Abbreviated Breast Magnetic Resonance Imaging Research Articles

Abbreviated breast magnetic resonance imaging (MRI) or digital breast tomosynthesis for breast cancer detection in dense breasts? A retrospective preliminary study with comparable results

To compare the diagnostic performance of abbreviated breast magnetic resonance (AB-MR) imaging (MRI) and digital breast tomosynthesis (DBT) for breast cancer detection in Malaysian women with dense breasts, using histopathology as the reference standard. This was a single-centre cross-sectional study of 115 women with American College of Radiology (ACR) Breast Imaging-Reporting and Data System (BIRADS) breast density C and D on DBT with breast lesions who underwent AB-MR from June 2018 to December 2021. AB-MR was performed on a 3 T MRI system with an imaging protocol consisting of three sequences: axial T1 fat-saturated unenhanced; axial first contrast-enhanced; and subtracted first contrast-enhanced with maximum intensity projection (MIP). DBT and AB-MR images were evaluated by two radiologists blinded to the histopathology and patient outcomes. Diagnostic accuracy (sensitivity, specificity, positive predictive value [PPV] and negative predictive value [NPV]) was assessed. Of the 115 women, the mean age was 50.6 years. There were 48 (41.7%) Malay, 54 (47%) Chinese, and 12 (10.4%) Indian women. The majority (n=87, 75.7%) were from the diagnostic population. Sixty-one (53.1%) were premenopausal and 54 (46.9%) postmenopausal. Seventy-eight (72.4%) had an increased risk of developing breast cancer. Ninety-one (79.1%) women had density C and 24 (20.9%) had density D. There were 164 histopathology-proven lesions; 69 (42.1%) were malignant and 95 (57.9%) were benign. There were 62.8% (n=103/164) lesions detected at DBT. All the malignant lesions 100% (n=69) and 35.7% (n=34) of benign lesions were detected. Of the 61 lesions that were not detected, 46 (75.4%) were in density C, and 15 (24.6%) were in density D. The sensitivity, specificity, PPV, and NPV for DBT were 98.5%, 34.6%, 66.3%, and 94.7%, respectively. There were 65.2% (n=107/164) lesions detected on AB-MR, with 98.6% (n=68) malignant and 41.1% (39) benign lesions detected. The sensitivity, specificity, PPV, and NPV for AB-MR were 98.5%, 43.9%, 67.2%, and 96.2%, respectively. One malignant lesion (0.6%), which was a low-grade ductal carcinoma in-situ (DCIS), was missed on AB-MR. The present findings suggest that both DBT and AB-MR have comparable effectiveness as an imaging method for detecting breast cancer and have high NPV for low-risk lesions in women with dense breasts.

Diagnostic validity of abbreviated breast MRI in the diagnosis of breast cancer: a comparative study to the full breast MRI protocol using BI-RADS.

This work aimed to determine the diagnostic performance of the magnetic resonance imaging (MRI) breast abbreviated protocol (AP) in diagnosing malignant breast lesions using BI-RADS compared with the diagnostic accuracy of the full diagnostic protocol (FDP). A prospective single-centre study was conducted. A total of 125 female patients with suspicious breast masses underwent MRI with the AP and the FDP. The images of AP and FDP were independently interpreted by 2 radiologists with 10 years of experience in breast imaging, and any disagreement was resolved with a third one. Using the histopathological examination as a reference test, the diagnostic effectiveness of both FDP and AP in breast cancer screening was calculated. ROC curve was utilised to estimate the optimal BI-RADS cut-off for prediction of malignancy. The difference in image interpretation time between both protocols was estimated using the Mann-Whitney test. Moreover, the inter-test agreement between both protocols was assessed using Cohen's κ test. The study included 83 malignant and 42 benign lesions. AP indicated a specificity, sensitivity, and accuracy of 90.5%, 96.4%, and 94.4%, while the FDP showed a specificity, sensitivity, and accuracy of 92.9%, 100%, and 97.6%, respectively. BI-RADS 3 category was the best cut-off for prediction of malignancy. There was a significant difference between both protocols concerning the interpretation time (p < 0.001). There was excellent agreement between both protocols, with a κ of 0.915. Breast MRI AP may be employed instead of FDP to identify breast cancer with similar diagnostic performance. Moreover, it reduces the interpretation time and the scan cost.

