The additional utility of ultrafast MRI on conventional DCE-MRI in evaluating preoperative MRI of breast cancer patients

Abstract

PurposeTo investigate whether the additional use of ultrafast MRI can improve the diagnostic performance of conventional dynamic contrast-enhanced MRI (DCE-MRI) in evaluating MRI-detected lesions in breast cancer patients. MethodsThis retrospective study enrolled 101 consecutive breast cancer patients with 202 breast lesions (62 benign and 140 malignant) who underwent preoperative DCE-MRI with ultrafast imaging (9 image sets with 6.5-second temporal resolution). Two reviewers assessed the BI-RADS categories of breast lesions using conventional DCE-MRI and assessed the following parameters using the ultrafast MRI: initial enhancement phase, maximum relative enhancement, slope, and maximum slope (slopemax) on the kinetic curve. Interobserver agreement was analyzed between the two reviewers. The ultrafast MRI parameters were compared between benign and malignant tumors, and cut-off values were determined. For 97 additional MRI-detected lesions, the BI-RADS category was re-assessed using cut-off values, and the diagnostic performance was compared between the conventional DCE-MRI and the combined conventional and ultrafast DCE-MRI. ResultsAll ultrafast MRI parameters differed significantly between malignant and benign tumors (p < 0.001). Initial enhancement phase by reviewer and slopemax were the top two parameters showing significant differences between benign and malignant tumors with high reliability. With the use of cut-off values for initial enhancement phase (≤phase 2) and slopemax (>9.8%/sec), the specificity of conventional DCE-MRI was significantly increased (29.4% vs 64.7%, p < 0.001) without significant loss of sensitivity (100% vs 88.2%, p = 0.157) in evaluating masses. ConclusionsThe additional use of ultrafast MRI can improve the specificity of conventional DCE-MRI when evaluating MRI-detected masses in breast cancer patients.