Chen Yun An, Kazerouni Anum S, Phelps Matthew D, Hippe Daniel S, Youn Inyoung, Lee Janie M, Partridge Savannah C, Rahbar Habib
Department of Radiology, University of Washington, Seattle, WA, USA.
Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA.
J Breast Imaging. 2025 Sep 2;7(4):453-462. doi: 10.1093/jbi/wbae089.
Breast MRI affords high sensitivity with intermediate specificity for cancer detection. Ultrafast dynamic contrast-enhanced (DCE) MRI assesses early contrast inflow with potential to supplement or replace conventional DCE-MRI kinetic features. We sought to determine whether radiologist's evaluation of ultrafast DCE-MRI can increase specificity of a clinical MRI protocol.
In this IRB-approved, HIPAA-compliant study, breast MRIs from March 2019 to August 2020 with a BI-RADS category 3, 4, or 5 lesion were identified. Ultrafast DCE-MRI was acquired during the first 40 seconds after contrast injection and before conventional DCE-MRI postcontrast acquisitions in the clinical breast MRI protocol. Three radiologists masked to outcomes retrospectively determined lesion time to enhancement (TTE) on ultrafast DCE-MRI. Interreader agreement, differences between benign and malignant lesion TTE, and TTE diagnostic performance were evaluated.
Ninety-five lesions (20 malignant, 75 benign) were included. Interreader agreement in TTE was moderate to substantial for both ultrafast source images and subtraction maximum intensity projections (overall κ = 0.63). Time to enhancement was greater across benign lesions compared with malignancies (P <.05), and all lesions demonstrating no enhancement during the ultrafast series were benign. With a threshold TTE ≥40 seconds, ultrafast DCE-MRI yielded an average 40% specificity (95% CI, 30%-48%) and 92% sensitivity (95% CI, 81%-100%), yielding a potential reduction in 31% (95% CI, 23%-39%) of benign follow-ups based on conventional DCE-MRI.
Ultrafast imaging can be added to conventional DCE-MRI to increase diagnostic accuracy while adding minimal scan time. Future work to standardize evaluation criteria may improve interreader agreement and allow for more robust ultrafast DCE-MRI assessment.
乳腺磁共振成像（MRI）在癌症检测方面具有高灵敏度和中等特异性。超快动态对比增强（DCE）MRI可评估早期对比剂流入情况，有可能补充或取代传统DCE-MRI的动力学特征。我们试图确定放射科医生对超快DCE-MRI的评估是否能提高临床MRI方案的特异性。
在这项经机构审查委员会（IRB）批准且符合健康保险流通与责任法案（HIPAA）的研究中，识别出2019年3月至2020年8月期间乳腺MRI检查结果为乳腺影像报告和数据系统（BI-RADS）3类、4类或5类病变的患者。在临床乳腺MRI检查方案中，于注射对比剂后的前40秒内且在传统DCE-MRI对比剂注射后采集之前，获取超快DCE-MRI图像。三位对结果不知情的放射科医生回顾性地确定超快DCE-MRI上病变的强化时间（TTE）。评估了阅片者间的一致性、良性和恶性病变TTE的差异以及TTE的诊断性能。
共纳入95个病变（20个恶性，75个良性）。超快源图像和减影最大强度投影的TTE阅片者间一致性为中等至高度（总体κ = 0.63）。与恶性病变相比，良性病变的强化时间更长（P <.05），并且在超快序列中未显示强化的所有病变均为良性。以TTE≥40秒为阈值，超快DCE-MRI的平均特异性为40%（95%可信区间，30%-48%），敏感性为92%（95%可信区间，81%-100%），基于传统DCE-MRI的良性随访可能减少31%（95%可信区间，23%-39%）。
超快成像可添加到传统DCE-MRI中，以提高诊断准确性，同时增加的扫描时间极少。未来标准化评估标准的工作可能会改善阅片者间的一致性，并实现更可靠的超快DCE-MRI评估。
