Service d'imagerie, Institut de cancérologie de Lorraine, Nancy, France.
Sorbonne Universités, UPMC Univ Paris 06, Institut Universitaire de Cancérologie, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Tenon, Service d'Imagerie, 4 rue de la Chine, Paris 75020, France.
Eur J Radiol. 2017 Oct;95:177-185. doi: 10.1016/j.ejrad.2017.07.025. Epub 2017 Aug 1.
To evaluate the added value of ULTRAFAST-MR sequence to an abbreviated FAST protocol in comparison with FULL protocol to distinguish benign from malignant lesions in a population of women, regardless of breast MR imaging indication.
From March 10th to September 22th, 2014, we retrospectively included a total of 70 consecutive patients with 106 histologically proven lesions (58 malignant and 48 benign) who underwent breast MR imaging for preoperative breast staging (n=38), high-risk screening (n=7), problem solving (n=18), and nipple discharge (n=4) with 12 time resolved imaging of contrast kinetics (TRICKS) acquisitions during contrast inflow interleaved in a regular high-resolution dynamic MRI protocol (FULL protocol). Two readers scored MR exams as either positive or negative and described significant lesions according to Bi-RADS lexicon with a TRICKS images (ULTRAFAST), an abbreviated protocol (FAST) and all images (FULL protocol). Sensitivity, specificity, positive and negative predictive values, and accuracy were calculated for each protocol and compared with McNemar's test.
For all readers, the combined FAST-ULTRAFAST protocol significantly improved the reading with a specificity of 83.3% and 70.8% in comparison with FAST protocol or FULL protocol, respectively, without change in sensitivity. By adding ULTRAFAST protocol to FAST protocol, readers 1 and 2 were able to correctly change the diagnosis in 22.9% (11/48) and 10.4% (5/48) of benign lesions, without missing any malignancy, respectively. Both interpretation and image acquisition times for combined FAST-ULTRAFAST protocol and FAST protocol were shorter compared to FULL protocol (p<0.001).
Compared to FULL protocol, adding ULTRAFAST to FAST protocol improves specificity, mainly in correctly reclassifying benign masses and reducing interpretation and acquisition time, without decreasing sensitivity.
评估在常规快速 MRI 方案（FULL 协议）中加入 ULTRAFAST-MR 序列与缩短的快速 MRI 方案（FAST 协议）相比，在区分女性人群中的良恶性病变方面的附加价值，而不考虑乳房 MRI 成像的适应证。
回顾性分析 2014 年 3 月 10 日至 9 月 22 日期间共 70 例连续患者，共 106 个经组织学证实的病变（58 个恶性和 48 个良性），这些患者接受术前乳房分期（n=38）、高风险筛查（n=7）、问题解决（n=18）和乳头溢液（n=4）的乳房 MRI 检查，采用 12 次时间分辨对比动力学成像（TRICKS）采集，在常规高分辨率动态 MRI 方案（FULL 协议）中穿插进行。两位读者根据 BI-RADS 词典，对 MRI 检查进行阳性或阴性评分，并对具有 TRICKS 图像（ULTRAFAST）、缩短方案（FAST）和所有图像（FULL 协议）的显著病变进行描述。计算每个方案的敏感性、特异性、阳性预测值、阴性预测值和准确性，并与 McNemar 检验进行比较。
对于所有读者，与 FAST 协议或 FULL 协议相比，联合 FAST-ULTRAFAST 方案的特异性分别提高到 83.3%和 70.8%，而敏感性无变化。通过在 FAST 协议中加入 ULTRAFAST 协议，读者 1 和 2 能够分别正确改变 22.9%（48 个良性病变中的 11 个）和 10.4%（48 个良性病变中的 5 个）良性病变的诊断，而不会遗漏任何恶性病变。与 FULL 协议相比，联合 FAST-ULTRAFAST 协议和 FAST 协议的解读和图像采集时间均缩短（p<0.001）。
与 FULL 协议相比，在 FAST 协议中加入 ULTRAFAST 可提高特异性，主要是正确重新分类良性肿块，并减少解读和采集时间，而不降低敏感性。
