From the *Department of Radiology, Charité University Medicine Berlin, Berlin; †Institute of Diagnostic and Interventional Radiology, SRH Clinic Gera, Gera; ‡Institute of Diagnostic Radiology, St. Joseph Stift, Bremen; §Imaging Science Institute, Berlin; and ∥Department of Internal Medicine III, Friedrich-Schiller-University, Jena University Hospital, Jena, Germany.
Invest Radiol. 2014 Jul;49(7):474-84. doi: 10.1097/RLI.0000000000000039.
In contrast to conventional breast imaging techniques, one major diagnostic benefit of breast magnetic resonance imaging (MRI) is the simultaneous acquisition of morphologic and dynamic enhancement characteristics, which are based on angiogenesis and therefore provide insights into tumor pathophysiology. The aim of this investigation was to intraindividually compare 2 macrocyclic MRI contrast agents, with low risk for nephrogenic systemic fibrosis, in the morphologic and dynamic characterization of histologically verified mass breast lesions, analyzed by blinded human evaluation and a fully automatic computer-assisted diagnosis (CAD) technique.
Institutional review board approval and patient informed consent were obtained. In this prospective, single-center study, 45 women with 51 histopathologically verified (41 malignant, 10 benign) mass lesions underwent 2 identical examinations at 1.5 T (mean time interval, 2.1 days) with 0.1-mmol kg doses of gadoteric acid and gadobutrol. All magnetic resonance images were visually evaluated by 2 experienced, blinded breast radiologists in consensus and by an automatic CAD system, whereas the morphologic and dynamic characterization as well as the final human classification of lesions were performed based on the categories of the Breast imaging reporting and data system MRI atlas. Lesions were also classified by defining their probability of malignancy (morpho-dynamic index; 0%-100%) by the CAD system. Imaging results were correlated with histopathology as gold standard.
The CAD system coded 49 of 51 lesions with gadoteric acid and gadobutrol (detection rate, 96.1%); initial signal increase was significantly higher for gadobutrol than for gadoteric acid for all and the malignant coded lesions (P < 0.05). Gadoteric acid resulted in more postinitial washout curves and fewer continuous increases of all and the malignant lesions compared with gadobutrol (CAD hot spot regions, P < 0.05). Morphologically, the margins of the malignancies were different between the 2 agents, whereas gadobutrol demonstrated more spiculated and fewer smooth margins (P < 0.05). Lesion classifications by the human observers and by the morpho-dynamic index compared with the histopathologic results did not significantly differ between gadoteric acid and gadobutrol.
Macrocyclic contrast media can be reliably used for breast dynamic contrast-enhanced MRI. However, gadoteric acid and gadobutrol differed in some dynamic and morphologic characterization of histologically verified breast lesions in an intraindividual, comparison. Besides the standardization of technical parameters and imaging evaluation of breast MRI, the standardization of the applied contrast medium seems to be important to receive best comparable MRI interpretation.
与传统的乳腺成像技术相比，乳腺磁共振成像（MRI）的一个主要诊断优势是同时获取形态学和动态增强特征，这些特征基于血管生成，因此可以深入了解肿瘤的病理生理学。本研究旨在通过盲法人类评估和全自动计算机辅助诊断（CAD）技术，对两种低风险致肾源性系统性纤维化的大环类 MRI 对比剂在组织学证实的乳腺肿块病变的形态学和动态特征进行个体内比较。
获得机构审查委员会批准和患者知情同意。在这项前瞻性、单中心研究中，45 名女性（41 名恶性，10 名良性）共 51 个经组织病理学证实的肿块病变在 1.5T 下接受了 2 次相同的检查（平均时间间隔为 2.1 天），使用 0.1mmol/kg 的钆特酸和钆布醇。所有磁共振图像均由 2 名经验丰富的、盲法的乳腺放射科医生进行共识评估，并由自动 CAD 系统进行评估，而病变的形态学和动态特征以及最终的人类分类则基于乳腺成像报告和数据系统 MRI 图谱的类别进行。CAD 系统还通过定义病变的恶性概率（形态动力学指数；0%-100%）对病变进行分类。将影像学结果与组织病理学作为金标准进行相关性分析。
CAD 系统对 51 个使用钆特酸和钆布醇的病变中的 49 个进行了编码（检出率，96.1%）；对于所有病变和恶性编码病变，与钆特酸相比，钆布醇的初始信号增强更高（P < 0.05）。与钆布醇相比，钆特酸在所有病变和恶性病变中导致更多的初始洗脱后曲线和更少的连续增加（CAD 热点区域，P < 0.05）。形态学上，两种药物的恶性病变边缘不同，而钆布醇显示出更多的刺状和更少的光滑边缘（P < 0.05）。与组织病理学结果相比，人类观察者和形态动力学指数的病变分类在钆特酸和钆布醇之间没有显著差异。
大环类对比剂可可靠地用于乳腺动态对比增强 MRI。然而，在个体内比较中，钆特酸和钆布醇在一些组织学证实的乳腺病变的动态和形态学特征方面存在差异。除了标准化技术参数和乳腺 MRI 的影像学评估外，似乎还需要标准化应用的对比剂，以获得最佳的可比较的 MRI 解释。
