Contrast-enhanced 3.0-T breast MRI for characterization of breast lesions: increased specificity by using vascular maps |
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Authors: | A C Schmitz N H G M Peters W B Veldhuis A M Fernandez Gallardo P J van Diest G Stapper R van Hillegersberg W P Th M Mali M A A J van den Bosch |
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Institution: | (1) Department of Radiology, University Medical Center, Utrecht, The Netherlands;(2) Department of Pathology, University Medical Center, Utrecht, The Netherlands;(3) Department of Surgery, University Medical Center, Utrecht, The Netherlands;(4) Radiological Sciences Laboratory, Lucas MRS Imaging Center, 1201 Welch Road, Stanford, CA 94305-5488, USA |
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Abstract: | Purpose: To assess the diagnostic accuracy of contrast-enhanced 3.0-T breast magnetic resonance imaging (MRI) for differentiating
benign from malignant breast masses and subsequently to test if specificity could be further improved by scoring of the overall
ipsilateral breast vascularity. Materials and methods: Fifty-four patients were prospectively enrolled in the study and underwent contrast-enhanced 3.0-T breast MRI. MR images
were evaluated and classified according to the MRI BI-RADS lexicon criteria. Lesion size, number of lesions, and localization
in the breast were systematically assessed. Maximum intensity projections (MIPS) were obtained by using high-resolution contrast-enhanced
(0.1 mmol/kg gadobutrol) fat-saturated T1-weighted images. Breast vascularization was scored according to the methods from
Sardanelli et al. by measuring the number, diameter, and length of the vessels on the MIPS. The score ranged from 0 (indicating
absent or low breast vascularity) to 3 (indicating high breast vascularity). Results: Final analysis of 56 lesions revealed 25 (45%) malignant lesions and 31 (55%) benign lesions. Correlation with the MRI BI-RADS
classification revealed cancer in none (0%) of the BI-RADS II lesions, in 1 (12%) of the BI-RADS III lesions, in 5 (83%) of
the BI-RADS IV lesions, and in 19 (100%) of the BI-RADS V lesions. Based on morphologic and kinetic data analysis, the sensitivity
and specificity of 3.0-T breast MRI was 100% (25/25) and 74% (23/31), respectively. After adjustment for the breast vascularity
score, specificity significantly (p = 0.048) increased to 87% (27/31) without affecting sensitivity. Conclusion: Diagnostic accuracy of contrast-enhanced 3.0-T breast MRI increased significantly when the vascularity score was added to
the standard morphologic and kinetic data analysis, resulting in a specificity of 87% without affecting sensitivity, which
remained 100%. |
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Keywords: | Magnetic resonance imaging 3 0 Tesla Breast Breast cancer Gadobutrol |
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