Schmitz A C, Peters N H G M, Veldhuis W B, Gallardo A M Fernandez, van Diest P J, Stapper G, van Hillegersberg R, Mali W P Th M, van den Bosch M A A J
Department of Radiology, University Medical Center, Utrecht, The Netherlands.
Eur Radiol. 2008 Feb;18(2):355-64. doi: 10.1007/s00330-007-0766-z. Epub 2007 Sep 20.
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.
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).
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.
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%.
评估3.0-T对比增强乳腺磁共振成像（MRI）鉴别乳腺良恶性肿块的诊断准确性，并随后测试通过对同侧乳腺整体血管化进行评分是否可进一步提高特异性。
前瞻性纳入54例患者并对其进行3.0-T对比增强乳腺MRI检查。根据MRI BI-RADS词典标准对MR图像进行评估和分类。系统评估病变大小、病变数量及在乳腺中的定位。通过使用高分辨率对比增强（0.1 mmol/kg钆布醇）脂肪抑制T1加权图像获得最大强度投影（MIP）。根据Sardanelli等人的方法，通过测量MIP上血管的数量、直径和长度对乳腺血管化进行评分。评分范围为0（表示无或低乳腺血管化）至3（表示高乳腺血管化）。
对56个病变的最终分析显示，有25个（45%）为恶性病变，31个（55%）为良性病变。与MRI BI-RADS分类的相关性显示，BI-RADS II类病变中无一例（0%）为癌症，BI-RADS III类病变中有1例（12%）为癌症，BI-RADS IV类病变中有5例（83%）为癌症，BI-RADS V类病变中有19例（100%）为癌症。基于形态学和动力学数据分析，3.0-T乳腺MRI的敏感性和特异性分别为100%（25/25）和74%（23/31）。在对乳腺血管化评分进行调整后，特异性显著（p = 0.048）提高至87%（27/31），而不影响敏感性。
当在标准形态学和动力学数据分析中加入血管化评分时，3.0-T对比增强乳腺MRI的诊断准确性显著提高，特异性达到87%，且不影响敏感性，敏感性仍为100%。
