Department of Diagnostic Radiology, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, Texas 77030, United States of America.
Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1354, Houston, TX 77030-4009, United States of America.
Magn Reson Imaging. 2020 Oct;72:87-94. doi: 10.1016/j.mri.2020.06.017. Epub 2020 Jul 2.
To evaluate non-inferiority and diagnostic performance of an American College of Radiology compliant abbreviated MRI protocol (AB-MRI) compared with standard-of-care breast MRI (SOC-BMRI) in patients with increased breast cancer risk.
Women with increased lifetime breast cancer risk by American Cancer Society guidelines underwent breast MRI at a single institution between October 2015 and February 2018. AB-MRI was acquired at 3.0 T with T2-weighted extended fast spin echo triple-echo Dixon and pre- and post-contrast 3D dual-echo fast spoiled gradient echo two-point Dixon sequences with an 8-channel breast coil 1-7 days after SOC-BMRI. Three readers independently reviewed AB-MRI and assigned BI-RADS categories for maximum intensity projection images (AB1), dynamic contrast-enhanced (DCE) images (AB2), and DCE and non-contrast T2 and fat-only images (AB3). These scores were compared to those from SOC-BMRI.
Cancer yield was 14 per 1000 (women-years) in 73 women aged 26-75 years (mean 53.5 years). AB-MRI acquisition times (mean 9.63 min) and table times (mean 15.07 min) were significantly shorter than those of SOC-BMRI (means 19.46 and 36.3 min, respectively) (p < .001). Accuracy, sensitivity, specificity, and positive and negative predictive values were identical for AB3 and SOC-BMRI (93%, 100%, 93%, 16.7%, and 100%, respectively). AB-MRI with AB1 and AB2 had significantly lower specificity (AB1 = 73.6%, AB2 = 77.8%), positive predictive values (AB1 = 5%, AB2 = 5.9%), and accuracy (AB1 = 74%, AB2 = 78%) than those of SOC-BMRI (p = .002 for AB1, p = .01 for AB2).
AB-MRI was acquired significantly faster than SOC-BMRI and its diagnostic performance was non-inferior. Inclusion of T2 and fat-only images was necessary to achieve non-inferiority by multireader evaluation.
评估符合美国放射学院标准的简化磁共振成像方案（AB-MRI）与标准护理乳腺磁共振成像（SOC-BMRI）在具有较高乳腺癌风险的患者中的非劣效性和诊断性能。
根据美国癌症协会指南，2015 年 10 月至 2018 年 2 月，在一家机构接受乳腺 MRI 检查的具有较高终生乳腺癌风险的女性。AB-MRI 在 3.0 T 下进行，使用 T2 加权扩展快速自旋回波三回波 Dixon 序列和预对比及后对比 3D 双回波快速扰相梯度回波两点 Dixon 序列，使用 8 通道乳腺线圈，在 SOC-BMRI 后 1-7 天进行。三位读者独立地对 AB-MRI 进行了评估，并对最大强度投影图像（AB1）、动态对比增强（DCE）图像（AB2）和 DCE 及非对比 T2 和仅脂肪图像（AB3）进行了 BI-RADS 分类。这些评分与 SOC-BMRI 的评分进行了比较。
在 73 名年龄在 26-75 岁（平均 53.5 岁）的女性中，每 1000 名女性年有 14 人患癌（癌症发生率）。AB-MRI 的采集时间（平均 9.63 分钟）和台位时间（平均 15.07 分钟）明显短于 SOC-BMRI（分别为 19.46 分钟和 36.3 分钟）（p<0.001）。AB3 与 SOC-BMRI 的准确性、敏感度、特异度、阳性预测值和阴性预测值均相同（93%、100%、93%、16.7%和 100%）。AB-MRI 与 AB1 和 AB2 的特异度（AB1=73.6%，AB2=77.8%）、阳性预测值（AB1=5%，AB2=5.9%）和准确性（AB1=74%，AB2=78%）明显低于 SOC-BMRI（AB1 为 p=0.002，AB2 为 p=0.01）。
AB-MRI 的采集速度明显快于 SOC-BMRI，其诊断性能非劣效。通过多读者评估，需要包含 T2 和仅脂肪图像才能达到非劣效性。