Evaluation of malignant breast masses with abbreviated breast magnetic resonance imaging

Objectives: Our study aimed to investigate the sensitivity of the abbreviated magnetic resonance imaging (MRI) in the detection of tumors in breast cancer patients. Methods: Patients who underwent breast MRI between March 2018 and October 2021 were reviewed retrospectively. Patients with a histologic diagnosis of breast malignancy were included in the study. Patients who underwent a biopsy or an interventional procedure before the MRI examination and who received neoadjuvant chemotherapy were excluded from the study. Abbreviated MR protocol included a pre-contrast T1-weighted, 1st minute contrast-enhanced T1-weighted, and 1st minute subtracted series. Additionally, 2nd minute post-contrast series were evaluated. Results: A total of 83 lesions with a histologic diagnosis of breast cancer were evaluated in 81 patients. The mean age of the patients included in the study was 51.08 years (range: 27-79 years). Seventy-four of the 83 breast lesions showed contrast enhancement in the 1st minute contrast-enhanced images and subtraction images (sensitivity 89.1%). When missed cases were re-evaluated all of them were visible in the second-minute contrast-enhanced series. Conclusions: In this study, malignant lesions could be detected with high-sensitivity abbreviated MRI protocol and the addition of second-minute contrast-enhanced series to the protocol significantly improve lesion detection. We believe that MRI with the abbreviated MRI protocol can be used for screening purposes in high-risk women with dense breasts.

Abbreviated breast MRI for evaluating breast cancer before initiation of neoadjuvant chemotherapy: A cross-sectional study

BackgroundAlthough, there are accumulating evidence about diagnostic role of abbreviated breast magnetic resonance imaging (MRI) in screening setting, the implementation of abbreviated MRI in staging of breast cancer has been poorly elucidated. ObjectiveTo evaluate the diagnostic performance of abbreviated breast MRI in estimating extent of disease before initiation of neoadjuvant chemotherapy. MethodsA total of 54 patients with biopsy-proven main lesion referred to evaluate by standard protocol breast MRI before initiation of neoadjuvant chemotherapy were retrospectively enrolled. From a standard protocol, a data set of abbreviated protocol consisting fat-saturated T1-weighted (T1W) pre-contrast and first two fat-saturated T1W post-contrast series with reconstruction of their subtraction including maximum intensity projection (MIP) were obtained and interpreted. The concordance rate of abbreviated with standard protocol (as a reference standard) were compared. Diagnostic accuracy, sensitivity, specificity, and positive and negative predictive value were calculated, as well. ResultsThe maximum size of the main mass was 38.6 ± 17.3 and 40.7 ± 17.9 for abbreviated and standard protocol, respectively. All of the main mass was detected by abbreviated protocol with 100% concordance. Concordance was 98.1% and 94.4% in terms of multifocal/multicentric status and for estimating of NME, respectively. The abbreviated protocol has high sensitivity and specificity with more than 90% value regarding main mass detection, measurement of the maximum size of the main mass, determination of multifocal/multicenter status and NAC involvement. ConclusionAbbreviated protocol may be a reliable surrogate for standard protocol breast MRI in evaluating extent of breast cancer.

The efficacy of abbreviated breast MRI protocols using 1.5 T MRI in the preoperative staging of newly diagnosed breast cancers

PurposeTo determine the efficacy of abbreviated breast magnetic resonance imaging (MRI) protocols using 1.5 T MRI in the preoperative staging of newly diagnosed breast cancers. MethodsEighty patients who underwent 1.5 T MRI between August 2014 and January 2018 for the preoperative staging of breast cancer were evaluated retrospectively. Three separate abbreviated breast MRI protocols (AP) were created from a full protocol, and the images were evaluated independently by two radiologists. AP1 included axial fat-saturated T2 weighted and diffusion-weighted (DW) images, while subtracted axial fat-saturated T1 weighted images were obtained 2 min after contrast administration in AP2. Finally, AP2 and DW images were evaluated in AP3. Lesion location, number, and size, and presence of axillary lymphadenopathy were evaluated in each protocol. Pathological data (lesion quadrant, lesion size, and presence of axillary metastases) from the 80 patients were compared with the abbreviated protocols and full diagnostic protocol. ResultsThe best correlation with the full protocol for detecting the lesion quadrant, number of lesions, and presence of axillary lymphadenopathy was achieved with AP3 for both readers (κ = 0.954, 0.954 for the lesion quadrant, κ = 0.971, 0.910 for the number of lesions, and κ = 0.973, 0.865 for the axillary lymphadenopathy). The evaluation time in all abbreviated protocols was shorter than for the full protocol (p < 0.05). Comparing the abbreviated protocols with pathological data for both readers, the best correlation for detecting the lesion quadrant, number of lesions, and presence of axillary lymphadenopathy was achieved with AP3 (κ = 0.939, 0.954 for the lesion quadrant, κ = 0.941, 0.879 for the number of lesions, and κ = 0.842, 0.740 for axillary lymphadenopathy, respectively). ConclusionAbbreviated breast MRI protocols can provide sufficient diagnostic accuracy in the preoperative staging of breast cancer, with shorter imaging and evaluation times.

