Diagnostic performance of initial enhancement analysis using ultra-fast dynamic contrast-enhanced MRI for breast lesions
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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.
• 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.
KeywordsBreast neoplasms Magnetic resonance imaging Contrast media Kinetics Classification
American College of Radiology
Breast imaging reporting and data system
Ductal carcinoma in situ
Field of view
Generalised autocalibrating partial parallel acquisition
Human epidermal growth factor receptor type 2
Invasive ductal carcinoma
Invasive lobular carcinoma
Time to enhancement
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.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional Review Board approval was obtained.
• Diagnostic or prognostic study
• Performed at one institution
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