Quantitative Three-Dimensional Assessment of the Pharmacokinetic Parameters of Intra- and Peri-tumoural Tissues on Breast Dynamic Contrast-Enhanced Magnetic Resonance Imaging

A Niukkanen,M Sudah,H Okuma,T Liimatainen,P Auvinen,R Vanninen,A Mannermaa

doi:10.1007/s10278-021-00509-3

Abstract

We aimed to assess the feasibility of three-dimensional (3D) segmentation and to investigate whether semi-quantitative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) parameters are associated with traditional prognostic factors for breast cancer. In addition, we evaluated whether both intra-tumoural and peri-tumoural DCE parameters can differentiate the breast cancers that are more aggressive from those that are less aggressive. Consecutive patients with newly diagnosed invasive breast cancer and structural breast MRI (3.0 T) were included after informed consent. Fifty-six patients (mean age, 57 years) with mass lesions of > 7 mm in diameter were included. A semi-automatic image post-processing algorithm was developed to measure 3D pharmacokinetic information from the DCE-MRI images. The kinetic parameters were extracted from time-signal curves, and the absolute tissue contrast agent concentrations were calculated with a reference tissue model. Markedly, higher intra-tumoural and peri-tumoural tissue concentrations of contrast agent were found in high-grade tumours (n = 44) compared to low-grade tumours (n = 12) at every time point (P = 0.006–0.040), providing positive predictive values of 90.6–92.6% in the classification of high-grade tumours. The intra-tumoural and peri-tumoural signal enhancement ratios correlated with tumour grade, size, and Ki67 activity. The intra-observer reproducibility was excellent. We developed a model to measure the 3D intensity data of breast cancers. Low- and high-grade tumours differed in their intra-tumoural and peri-tumoural enhancement characteristics. We anticipate that pharmacokinetic parameters will be increasingly used as imaging biomarkers to model and predict tumour behavior, prognoses, and responses to treatment.

Highlights

Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) has been used extensively in oncological imaging for decades
A total of 56 patients with 56 invasive breast cancers were included in the study
In the intra-tumoural area, the area under the curve (AUC) value for the concentration of contrast agent was significantly higher in the high-grade tumours than in the low-grade tumours

Summary

Introduction

Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) has been used extensively in oncological imaging for decades. DCE-MRI allows for malignant and benign tumours in the breast to be distinguished based on differences in the contrast agent enhancement patterns, and the method improves diagnostic accuracy, with proven importance in differential diagnostics and preoperative evaluation [1]. To evaluate the enhancement characteristics of lesions over time, a time intensity curve (TIC) is calculated by defining the region of interest (ROI) on the most suspicious region of enhancement within a lesion as instructed by the American College of Radiology Breast Imaging Reporting and Data System (ACR BI-RADS) [2]. In DCE-MRI, the distribution of gadolinium contrast agent is compared between the vasculature and the intracellular and extracellular spaces at different time points. The vascular density and the permeability of the vasculature in these tissues can be assessed, and the shape of the TIC can be determined. DCE-MRI-based parameters may be associated with the histopathological properties of tumours and may indicate their relative aggressiveness, and DCE-MRI may allow for higher precision pathophysiological assessment of tumours and the monitoring of therapeutic interventions [4]

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