Diagnostic value of combined use of abbreviated breast MRI and diffusion-weighted MRI in the prediction of breast cancer

Purpose: The aim of this study was to compare the diagnostic performances of abbreviated protocol (AP) magnetic resonance imaging (MRI), AP combined with diffusion-weighted imaging (DWI), and full dynamic protocol (FDP) in the differentiation of breast cancers from benign breast diseases.&#x0D; Materials and Methods: The total study population consisted of 68 patients who underwent breast MRI (1.5 Tesla) between January 2016 and December 2021 for the evaluation of suspicious findings on mammography or ultrasonography. All lesions were evaluated by 2 radiologists using AP, AP+DWI, and FDP. The reader sensitivity, specificity, and accuracy were analyzed using the “Chi-squared” test. The inter-observer agreement (IOA) between the Breast Imaging Reporting and Data System (BI-RADS) category assessments of the two readers was evaluated by using the “Kappa statistics”.&#x0D; Results: Sixty-eight patients with 72 lesions (31 malignant and 41 benign) were analyzed. The sensitivity/specificity for AP and AP+DWI for reader 1 was 67.7/90.2% and 80.6/87.8%, respectively, and for reader 2 was 67.7/92.6% and 70.9/90.2%, respectively. The sensitivity/specificity for FDP for reader 1 was 83.7/85.3% and for reader 2 was 80.6/90.2%. The IOA in the BI-RADS category assessment was almost perfect in all models between two readers (the kappa value was 0.907, 0.825, and 0.858 in AP, AP+DWI, and FDP, respectively).&#x0D; Conclusion: FDP showed greater diagnostic efficiency in the characterization of tumor biology as compared to AP and AP +DWI. Combining AP with DWI improved the diagnostic performance of MRI for the determination of malignancy.

Predicting lymphovascular invasion in clinically node-negative breast cancer detected by abbreviated magnetic resonance imaging: Transfer learning vs. radiomics.

ObjectiveTo compare the performance of abbreviated breast magnetic resonance imaging (AB-MRI)-based transfer learning (TL) algorithm and radionics analysis for lymphovascular invasion (LVI) prediction in patients with clinically node-negative invasive breast cancer (IBC).MethodsBetween November 2017 and October 2020, 233 clinically node-negative IBCs detected by AB-MRI were retrospectively enrolled. One hundred thirty IBCs from center 1 (37 LVI-positive and 93 LVI-negative) were assigned as the training cohort and 103 from center 2 (25 LVI-positive and 78 LVI-negative) as the validation cohort. Based on AB-MRI, a TL signature (TLS) and a radiomics signature (RS) were built with the least absolute shrinkage and selection operator (LASSO) logistic regression. Their diagnostic performances were validated and compared using areas under the receiver operating curve (AUCs), net reclassification improvement (NRI), integrated discrimination improvement (IDI), decision curve analysis (DCA), and stratification analysis. A convolutional filter visualization technique was used to map the response areas of LVI on the AB-MRI.ResultsIn the validation cohort, compared with RS, the TLS showed better capability in discriminating LVI-positive from LVI-negative lesions (AUC: 0.852 vs. 0.726, p < 0.001; IDI = 0.092, p < 0.001; NRI = 0.554, p < 0.001). The diagnostic performance of TLS was not affected by the menstrual state, molecular subtype, or contrast agent type (all p > 0.05). Moreover, DCA showed that the TLS added more net benefit than RS for clinical utility.ConclusionsAn AB-MRI-based TLS was superior to RS for preoperative LVI prediction in patients with clinically node-negative IBC.

Implementation of abbreviated breast MRI in diagnostic and screening settings.

