Accuracy Of Contrast-enhanced Magnetic Resonance Imaging Research Articles

Comparison of Contrast-Enhanced Spectral Mammography and Contrast-Enhanced MRI in Screening Multifocal and Multicentric Lesions in Breast Cancer Patients.

Objectives We aimed to determine the difference between contrast-enhanced spectral mammography (CESM) and contrast-enhanced magnetic resonance imaging (CE-MRI) in detecting multifocal and multicentric breast cancer (MMBC). Methods: This study was conducted among breast cancer patients between July 1, 2017, and May 30, 2021. The sensitivity, specificity, and accuracy of CESM and CE-MRI in the diagnosis of MMBC were evaluated with pathological results as the gold standard. Results A total of 188 lesions were detected in 54 patients with MMBC, including 177 breast cancer and 11 benign lesions. Based on CESM and CE-MRI, 4 false-positive cases and 3 false-negative cases and 7 false-positive cases and 1 false-negative case, respectively, were found. The accuracy of CESM was higher than that of MRI (96.3% vs 95.7%), and the specificity was higher than that of MRI (63.6% vs 36.4%). There were no significant differences in the sensitivity, specificity, and accuracy for the detection of MMBC between CESM and CE-MRI (p = 0.500; p = 0.250; p = 0.792). Conclusion CESM is an effective method for the detection of MMBC, which is consistent with the sensitivity and accuracy of CE-MRI.

Abstract P4-02-02: Contrast-enhanced MRI does not accurately predict pathologic complete response (pCR) after neoadjuvant chemotherapy in early or locally advanced breast cancer

Abstract Background: Patients with early or locally advanced breast cancer achieving a pathologic complete response (pCR) after neoadjuvant chemotherapy have a lower risk for recurrence or death compared to patients with residual invasive cancer. In the future, breast surgery might be avoided in patients in whom the presence of residual tumor after neoadjuvant therapy can be ruled out with very high confidence. Magnetic resonance imaging (MRI) has been shown to be the most accurate radiologic tool in breast cancer diagnostics and follow-up care. Therefore, we investigated the diagnostic accuracy of contrast-enhanced MRI to predict a pathological complete remission after neoadjuvant chemotherapy. Methods: This retrospective study included all non-metastatic breast cancer patients treated with neoadjuvant chemotherapy followed by a contrast-enhanced MRI and breast cancer surgery at our institution between 09/2006 and 05/2016. Three specialized breast radiologists, blinded to the clinical and pathological data, reevaluated all preoperative MRI scans and recorded the presence or absence of contrast enhancement as indicator for residual cancer. pCR was defined as no invasive tumor in breast and axilla (ypT0/is N0), however 3 alternative definitions were investigated as well (ypT0 N0, ypT0/is and ypT). Cross tables were used to calculate sensitivity, specificity, pCR-predictive value (PPV), non-pCR-predictive value (NPV) and accuracy. P-values reflecting PPV and NPV differences between various patient subgroups were calculated with Fisher's exact test. The Kaplan-Meier method was used for estimates of distant-recurrence-free survival (DRFS) and overall survival (OS). Results: In total, 246 patients fulfilled the inclusion criteria and were evaluated. Overall pCR and radiologic complete remission (rCR) rate were 29% and 45%, respectively. Only 48% of rCR corresponded to a pCR (PPV). Conversely, in 87% of cases, residual tumor in the MRI was pathologically confirmed (NPV). The sensitivity to detect a pCR was 75%, while specificity and accuracy were 67% and 69%, respectively. The diagnostic performance of MRI to predict treatment response varied between different histologic and molecular tumor subtypes, however there were little differences between the 4 pCR definitions. The PPV was significantly lower in the hormone-receptor(HR)-positive subgroup compared with the HR-negative subgroup (33% vs. 61%; P = 0.004), especially in luminal-A-like (7%) and lobular carcinomas (0%), respectively. Despite the low concordance (Kohens kappa -0.1), the prognostic value for distant recurrence-free survival was similar between rCR (HR 0.29) and pCR (HR 0.27), respectively. The median pathologic tumor size of residual disease in false-positive cases (rCR but no pCR) was 0.7 cm (SD 0.98 cm). Conclusion: Contrast-enhanced MRI does not accurately predict pCR after neoadjuvant chemotherapy in early or locally advanced breast cancer, especially in HR-positive tumors. However, in case of false rCR the dimension of residual disease is generally small. Since residual tumor tissue can be detected with high precision, preoperative breast MRI is still of value for operation planning. Citation Format: Gampenrieder SP, Peer A, Weismann C, Meissnitzer M, Rinnerthaler G, Webhofer J, Westphal T, Popovscaia M, Meissnitzer T, Reitsamer R, Hauser-Kronberger C, Egger H, Hergan K, Mlineritsch B, Greil R. Contrast-enhanced MRI does not accurately predict pathologic complete response (pCR) after neoadjuvant chemotherapy in early or locally advanced breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-02-02.

