Ultrafast dynamic contrast-enhanced breast MRI may generate prognostic imaging markers of breast cancer

Natsuko Onishi,Peter Gibbs,Theodore J Hunt,Danny F Martinez,Katherine M Gallagher,Eun Sook Ko,Elizabeth J Sutton,Maggie M Fung,Amita Shukla-Dave,Meredith Sadinski,Elizabeth A Morris,Mary C Hughes

doi:10.1186/s13058-020-01292-9

Abstract

BackgroundUltrafast dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI)-derived kinetic parameters have demonstrated at least equivalent accuracy to standard DCE-MRI in differentiating malignant from benign breast lesions. However, it is unclear if they have any efficacy as prognostic imaging markers. The aim of this study was to investigate the relationship between ultrafast DCE-MRI-derived kinetic parameters and breast cancer characteristics.MethodsConsecutive breast MRI examinations between February 2017 and January 2018 were retrospectively reviewed to determine those examinations that meet the following inclusion criteria: (1) BI-RADS 4–6 MRI performed on a 3T scanner with a 16-channel breast coil and (2) a hybrid clinical protocol with 15 phases of ultrafast DCE-MRI (temporal resolution of 2.7–4.6 s) followed by early and delayed phases of standard DCE-MRI. The study included 125 examinations with 142 biopsy-proven breast cancer lesions. Ultrafast DCE-MRI-derived kinetic parameters (maximum slope [MS] and bolus arrival time [BAT]) were calculated for the entire volume of each lesion. Comparisons of these parameters between different cancer characteristics were made using generalized estimating equations, accounting for the presence of multiple lesions per patient. All comparisons were exploratory and adjustment for multiple comparisons was not performed; P values < 0.05 were considered statistically significant.ResultsSignificantly larger MS and shorter BAT were observed for invasive carcinoma than ductal carcinoma in situ (DCIS) (P < 0.001 and P = 0.008, respectively). Significantly shorter BAT was observed for invasive carcinomas with more aggressive characteristics than those with less aggressive characteristics: grade 3 vs. grades 1–2 (P = 0.025), invasive ductal carcinoma vs. invasive lobular carcinoma (P = 0.002), and triple negative or HER2 type vs. luminal type (P < 0.001).ConclusionsUltrafast DCE-MRI-derived parameters showed a strong relationship with some breast cancer characteristics, especially histopathology and molecular subtype.

Highlights

Breast magnetic resonance imaging (MRI) is based on the dynamic contrast-enhanced (DCE) protocol with at least three phases: pre-contrast, early, and delayed phases
We included all pathologically proven breast lesions depicted on these examinations with the exception of the following lesions: lesions pathologically diagnosed as a special type malignancy (n = 2, malignant phyllodes tumor, 1; spindle cell sarcoma, 1), lesions pathologically diagnosed as benign lesions (n = 79), lesions without a one-to-one pathological diagnosis (n = 36), lesions with no or minimal residual enhancement difficult to differentiate from post-biopsy change (n = 19; invasive carcinoma, 15; ductal carcinoma in situ [DCIS], 4), and lesions with severe patient motion during MRI scanning which could not be resolved by motion correction technique (n = 7; invasive carcinoma, 6; DCIS, 1)
The current study included a partial overlap in the study cohort, with separate studies investigating the diagnostic performance of ultrafast DCE-MRIderived parameters [15] and the efficacy of radiomic analysis using standard dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for sub-1 cm lesions [16]: 97 examinations with 106 lesions and 74 examinations with 79 lesions, respectively

Summary

Introduction

Breast magnetic resonance imaging (MRI) is based on the dynamic contrast-enhanced (DCE) protocol with at least three phases: pre-contrast, early, and delayed phases. Several studies have shown that these parameters present higher or comparable accuracy to Breast Imaging Reporting and Data System (BI-RADS) [1] delayed phase kinetic curve assessment, suggesting that ultrafast DCEMRI in the very early phase may substitute for the standard DCE-MRI delayed phase [5, 7, 9, 13,14,15]. Ultrafast dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI)-derived kinetic parameters have demonstrated at least equivalent accuracy to standard DCE-MRI in differentiating malignant from benign breast lesions. It is unclear if they have any efficacy as prognostic imaging markers. The aim of this study was to investigate the relationship between ultrafast DCE-MRI-derived kinetic parameters and breast cancer characteristics

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Discussion

Conclusion