Abbreviated magnetic resonance imaging (MRI) includes fewer sequences than standard MRI, which could be utilized for breast cancer detection. To evaluate the diagnostic accuracy of abbreviated MRI protocol in screening and diagnostic settings. All women with screening and diagnostic (problem-solving and preoperative staging) MRI examination were recruited from 2017 to 2020. Two expert radiologists assessed designed abbreviated protocol (fat-saturated T1-weighted [T1W] pre-contrast and two first fat-saturated T1W post-contrast series with reconstruction of their subtraction) including maximum intensity projection (MIP) and then evaluated standard protocol of breast MRI. Associated findings, including axillary lymphadenopathy and invasion to nipple, skin, or pectoralis muscle were also evaluated. The concordance rate of abbreviated with standard protocol in screening and diagnostic settings were also compared, based on BI-RADS classification. Diagnostic accuracy, sensitivity, specificity, and positive and negative predictive value were calculated. A total of 108 (26.5%) of 408 patients (mean age = 43 ± 9 years) were classified as BI-RADS 4-5 and considered positive findings based on suspicious enhancement (mass or non-mass enhancement). Compared to standard protocol, abbreviated protocol revealed >98% accuracy in the diagnostic setting as well as 100% accuracy in the screening setting. Concordance rates in screening and diagnostic settings were 99.6% and 98.1%, respectively. There was no discordance between abbreviated and standard protocol in the evaluation of associated findings. Abbreviated MRI protocol possesses substantial diagnostic accuracy in both screening and diagnostic settings. Additional information provided by standard protocol might not require for cancer detection.

FAST breast magnetic resonance imaging: a new approach for breast cancer screening?

ABSTRACTObjective To develop an abbreviated breast magnetic resonance imaging protocol (FAST) and to compare it with the complete protocol (FULL) to determine its diagnostic accuracy for detecting malignant or suspicious lesions (BI-RADS 4, 5 and 6) and the time required for image interpretation using BI-RADS categorization.Methods Retrospective study with 100 consecutive women who underwent breast magnetic resonance imaging between January and February 2014. All patients were submitted to a complete breast magnetic resonance imaging protocol, which was then compared with an abbreviated protocol (pre-contrast sequence, second post-contrast sequence and subtraction of pre- from post-contrast images).Results Of 100 patients, 4 were classified as BI-RADS 5 or 6 and 16 as BI-RADS 4. In these 20 patients, there was full agreement among readers regarding the final BI-RADS categorization in both (FAST and FULL) protocols.Conclusion The FAST protocol reduces interpretation time without compromising the accuracy of the method for detection of malignant or suspicious lesions.

Breast MRI: Simplifying Protocol and BI-RADS Categories

BackgroundBreast magnetic resonance imaging (MRI) is a useful imaging method, and studies have proven abbreviated protocols may reduce its time and costs with comparable accuracy. To assess the agreement of the abbreviated and full MRI protocols for breast cancer. Patients and MethodsThis retrospective cross-sectional study included consecutive women who underwent breast MRI from June 2019 to May 2020. Breast MRIs were performed in 2 hospitals, and 3 board-certified radiologists conducted its evaluations. The abbreviated breast MRI was assessed in the following order: MIP; subtraction; and T1W pre- and post-contrast. Findings were categorized according Breast Imaging - Reporting and Data System (BI-RADS 5th edition). The groups were named simplified BI-RADS and were adapted from BI-RADS 5-point scoring system. ResultsFour hundred and nineteen women (838 BI-RADS), with mean age of 49.5 ± 12.3 years were evaluated. A very good agreement was found between the protocols for total population (weighted kappa: 0.95; P <.001) and for MRI indication subgroups (weighted kappa: 0.86-1.00; P <.001). A high accuracy was also observed comparing abbreviated breast MRI compared to a full diagnostic MRI (97.6%). ConclusionAbbreviated breast MRI has demonstrated performance comparable to full diagnostic MRI protocols for breast cancer screening and diagnostic. In addition, the present study proposes the use of the simplified BI-RADS as a new classification, in order to assist physicians in clinical management.

Diagnostic Accuracy of Unenhanced Abbreviated Diffusion-Weighted Magnetic Resonance Imaging Versus Postcontrast Abbreviated Breast Magnetic Resonance Imaging for Breast Cancer

Diagnostic Accuracy of Unenhanced Abbreviated Diffusion-Weighted Magnetic Resonance Imaging Versus Postcontrast Abbreviated Breast Magnetic Resonance Imaging for Breast Cancer

The Diagnostic Accuracy of Abbreviated Breast Magnetic Resonance Imaging (Abbreviated Breast MRI)

