Abstract
Dynamic contrast-enhanced magnetic resonance imaging (DCE MRI) of the breast is a routinely used imaging method which is highly sensitive for detecting breast malignancy. Specificity, though, remains suboptimal. Dynamic susceptibility contrast magnetic resonance imaging (DSC MRI), an alternative dynamic contrast imaging technique, evaluates perfusion-related parameters unique from DCE MRI. Previous work has shown that the combination of DSC MRI with DCE MRI can improve diagnostic specificity, though an additional administration of intravenous contrast is required. Dual-echo MRI can measure both T1W DCE MRI and T2*W DSC MRI parameters with a single contrast bolus, but has not been previously implemented in breast imaging. We have developed a dual-echo gradient-echo sequence to perform such simultaneous measurements in the breast, and use it to calculate the semi-quantitative T1W and T2*W related parameters such as peak enhancement ratio, time of maximal enhancement, regional blood flow, and regional blood volume in 20 malignant lesions and 10 benign fibroadenomas in 38 patients. Imaging parameters were compared to surgical or biopsy obtained tissue samples. Receiver operating characteristic (ROC) curves and area under the ROC curves were calculated for each parameter and combination of parameters. The time of maximal enhancement derived from DCE MRI had a 90% sensitivity and 69% specificity for predicting malignancy. When combined with DSC MRI derived regional blood flow and volume parameters, sensitivity remained unchanged at 90% but specificity increased to 80%. In conclusion, we show that dual-echo MRI with a single administration of contrast agent can simultaneously measure both T1W and T2*W related perfusion and kinetic parameters in the breast and the combination of DCE MRI and DSC MRI parameters improves the diagnostic performance of breast MRI to differentiate breast cancer from benign fibroadenomas.
Highlights
Magnetic resonance imaging (MRI) has become an important technique for breast cancer detection, diagnosis, and staging [1]
When lesion morphology is combined with the dynamic analysis of contrast kinetics within breast lesions, the overall sensitivity of MRI is nearly 90%, and specificity varies between 67% and 72% [2,3]
An alternative dynamic contrast technique, known as dynamic susceptibility-contrast MRI (DSC MRI) uses high temporal resolution to obtain perfusionrelated parameters based on T2*measurements, such as relative regional blood volumeand relative regional blood flow
Summary
Magnetic resonance imaging (MRI) has become an important technique for breast cancer detection, diagnosis, and staging [1]. When lesion morphology is combined with the dynamic analysis of contrast kinetics within breast lesions, the overall sensitivity of MRI is nearly 90%, and specificity varies between 67% and 72% [2,3]. Conventional dynamic contrast enhanced MRI (DCE MRI) is the most widely used and clinically validated technique for breast cancer MRI. It provides morphological information, and typically uses high spatial resolution to estimate T1W-related contrast uptake parameters. An alternative dynamic contrast technique, known as dynamic susceptibility-contrast MRI (DSC MRI) uses high temporal resolution to obtain perfusionrelated parameters based on T2*measurements, such as relative regional blood volume (rBV)and relative regional blood flow (rBF)
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