Comparative diagnostic accuracy of contrast-enhanced MRI and 18F-FDOPA PET-CT in recurrent glioma

To compare the diagnostic accuracy of contrast enhanced magnetic resonance imaging (Ce-MRI) and (18)F-fluorodopa ((18)F-FDOPA) positron emission tomography (PET)-computed tomography (CT) for detecting recurrent glioma. In this prospective study, 35 patients (age, 36.62 ± 0.86years; 80% male) with histopathologically proven glioma with clinical suspicion of recurrence were evaluated using Ce-MRI and (18)F-FDOPA PET-CT. (18)F-FDOPA PET-CT images were evaluated qualitatively and semi-quantitatively. Combination of clinical follow-up (minimum 1year), repeat imaging and/or biopsy (when available) was taken as the reference standard. Based on the reference standard, 26 patients were positive and nine were negative for recurrence. The sensitivity, specificity and accuracy of Ce-MRI were 92.3%, 44.4% and 80% respectively, whereas those of (18)F-FDOPA PET-CT were 100%, 88.89% and 97.1% respectively. Results of Ce-MRI and (18)F-FDOPA PET-CT were concordant in 74.3% (29/35) and discordant in 17.1% of patients (6/35). On McNemar analysis the difference was not statistically significant overall (P = 0.687), for high-grade tumour (P = 0.5) or low-grade tumours (P = 1.0). However, (18)F-FDOPA PET-CT was more specific than Ce-MRI overall (P = 0.0002), for high-grade tumour (P = 0.006) and low-grade tumours (P = 0.004). F-FDOPA PET-CT shows a high but comparable diagnostic accuracy to Ce-MRI for the detection of recurrent glioma. However, it is more specific than Ce-MRI. • Recurrent glioma in the postoperative site remains a diagnostic dilemma. • (18) F-FDOPA PET-CT shows high diagnostic accuracy for detecting recurrent glioma. • Diagnostic accuracies for (18) F-FDOPA PET-CT and contrast enhanced MRI are comparable. • However, (18) F-FDOPA PET-CT is more specific than Ce-MRI for recurrent glioma.

Comparison Between Contrast-enhanced Magnetic Resonance Imaging and Technetium 99m Glucohepatonic Acid Single Photon Emission Computed Tomography With Histopathologic Correlation in Gliomas

: To determine and compare the accuracy of contrast-enhanced magnetic resonance imaging (MRI) and Technetium 99m glucohepatonic acid single photon emission computed tomography (Tc-GHA SPECT) in grading of gliomas, compared with neuropathologic findings. : The study included 20 adult patients (13 men and 7 women) with clinical/radiological suspicion of brain tumor (glial tumor) who were subjected to magnetic resonance examination and Tc-GHA brain SPECT.The lesions were evaluated by using MRI imaging score, based on 9 MRI criteria. Based on the discrimination threshold of 0.9 for mean MRI score, the gliomas were graded as low- or high-grade glioma. The Tc-GHA SPECT retention index was calculated as the ratio between delayed and early uptake ratios. Based on the discrimination threshold of 1 for Tc-GHA SPECT retention index, the gliomas were graded as low- or high-grade glioma.The diagnosis was verified by means of histopathologic examination in all patients (open surgery in 19 patients and stereotactic biopsy in 1 patient). Correlation between MRI findings/scores, SPECT scores, and histopathologic grades was done in all the patients, and comparison between MRI and Tc-GHA SPECT was made using paired Student t test and correlation coefficient. : The study revealed significant difference between the mean MRI scores and early uptake ratio, delayed uptake ratio, and retention index of low-grade (grades I-II) and high-grade (grades III-IV) gliomas. No statistically significant difference could be demonstrated between the abilities of contrast-enhanced MRI and Tc-GHA SPECT to allow differentiation between high- and low-grade gliomas. The accuracy of MRI (78.4%), however, was slightly higher than that of Tc-GHA SPECT (73.68%). However, Tc-GHA SPECT allowed differentiation between high-grade gliomas (between grades III and IV gliomas). : The accuracy of contrast-enhanced MRI in the distinction of high- and low-grade malignancy was higher than that of Tc-GHA SPECT. The performance of Tc-GHA SPECT adds little in determining tumor grade when MRI is performed. However, it may act as a useful adjunct to differentiate between grades III and IV gliomas.