Santonocito Ambra, Zarcaro Calogero, Zeitouni Layla, Ferrara Francesca, Kapetas Panagiotis, Helbich Thomas H, Clauser Paola, Baltzer Pascal A T
Department of Biomedical Imaging and Image-Guided Therapy, Division of General and Pediatric Radiology, General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
Department of Biomedicine, Neuroscience and Advanced Diagnostic (Bi.N.D.), University Hospital "Policlinico P. Giaccone", Via Del Vespro 129, 90127, Palermo, Italy.
Eur Radiol. 2025 Jun;35(6):3070-3079. doi: 10.1007/s00330-024-11195-4. Epub 2024 Dec 3.
Lesion conspicuity, the relative enhancement of a lesion compared to surrounding tissue, is a new descriptor in the ACR BI-RADS 2022 CEM supplement. We compared lesion conspicuity in contrast-enhanced mammography (CEM) and contrast-enhanced MRI (CE-MRI) in patients with suspicious breast lesions.
IRB-approved retrospective study; three blinded readers rated 462 indeterminate or suspicious breast lesions in 388 patients (54.2 ± 11 years; range 30-90) who underwent CEM and CE-MRI from 2018 to 2022. Each lesion's conspicuity was scored from 1 to 5, with 5 indicating excellent conspicuity. Visual grading characteristics (VGC) analysis and area under the curve (AUC) were used for comparison, with sub-analyses for benign and malignant lesions.
VGC analysis showed a significant AUC of 0.670 to 0.723 (p < 0.001) favouring CE-MRI. No lesion enhancement (score 1) was observed in 16.2% of CE-MRI and 44.7% of CEM. Excellent conspicuity was seen in 29.6% of CE-MRI and 11.9% of CEM. Sub-analysis showed higher conspicuity on CE-MRI for both malignant (AUC 0.665 to 0.732, p < 0.001) and benign lesions (AUC 0.734 to 0.798, p < 0.001). CE-MRI showed higher lesion conspicuity compared to CEM both for non-mass lesions (0.656) and for mass lesions 0.605.
CE-MRI shows significantly higher conspicuity for benign and malignant breast lesions compared to CEM, especially for benign lesions. The low conspicuity of benign lesions on CEM may help reduce false positives in clinical practice.
Question Lesion conspicuity is a new descriptor for lesion enhancement according to the new CEM lexicon. Data correlating lesion conspicuity with malignancy likelihood are limited. Findings Lesion conspicuity is higher for contrast-enhanced-MRI than for contrast-enhanced mammography (CEM) for all lesions but significantly better for benign lesions. Clinical relevance The low conspicuity of benign lesions on CEM may reduce false-positive results, making it a valuable tool in breast cancer screening.
病变清晰度，即病变相对于周围组织的相对强化程度，是美国放射学会（ACR）乳腺影像报告和数据系统（BI-RADS）2022年对比增强乳腺造影（CEM）补充版中的一个新描述符。我们比较了可疑乳腺病变患者在对比增强乳腺造影（CEM）和对比增强磁共振成像（CE-MRI）中的病变清晰度。
经机构审查委员会（IRB）批准的回顾性研究；三名盲法阅片者对2018年至2022年期间接受CEM和CE-MRI检查的388例患者（年龄54.2±11岁，范围30 - 90岁）中的462个不确定或可疑乳腺病变进行评分。每个病变的清晰度从1到5分进行评分，5分表示清晰度极佳。采用视觉分级特征（VGC）分析和曲线下面积（AUC）进行比较，并对良性和恶性病变进行亚分析。
VGC分析显示，支持CE-MRI的AUC显著为0.670至0.723（p < 0.001）。在CE-MRI中，16.2%的病变无强化（1分），在CEM中为44.7%。在CE-MRI中，29.6%的病变清晰度极佳，在CEM中为11.9%。亚分析显示，CE-MRI对恶性病变（AUC 0.665至0.732，p < 0.001）和良性病变（AUC 0.734至0.798，p < 0.001）的清晰度均更高。与CEM相比，CE-MRI对非肿块病变（0.656）和肿块病变（0.605）的病变清晰度均更高。
与CEM相比，CE-MRI对良性和恶性乳腺病变的清晰度显著更高，尤其是对良性病变。CEM上良性病变的低清晰度可能有助于在临床实践中减少假阳性。
问题病变清晰度是根据新的CEM词汇表对病变强化的一个新描述符。将病变清晰度与恶性可能性相关的数据有限。发现对于所有病变，对比增强磁共振成像的病变清晰度高于对比增强乳腺造影（CEM），但对良性病变明显更好。临床意义CEM上良性病变的低清晰度可能减少假阳性结果，使其成为乳腺癌筛查中的一个有价值的工具。
