations

ACR:

American College of Radiology

BI-RADS:

Breast imaging reporting and data system

CI:

Confidence interval

DCIS:

Ductal carcinoma in situ

FOV:

Field of view

GRAPPA:

Generalised autocalibrating partial parallel acquisition

HER2:

Human epidermal growth factor receptor type 2

HR:

Hormone receptor

IDC:

Invasive ductal carcinoma

ILC:

Invasive lobular carcinoma

IQR:

Interquartile range

MS:

Maximum slope

NME:

Non-mass enhancement

TTE:

Time to enhancement

T2WI:

T2-weighted imaging

TWIST:

Time-resolved angiography with interleaved stochastic trajectories

VIBE:

Volume-interpolated breath-hold examination

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Funding

This study has received funding by the Japan Society for the Promotion of Science (JSPS) KAKENHI Grant Number JP16K19840.

Author information

Authors and Affiliations

  1. Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi Hirokoji, Kamigyoku, Kyoto, 602-8566, Japan

    Mariko Goto, Koji Sakai, Mariko Yoshida & Kei Yamada

  2. Department of Radiology, Chiba University Hospital, Chiba, Japan

    Hajime Yokota

  3. Department of Radiology, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan

    Maki Kiba

  4. Siemens Healthcare K.K., Tokyo, Japan

    Hiroshi Imai

  5. Siemens Healthcare GmbH, Erlangen, Germany

    Elisabeth Weiland

  6. Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Isao Yokota

Authors
  1. Mariko Goto
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  2. Koji Sakai
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  3. Hajime Yokota
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  4. Maki Kiba
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  5. Mariko Yoshida
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  6. Hiroshi Imai
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  7. Elisabeth Weiland
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  8. Isao Yokota
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  9. Kei Yamada
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Corresponding author

Correspondence to Mariko Goto.

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Guarantor

The scientific guarantor of this publication is Mariko Goto MD, PhD, Assistant Professor of the Department of Radiology, Kyoto Prefectural University of Medicine.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: Two of the co-authors (Elisabeth Weiland and Hiroshi Imai) are employees of Siemens Healthcare.

Statistics and biometry

One of the authors (Isao Yokota) has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Diagnostic or prognostic study

• Performed at one institution

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Goto, M., Sakai, K., Yokota, H. et al. Diagnostic performance of initial enhancement analysis using ultra-fast dynamic contrast-enhanced MRI for breast lesions. Eur Radiol 29, 1164–1174 (2019). https://doi.org/10.1007/s00330-018-5643-4

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  • DOI: https://doi.org/10.1007/s00330-018-5643-4

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