Objective: Abbreviated Breast Magnetic Resonance Imaging (MRI) is a fast and a selected scan, used for screening women at high risk of breast cancer. The objective of this study is to assess the diagnostic accuracy of a new shortened Abbreviated Protocol (AP) relative to Full Diagnostic Protocol (FDP).&#x0D; Methods: 206 breast MRIs were evaluated, respectively. AP was derived from the FDP and re-recorded. The new report was compared with the report of the previous FDP. The interpretation time of the shortened protocol was recorded. The results of the two protocols in terms of finding the lesion were compared using sensitivity, specificity, NPV, and PPV according to the histopathology results.&#x0D; Results: 124 of 206 MRIs were malignant and 82 of 206 MRIs were benign. The average interpretation time was 58±35s with AP. The MIP sequence evaluation time was only 17±12s. The PPV, NPV, sensitivity and specificity values for AP MRI were 93.0%, 94.8%, 96.77%, 96.8% and 89.0% respectively. The PPV, NPV, sensitivity and specificity values for FDP MRI were 94.5%, 96.2%, 97.6% and 91.5% respectively. There was no significant difference in sensitivity and specificity for both protocols (p&lt; 0.05).&#x0D; Conclusion: AP is a new and shorter version of a Breast MRI. The diagnostic accuracy of abbreviated breast MRI for the detection of breast lesions shows a high level of sensitivity and specificity, with the advantages of shortening both the exam time and the interpretation time.

Added value of abbreviated breast magnetic resonance imaging for assessing suspicious microcalcification on screening mammography-a prospective study.

To investigate the added diagnostic value of abbreviated breast magnetic resonance imaging (MRI) for suspicious microcalcifications on screening mammography. This prospective study included 80 patients with suspicious calcifications on screening mammography who underwent abbreviated MRI before undergoing breast biopsy between August 2017 and September 2020. The abbreviated protocol included one pre-contrast and the first post-contrast T1-weighted series. MRI examinations were interpreted as either positive or negative based on the visibility of any significant enhancement. The positive predictive value (PPV) was compared before and after the MRI. Of the 80 suspicious microcalcifications, 33.8% (27/80) were malignant and 66.2% (53/80) were false positives. Abbreviated MRI revealed 33 positive enhancement lesions, and 25 and two lesions showed true-positive and false-negative findings, respectively. Abbreviated MRI increased PPV from 33.8 (27 of 80 cases; 95% CI: 26.2%, 40.8%) to 75.8% (25 of 33 cases; 95% CI: 62.1%, 85.7%). A total of 85% (45 of 53) false-positive diagnoses were reduced after abbreviated MRI assessment. Abbreviated MRI added significant diagnostic value in patients with suspicious microcalcifications on screening mammography, as demonstrated by a significant increase in PPV with a potential reduction in unnecessary biopsy. • Abbreviated breast magnetic resonance imaging increased the positive predictive value of suspicious microcalcifications on screening mammography from 33.8 (27/80 cases) to 75.8% (25/33 cases) (p < .01). • Abbreviated magnetic resonance imaging helped avoid unnecessary benign biopsies in 85% (45/53 cases) of lesions without missing invasive cancer.

Ultra-High b-Value Diffusion-Weighted Imaging-Based Abbreviated Protocols for Breast Cancer Detection.

Contrast-enhanced (CE) magnetic resonance imaging (MRI) is the most effective imaging modality for breast cancer detection. A contrast agent-free examination technique would be desirable for breast MRI screening. The purpose of this study was to evaluate the capability to detect and characterize suspicious breast lesions with an abbreviated, non-contrast-enhanced MRI protocol featuring ultra-high b-value diffusion-weighted imaging (DWI) compared with CE images. The institutional review board-approved prospective study included 127 female subjects with different clinical indications for breast MRI. Magnetic resonance imaging examinations included DWI sequences with b-values of 1500 s/mm2 (b1500) and 2500 s/mm2 (b2500), native T1- and T2-weighted images, and CE sequences at 1.5 T and 3 T scanners. Two reading rounds were performed, including either the b1500 or the b2500 DWI in consecutive assessment steps: (A) maximum intensity projections (MIPs) of DWI, (B) DWI and apparent diffusion coefficient maps, (C) as (B) but with additional native T1- and T2-weighted images, and (D) as (C) but with additional CE images (full-length protocol). Two readers independently determined the presence of a suspicious lesion. Histological confirmation was obtained for conspicuous lesions, whereas the full MRI data set was obtained for inconspicuous and clearly benign lesions. Statistical analysis included calculation of diagnostic accuracy and interrater agreement via the intraclass correlation coefficient. The cohort comprised 116 cases with BI-RADS 1 findings and 138 cases with BI-RADS ≥2 findings, including 38 histologically confirmed malignancies. For (A), breasts without pathological findings could be recognized with high diagnostic accuracy (negative predictive value, ≥97.0%; sensitivity, ≥92.1% for both readers), but with a limited specificity (≥58.3%; positive predictive value, ≥28.6%). Within the native readings, approach (C) with b2500 performed best (negative predictive value, 99.5%; sensitivity, 97.4%; specificity, 88.4%). The intraclass correlation coefficient was between 0.683 (MIP b1500) and 0.996 (full protocol). A native abbreviated breast MRI protocol with advanced high b-value DWI might allow nearly equivalent diagnostic accuracy as CE breast MRI and seems to be well suited for lesion detection purposes.

