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DCEMRI of breast lesions: Is kinetic analysis equally effective for both mass and nonmass‐like enhancement?
Author(s) -
Jansen Sanaz A.,
Fan Xiaobing,
Karczmar Gregory S.,
Abe Hiroyuki,
Schmidt Robert A.,
Giger Maryellen,
Newstead Gillian M.
Publication year - 2008
Publication title -
medical physics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.473
H-Index - 180
eISSN - 2473-4209
pISSN - 0094-2405
DOI - 10.1118/1.2936220
Subject(s) - nuclear medicine , washout , coronal plane , medicine , lesion , bi rads , kappa , radiology , breast cancer , mathematics , pathology , cancer , mammography , geometry
To perform a pilot study investigating whether the sensitivity and specificity of kinetic parameters can be improved by considering mass and nonmass breast lesions separately. The contrast media uptake and washout kinetics in benign and malignant breast lesions were analyzed using an empirical mathematical model (EMM), and model parameters were compared in lesions with mass‐like and nonmass‐like enhancement characteristics. 34 benign and 78 malignant breast lesions were selected for review. Dynamic MR protocol: 1 pre and 5 postcontrast images acquired in the coronal plane using a 3D T1‐weighted SPGR with 68 s timing resolution. An experienced radiologist classified the type of enhancement as mass, nonmass, or focus, according to the BI‐RADS ® lexicon. The kinetic curve obtained from a radiologist‐drawn region within the lesion was analyzed quantitatively using a three parameter EMM. Several kinetic parameters were then derived from the EMM parameters: the initial slope ( Slope ini ) , curvature at the peak ( κ peak ) , time to peak ( T peak ) , initial area under the curve at 30 s( iAUC 30 ) , and the signal enhancement ratio (SER). The BI‐RADS classification of the lesions yielded: 70 mass lesions, 38 nonmass, 4 focus. For mass lesions, the contrast uptake rate ( α ) , contrast washout rate ( β ) ,iAUC 30 , SER,Slope ini,T peakandκ peakdiffered substantially between benign and malignant lesions, and after correcting for multiple tests of significance SER andT peakdemonstrated significance ( p < 0.007 ) . For nonmass lesions, we did not find statistically significant differences in any of the parameters for benign vs. malignant lesions ( p > 0.5 ) . Kinetic parameters could distinguish benign and malignant mass lesions effectively, but were not quite as useful in discriminating benign from malignant nonmass lesions. If the results of this pilot study are validated in a larger trial, we expect that to maximize diagnostic utility, it will be better to classify lesion morphology as mass or nonmass‐like enhancement prior to kinetic analysis.