Jansen Sanaz A, Shimauchi Akiko, Zak Lindsay, Fan Xiaobing, Wood Abbie M, Karczmar Gregory S, Newstead Gillian M
Department of Radiology, University of Chicago, 5841 S Maryland Ave., MC 2026, Chicago, IL 60637, USA.
AJR Am J Roentgenol. 2009 Sep;193(3):832-9. doi: 10.2214/AJR.08.2025.
The purpose of this study was to compare MRI kinetic curve data acquired with three systems in the evaluation of malignant lesions of the breast.
The cases of 601 patients with 682 breast lesions (185 benign, 497 malignant) were selected for review. The malignant lesions were classified as ductal carcinoma in situ (DCIS), invasive ductal carcinoma (IDC), and other. The dynamic MRI protocol consisted of one unenhanced and three to seven contrast-enhanced images acquired with one of three imaging protocols and systems. An experienced radiologist analyzed the shapes of the kinetic curves according to the BI-RADS lexicon. Several quantitative kinetic parameters were calculated, and the kinetic parameters of malignant lesions were compared across the three systems.
Imaging protocol and system 1 were used to image 304 malignant lesions (185 IDC, 62 DCIS); imaging protocol and system 2, 107 lesions (72 IDC, 21 DCIS); and imaging protocol and system 3, 86 lesions (64 IDC, 17 DCIS). Compared with those visualized with imaging protocols and systems 1 and 2, IDC lesions visualized with imaging protocol and system 3 had significantly less initial enhancement, longer time to peak enhancement, and a slower washout rate (p < 0.004). Only 47% of IDC lesions imaged with imaging protocol and system 3 exhibited washout type curves, compared with 75% and 74% of those imaged with imaging protocols and systems 2 and 1, respectively. The diagnostic accuracy of kinetic analysis was lowest for imaging protocol and system 3, but the difference was not statistically significant.
The kinetic curve data on malignant lesions acquired with one system showed significantly lower initial contrast uptake and a different curve shape in comparison with data acquired with the other two systems. Differences in k-space sampling, T1 weighting, and magnetization transfer effects may be explanations for the difference.
本研究旨在比较使用三种系统获取的MRI动力学曲线数据在评估乳腺恶性病变中的应用。
选取601例患者的682个乳腺病变（185个良性，497个恶性）病例进行回顾性分析。恶性病变分为原位导管癌（DCIS）、浸润性导管癌（IDC）和其他类型。动态MRI方案包括一幅平扫图像以及采用三种成像方案和系统之一获取的三至七幅对比增强图像。一名经验丰富的放射科医生根据BI-RADS词典分析动力学曲线的形态。计算了几个定量动力学参数，并比较了三种系统中恶性病变的动力学参数。
成像方案和系统1用于对304个恶性病变（185个IDC，62个DCIS）进行成像；成像方案和系统2用于对107个病变（72个IDC，21个DCIS）进行成像；成像方案和系统3用于对86个病变（64个IDC，17个DCIS）进行成像。与成像方案和系统1及2所显示的病变相比，成像方案和系统3所显示的IDC病变初始强化明显较少，达到峰值强化的时间更长，廓清率更慢（p<0.004）。成像方案和系统3成像的IDC病变中只有47%表现为廓清型曲线，而成像方案和系统2及1成像的病变中这一比例分别为75%和74%。成像方案和系统3的动力学分析诊断准确性最低，但差异无统计学意义。
与其他两个系统获取的数据相比，使用一个系统获取的恶性病变动力学曲线数据显示初始对比剂摄取明显较低且曲线形态不同。k空间采样、T1加权和磁化传递效应的差异可能是造成这种差异的原因。