Abstract PS3-26: Characterizing errors in perfusion model parameters derived from retrospectively abbreviated quantitative DCE-MRI data

Abstract Introduction. X-ray mammography is the standard-of-care screening protocol for breast cancer due to its low cost, widespread availability, and greater specificity. While magnetic resonance imaging (MRI) has lower specificity, it has superior tissue contrast, and dynamic contrast-enhanced (DCE) MRI has been shown to increase MRI specificity due to its ability to estimate tissue vascular properties. Because of the increased expense and scan time for MRI, there is an ongoing effort to develop abbreviated breast MRI scans for screening high-risk patients at a lower cost without compromising quantitative information. Here we investigate the effects of the limited dynamic time course afforded by an abbreviated breast MRI exam on the quantitative tissue information computed from retrospectively abbreviated DCE-MRI data. Methods. Data acquisition. We evaluate the error in perfusion model parameters computed using DCE-MRI time courses sourced from three datasets acquired with very different temporal resolutions (dt). These datasets are the ACRIN 6883 multi-site breast trial (dt = 15 s), The University of Texas at Austin (UTA) neoadjuvant therapy study (dt = 7.3 s), and The University of Chicago (UC) ultra-fast breast DCE-MRI study (dt = 3.4 s). Ten representative patients are chosen from each of these datasets for a total of 30 DCE-MRI patient datasets. All 30 full-time courses (FTCs) are retrospectively truncated into a series of abbreviated-time courses (ATCs). An ATC containing the first n post-contrast injection time points of a DCE-MRI time course is referred to as “ATC n.” For the ACRIN dataset, n is the inclusive set of integers from 7 to 18; and, similarly, for the UC data, n is the inclusive set of integers from 12 to 23. For the UTA dataset, n is the inclusive set ranging from 13 through 53, incrementing by eight. Data Analysis. The groups of FTCs and ATCs are analyzed by one of three models, determined by the specifics of the acquisition details of each dataset. The standard Kety-Tofts (SKT) model is fit to the UTA time courses, the reference-region (RR) model is fit to the ACRIN time courses, and the Patlak model is fit to the UC time courses. The volume transfer constant (Ktrans) characterizes tissue enhancement in all three models; whereas, the extravascular/extracellular volume fraction (ve) is specific to the SKT and RR models, and the plasma volume fraction (vp) is specific to the Patlak model. Due to the absence of an arterial input function (AIF) for the ACRIN dataset, the RR model was most appropriate with the pectoral muscle serving as the reference region. The UTA dataset has a population AIF and is thus able to be modeled by the SKT. Lastly, the UC dataset does not capture the tissue washout necessary for ve estimation, so the Patlak model was chosen for analyzing tissue enhancement. Results and Conclusion. The longest ATCs of 4.5, 6.4, and 1.3 min. yielded average errors of 9.1%, 7%, and 3.6% in Ktrans for the ACRIN, UTA, and UC datasets, respectively; and the shortest ATCs of 2, 1.6, and 0.6 min. yielded higher average errors of 24.2%, 22.8%, and 65% in Ktrans, respectively. This is expected from simulations as even the most aggressive ATCs did not substantially exclude the tissue enhancement, characterized by Ktrans. Errors in ve were higher overall since shorter ATCs exclude much of the washout phase. As Ktrans has been shown to discriminate between malignant and benign lesions in full length DCE-MRI scans, it is promising that tolerable errors are observed in the abbreviated MRI setting. There is potential for implementing quantitative abbreviated DCE-MRI scans in the clinic for enhanced diagnostic specificity while freeing up scan time for additional imaging sequences without interfering with standard-of-care image acquisition. Citation Format: Kalina P Slavkova, Julie C DiCarlo, Anum K Syed, Chengyue Wu, John Virostko, Anna G Sorace, Thomas E Yankeelov. Characterizing errors in perfusion model parameters derived from retrospectively abbreviated quantitative DCE-MRI data [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS3-26.

