European Radiology

, Volume 29, Issue 3, pp 1164–1174 | Cite as

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

  • Mariko GotoEmail author
  • Koji Sakai
  • Hajime Yokota
  • Maki Kiba
  • Mariko Yoshida
  • Hiroshi Imai
  • Elisabeth Weiland
  • Isao Yokota
  • Kei Yamada



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.


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.


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).


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.


Breast neoplasms Magnetic resonance imaging Contrast media Kinetics Classification 



American College of Radiology


Breast imaging reporting and data system


Confidence interval


Ductal carcinoma in situ


Field of view


Generalised autocalibrating partial parallel acquisition


Human epidermal growth factor receptor type 2


Hormone receptor


Invasive ductal carcinoma


Invasive lobular carcinoma


Interquartile range


Maximum slope


Non-mass enhancement


Time to enhancement


T2-weighted imaging


Time-resolved angiography with interleaved stochastic trajectories


Volume-interpolated breath-hold examination



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

Compliance with ethical standards


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.


• Retrospective

• Diagnostic or prognostic study

• Performed at one institution


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of Radiology, Graduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
  2. 2.Department of RadiologyChiba University HospitalChibaJapan
  3. 3.Department of RadiologyJapanese Red Cross Kyoto Daini HospitalKyotoJapan
  4. 4.Siemens Healthcare K.K.TokyoJapan
  5. 5.Siemens Healthcare GmbHErlangenGermany
  6. 6.Department of Biostatistics, Graduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan

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