Nonmass Enhancement Breast Lesions: Diagnostic Performance of Kinetic Assessment on Ultrafast and Standard Dynamic Contrast-Enhanced MRI in Comparison With Morphologic Evaluation

Abstract

OBJECTIVE. The purpose of this article was to evaluate the diagnostic performance of the kinetic parameters of ultrafast and standard dynamic contrast-enhanced MRI (DCE-MRI) compared with morphologic evaluation in differentiating benign from malignant nonmass enhancement (NME) breast lesions. MATERIALS AND METHODS. A total of 77 consecutive patients with 77 NMEs (23 benign and 54 malignant) underwent 3-T MRI, including one unenhanced and eight contrast-enhanced ultrafast DCE-MRI scans (7-second scans) and standard DCE-MRI scans. The two readers evaluated the lesions' likelihood of malignancy on a continuous scale from 0 to 100% as the morphologic score using standard DCE-MRI. The kinetic curves of ultrafast DCE-MRI were fitted using an empirical mathematical model, ΔS(t) = A × (1 - e-αt), where A is the upper limit of signal intensity, e is the Euler number, and alpha (s-1) is the rate of signal increase. The initial slope of the kinetic curve (A × α) and the initial AUC (AUC30, which is the integration of the kinetic curve from 0 to 30 seconds) were calculated. From standard DCE-MRI, initial enhancement rate and signal enhancement ratio (SER) were calculated. These parameters were compared between benign and malignant NMEs. RESULTS. The morphologic score of malignant NME was statistically significantly higher than that of benign NME (p < 0.0001). The upper limit of signal intensity, rate of signal increase, initial slope of the kinetic curve, and AUC30 of ultrafast DCE-MRI, initial enhancement rate, SER of standard DCE-MRI of malignant NMEs were statistically significantly higher than those of benign NMEs (p = 0.0011, 0.0045, < 0.0001, < 0.0001, 0.0017, and < 0.0001, respectively). AUC ROC analysis found no statistically significant difference between morphologic score, AUC30 of ultrafast DCE-MRI, or SER of standard DCE-MRI. CONCLUSION. The kinetic parameters of ultrafast and standard DCE-MRI were as effective as morphologic evaluation for differentiation between benign and malignant NMEs.