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Effects of gadobutrol on background parenchymal enhancement and differential diagnosis between benign and malignant lesions in dynamic magnetic resonance imaging of the breast

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Abstract

Background

The high concentration of gadolinium in gadobutrol, which is widely used in Japan, helps visualize signal enhancement of neoplastic lesions, however, there was concern that high T1 relaxivity could decrease the contrast between the lesion and the background mammary gland. We evaluate the effect of gadobutrol on background parenchymal enhancement (BPE) and differential diagnosis between benign and malignant lesions in dynamic MRI of the breast.

Methods

Ninety-nine patients were enrolled prospectively. Measurements of the following signal intensities (SIs) were obtained: breast tissue on a pre-contrast image (SIpre) and an early-phase image (SIearly); and the SIs of breast cancer on a pre-contrast image (SIpre-cancer) and an early-phase image (SIearly-cancer). We calculated the BPE ratio, i.e., (SIearly − SIpre)/SIpre and the cancer/BPE ratio, i.e., (SIearly-cancer − SIpre-cancer)/(SIearly on the affected side − SIpre on the affected side). These quantitative assessments were compared with the data from the recently published multicenter study (reference study without use of gadobutrol). In addition, two radiologists reinterpreted each of the MR images, and a third radiologist set the ROIs in the lesions and performed kinetic analysis as a Reader 3.

Results

While there was no significant difference in the SI of breast cancer in the premenopausal patients between the two studies, that in postmenopausal patients was significantly higher in the present study than in the reference study (p = 0.002). Although there was no significant difference in the cancer/BPE ratio in the postmenopausal patients between the two studies, the cancer/BPE ratio in the premenopausal patients was significantly higher in the reference study than in the present study (p = 0.028). For differentiation between benign and malignant masses, the mass margin was found to be the most important term (p < 0.001). According to the data of Reader 3, visual washout was observed in all 18 patients in whom the interpretation was changed from “plateau” to “washout”.

Conclusions

Gadobutrol may decrease the contrast between breast cancer and background parenchyma in premenopausal patients, and it may have a characteristic that “washout” does not easily occur, leading to “plateau” in patients with breast cancer.

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Acknowledgements

This work was supported by a Grant from Bayer Yakuhin Ltd. (Osaka, Japan). Part of the statistical analyses was conducted by Kondo Photo Process Co. Ltd. (Osaka, Japan).

Funding

This study was supported by Bayer Yakuhin Ltd. (Osaka, Japan), which had no role regarding the study performance.

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Authors and Affiliations

  1. Department of Radiology, Sagara Hospital, 3-31 Matsubara-cho, Kagoshima City, Kagoshima, 892-0833, Japan

    Mitsuhiro Tozaki

  2. Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Hidetake Yabuuchi

  3. Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto City, 602-8566, Japan

    Mariko Goto

  4. Department of Radiology, Sagara Perth Avenue Clinic, 26-13 Shinyashiki-cho, Kagoshima City, Kagoshima, 892-0838, Japan

    Michiro Sasaki

  5. Department of Radiology, Dokkyo Medical University, 880 Kitakobayashi, Mibu-machi, Shimotsuga-gun, Tochigi, 321-0293, Japan

    Kazunori Kubota

  6. Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima Bunkyo-ku, Tokyo, 113-8510, Japan

    Kazunori Kubota

  7. Department of Radiology, Sagara Hospital Miyazaki, 2-112-1 Maruyama, Miyazaki City, Miyazaki, 880-0052, Japan

    Hiroshi Nakahara

Authors
  1. Mitsuhiro Tozaki
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  2. Hidetake Yabuuchi
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  3. Mariko Goto
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  4. Michiro Sasaki
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  5. Kazunori Kubota
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  6. Hiroshi Nakahara
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Correspondence to Mitsuhiro Tozaki.

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Tozaki, M., Yabuuchi, H., Goto, M. et al. Effects of gadobutrol on background parenchymal enhancement and differential diagnosis between benign and malignant lesions in dynamic magnetic resonance imaging of the breast. Breast Cancer 28, 927–936 (2021). https://doi.org/10.1007/s12282-021-01229-w

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  • DOI: https://doi.org/10.1007/s12282-021-01229-w

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