The potential utility of abbreviated breast MRI (FAST MRI) as a tool for breast cancer screening: a systematic review and meta-analysis

To synthesise evidence comparing abbreviated breast magnetic resonance imaging (abMRI) to full-protocol MRI (fpMRI) in breast cancer screening. A systematic search was undertaken in multiple databases. Cohort studies without enrichment, presenting accuracy data of abMRI in screening, for any level of risk (population, moderate, high risk) were included. Level of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Meta-analyses (bivariate random effects model) were performed for abMRI, with fpMRI and histology from fpMRI-positive cases as reference standard, and with follow-up to symptomatic detection added to the fpMRI. The review also covers evidence comparing abMRI with mammographic techniques. The title and abstract review retrieved 23 articles. Five studies (six articles) were included (2,763 women, 3,251 screening rounds). GRADE assessment of the evidence was very low because the reference standard was interpreted with knowledge of the index test and biopsy was not obtained for all abMRI positives. The overall sensitivity for abMRI, with fpMRI (and histology for fpMRI positives) as reference standard, was 94.8% (95% confidence interval [CI] 85.5-98.2) and specificity as 94.6% (95% CI: 91.5-96.6). Three studies (1,450 women, 1,613 screening rounds) presented follow-up data, enabling comparison between abMRI and fpMRI. Sensitivities and specificities for abMRI did not differ significantly from those for fpMRI (p=0.83 and p=0.37, respectively). A very low level of evidence suggests abMRI could be accurate for breast cancer screening. Research is required, with follow-up to interval cancer, to determine the effect its use could have on clinical outcome.

Abbreviated Breast Magnetic Resonance Imaging for Supplemental Screening of Women With Dense Breasts and Average Risk

Although mammography is the standard of care for breast cancer screening, dense breast tissue decreases mammographic sensitivity. We report the prevalent cancer detection rate (CDR) from the first clinical implementation of abbreviated breast magnetic resonance imaging (AB-MR) as a supplemental screening test in women with dense breasts. The study was approved by the institutional review board and is Health Insurance Portability and Accountability Act complaint. This retrospective review includes women who were imaged between January 1, 2016 and February 28, 2019. On a 1.5 Tesla magnet, the imaging protocol consisted of three sequences: Short-TI Inversion Recovery (STIR), precontrast, and postcontrast. A subtraction sequence and a maximum intensity projection were generated. We report the patient-level CDR and the positive predictive value of AB-MR examinations after negative/benign digital breast tomosynthesis (DBT). Out of 511 prevalent rounds of AB-MR examinations, 36 women were excluded. The remaining 475 asymptomatic women with dense breasts had negative/benign DBT examinations before the AB-MR. There were 420 of 475 (88.4%) benign/negative examinations, 13 of 475 (2.7%) follow-up recommendations, and 42 biopsy recommendations. Thirty-nine biopsies were completed, resulting in 12/39 (30.8%) malignancies in 12 women: seven invasive carcinomas and five ductal carcinoma in situ. One additional patient was diagnosed with invasive ductal carcinoma at the time of 6-month follow-up. The CDR was 27.4 per 1,000 (13 of 475; 95% CI, 16.1 to 46.3). The size of invasive carcinomas ranged from 0.6-1.0 cm (mean, 0.5 cm). Of the seven women who underwent surgical evaluation of the axilla, zero of seven patients had positive nodes. There were no interval cancers at 1-year follow-up. Preliminary results from clinical implementation of screening AB-MR resulted in a CDR of 27.4/1,000 at the patient level after DBT in women with dense breasts. Additional evaluation is warranted.

Comparison of Abbreviated Breast MRI vs Digital Breast Tomosynthesis for Breast Cancer Detection Among Women With Dense Breasts Undergoing Screening

