Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
Diagnostic Imaging, Siemens Healthcare GmbH, Forchheim, Germany.
J Magn Reson Imaging. 2020 Aug;52(2):589-595. doi: 10.1002/jmri.27079. Epub 2020 Feb 14.
Contrast-enhanced MRI (CE-MRI) is the most sensitive technique for breast cancer detection. Contrast-enhanced mammography (CEM) is emerging as a possible alternative to CE-MRI.
To evaluate the diagnostic performance of a low radiation dose contrast-enhanced mammography (L-CEM) in women with suspicious findings on conventional imaging compared to CE-MRI of the breast.
Prospective, single center.
Women with suspicious findings on mammography, tomosynthesis, or ultrasound, and no contraindications for L-CEM or CE-MRI. Eighty women were included.
FIELD STRENGTH/SEQUENCE: 1.5 and 3T CE-MRI, standard protocol for breast, with dedicated coils, according to international guidelines. L-CEM was performed using a dedicated prototype.
Three, off-site, blinded readers evaluated the images according to the BI-RADS lexicon in a randomized order, each in two separate reading sessions. Histology served as a gold standard.
Lesion detection rate, sensitivity, specificity, and negative and positive predictive values (NPV, PPV) were calculated and compared with multivariate statistics.
Included were 80 women (mean age, 54.3 years ±11.2 standard deviation) with 93 lesions (32 benign, 61 malignant). The detection rate was significantly higher with CE-MRI (92.5-94.6%; L-CEM 79.6-91.4%, P = 0.014). Sensitivity (L-CEM 65.6-90.2%; CE-MRI 83.6-93.4%, P = 0.086) and NPV (L-CEM 59.6-71.4%; CE-MRI 63.0-76.5%, P = 0.780) did not differ between the modalities. Specificity (L-CEM 46.9-96.9%; CE-MRI 37.5-53.1%, P = 0.001) and PPV (L-CEM 76.4-97.6%; CE-MRI 73.3-77.3%, P = 0.007) were significantly higher with L-CEM. Variations between readers were significant for sensitivity and NPV. The accuracy of L-CEM was as good as CE-MRI (75.3-76.3% vs. 72.0-75.3%, P = 0.514).
L-CEM showed a high sensitivity and accuracy in women with suspicious findings on conventional imaging. Compared to CE-MRI, L-CEM has the potential to increase specificity and PPV. L-CEM might help to reduce false-positive biopsies while obtaining sensitivity comparable to that of CE-MRI LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY STAGE: 2 J. Magn. Reson. Imaging 2020;52:589-595.
对比增强磁共振成像（CE-MRI）是乳腺癌检测最敏感的技术。对比增强乳房 X 线摄影术（CEM）作为 CE-MRI 的一种可能替代方法正在出现。
评估低辐射剂量对比增强乳房 X 线摄影术（L-CEM）在常规成像检查发现可疑病变的女性中的诊断性能，与乳房 CE-MRI 相比。
前瞻性，单中心。
有乳腺摄影、断层合成或超声检查可疑发现且无 L-CEM 或 CE-MRI 禁忌证的女性。共纳入 80 名女性。
磁场强度/序列：1.5 和 3T CE-MRI，乳房标准方案，专用线圈，符合国际指南。L-CEM 使用专用原型进行。
三位在现场的、盲目的读者根据 BI-RADS 词汇表以随机顺序评估图像，每位读者在两个单独的阅读会议中各评估两次。组织学作为金标准。
计算并比较了病变检出率、灵敏度、特异性、阴性和阳性预测值（NPV、PPV），并进行了多变量统计分析。
共纳入 80 名女性（平均年龄 54.3 ±11.2 标准差），共 93 个病灶（32 个良性，61 个恶性）。CE-MRI 的检出率明显更高（92.5-94.6%；L-CEM 为 79.6-91.4%，P = 0.014）。灵敏度（L-CEM 为 65.6-90.2%；CE-MRI 为 83.6-93.4%，P = 0.086）和 NPV（L-CEM 为 59.6-71.4%；CE-MRI 为 63.0-76.5%，P = 0.780）在两种方式之间无差异。特异性（L-CEM 为 46.9-96.9%；CE-MRI 为 37.5-53.1%，P = 0.001）和 PPV（L-CEM 为 76.4-97.6%；CE-MRI 为 73.3-77.3%，P = 0.007）L-CEM 明显更高。灵敏度和 NPV 读者间差异显著。L-CEM 的准确性与 CE-MRI 相当（75.3-76.3% vs. 72.0-75.3%，P = 0.514）。
在常规成像检查发现可疑病变的女性中，L-CEM 显示出较高的灵敏度和准确性。与 CE-MRI 相比，L-CEM 具有提高特异性和 PPV 的潜力。L-CEM 可能有助于减少假阳性活检，同时获得与 CE-MRI 相当的灵敏度。
1 技术功效阶段：2 J. Magn. Reson. Imaging 2020；52：589-595。
