Room: Exhibit Hall | Forum 8
Purpose: To identify initial enhancement parameters measured from ultrafast DCE-MRI that may aid in ruling out malignancy for suspicious breast lesions.
Methods: 59 patients with dense breasts and suspicious findings on screening mammograms were enrolled in this prospective study that involved a pre-biopsy MRI that included ultrafast imaging during the first post-contrast minute. The temporal resolution of the ultrafast scans ranged from 3.5 to 10 seconds. Relative enhancement was calculated for each voxel and then fit to a linear sigmoid. From the fit parameters, time-to-enhancement (TTE), maximum slope of enhancement (MS), and initial area under the contrast curve (iAUC30) were calculated. TTE was expressed relative to the time of enhancement in the aorta to mitigate influence from systemic parameters. ROC analysis was performed in order to identify the highest performing parameters in differentiating benign and malignant lesions. Biopsy results were used as ground truth.
Results: 83 total lesions were included in this analysis with 39 benign lesions, and 44 malignancies (invasive and pre-invasive). The average TTE of benign lesions was 13.2Â±6.4s, and 9.9Â±4.2s for malignant lesions (p < 0.005). The malignant-to-benign ratio of MS and iAUC30 were 1.55 and 1.36, respectively. Of these kinetic parameters, MS had the best performance discriminating between benign and malignant lesions, with an area under the ROC curve (AUC) of 0.74. Twelve (of 39) benign lesions (~31%) had a mean MS value lower than the lowest measured in all malignancies.
Conclusion: Ultrafast DCE-MRI could be a valuable aid in the evaluation of suspicious breast lesions. Maximum slope of initial enhancement was found to have the highest performance of the parameters analyzed in differentiating lesions. The results suggest that this type of analysis has the potential of ruling out malignancy in some suspicious lesions and could lead to a reduction in the number of biopsies performed.