Improved screening methods for women with dense breasts are needed because of their increased risk of breast cancer and of failed early diagnosis by screening mammography. To compare the screening performance of abbreviated breast magnetic resonance imaging (MRI) and digital breast tomosynthesis (DBT) in women with dense breasts. Cross-sectional study with longitudinal follow-up at 48 academic, community hospital, and private practice sites in the United States and Germany, conducted between December 2016 and November 2017 among average-risk women aged 40 to 75 years with heterogeneously dense or extremely dense breasts undergoing routine screening. Follow-up ascertainment of cancer diagnoses was complete through September 12, 2019. All women underwent screening by both DBT and abbreviated breast MRI, performed in randomized order and read independently to avoid interpretation bias. The primary end point was the invasive cancer detection rate. Secondary outcomes included sensitivity, specificity, additional imaging recommendation rate, and positive predictive value (PPV) of biopsy, using invasive cancer and ductal carcinoma in situ (DCIS) to define a positive reference standard. All outcomes are reported at the participant level. Pathology of core or surgical biopsy was the reference standard for cancer detection rate and PPV; interval cancers reported until the next annual screen were included in the reference standard for sensitivity and specificity. Among 1516 enrolled women, 1444 (median age, 54 [range, 40-75] years) completed both examinations and were included in the analysis. The reference standard was positive for invasive cancer with or without DCIS in 17 women and for DCIS alone in another 6. No interval cancers were observed during follow-up. Abbreviated breast MRI detected all 17 women with invasive cancer and 5 of 6 women with DCIS. Digital breast tomosynthesis detected 7 of 17 women with invasive cancer and 2 of 6 women with DCIS. The invasive cancer detection rate was 11.8 (95% CI, 7.4-18.8) per 1000 women for abbreviated breast MRI vs 4.8 (95% CI, 2.4-10.0) per 1000 women for DBT, a difference of 7 (95% CI, 2.2-11.6) per 1000 women (exact McNemar P = .002). For detection of invasive cancer and DCIS, sensitivity was 95.7% (95% CI, 79.0%-99.2%) with abbreviated breast MRI vs 39.1% (95% CI, 22.2%-59.2%) with DBT (P = .001) and specificity was 86.7% (95% CI, 84.8%-88.4%) vs 97.4% (95% CI, 96.5%-98.1%), respectively (P < .001). The additional imaging recommendation rate was 7.5% (95% CI, 6.2%-9.0%) with abbreviated breast MRI vs 10.1% (95% CI, 8.7%-11.8%) with DBT (P = .02) and the PPV was 19.6% (95% CI, 13.2%-28.2%) vs 31.0% (95% CI, 17.0%-49.7%), respectively (P = .15). Among women with dense breasts undergoing screening, abbreviated breast MRI, compared with DBT, was associated with a significantly higher rate of invasive breast cancer detection. Further research is needed to better understand the relationship between screening methods and clinical outcome. ClinicalTrials.gov Identifier: NCT02933489.

Abbreviated Breast MRI for Estimating Extent of Disease in Newly Diagnosed Breast Cancer.

To evaluate extent of disease estimation of abbreviated protocol (ap) magnetic resonance imaging (MRI) compared with full protocol (fp) MRI in newly diagnosed breast cancer. In this institutional review board-approved, Health Insurance Portability and Accountability Act-compliant, retrospective study of women with breast cancer who underwent pretreatment fpMRI on a 3 Tesla MRI in 2013, axial fat-saturated pre- and first postcontrast T1, maximum-intensity projection, and subtraction sequences were interpreted independently by three breast radiologists in two sessions, without and with prior imaging, respectively. Agreement was calculated using Cohen's kappa. Interpretations were compared with histology or clinical stability. Diagnostic performances were compared using Bennett's statistic. P < 0.05 was significant. Eighty-one women (mean age 56 years, range 32-92 years), 116 lesions, and 95 cancers (mean size 27 mm, range 4-110 mm) were included. Agreement among radiologists for lesion assessment was excellent (0.83). apMRI cancer detection improved with prior imaging (mean sensitivity from 95% to 99%, specificity from 91% to 97%, positive predictive value [PPV] from 92% to 98%, and negative predictive value [NPV] from 95% to 99%) versus fpMRI (sensitivity 98% [93/95], specificity 94% [76/81], PPV 95% [93/98], and NPV 97% [76/78]). apMRI detected all multifocal, multicentric, and contralateral disease seen in 19% (15/81) of women to the same extent as fpMRI. apMRI axillary metastases detection improved with prior imaging (mean sensitivity from 78% to 86%, specificity from 90% to 92%, PPV from 76% to 82%, and NPV from 89% to 94%) versus fpMRI (sensitivity 71% [17/24], specificity 88% [51/58]), PPV 71% [17/24], and NPV 88% [51/58]). apMRI may be acceptable for women with newly diagnosed cancer.

Abbreviated MRI of the Breast: A Practical Guide

This book gives a good overview of abbreviated breast magnetic resonance imaging (MRI) in relation to screening with mammography and other techniques. For a breast care nurse readership its most valuable part is its section on clinical evidence, which puts breast MRI techniques into context.