Bode Maike, Morscheid Stephanie, Iordanishvili Elene, Huck Luisa C, Zhang Shuo, Lemainque Teresa, Kuhl Christiane K
Department of Diagnostic and Interventional Radiology, University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
Philips, Hamburg, Germany.
Radiology. 2025 May;315(2):e241371. doi: 10.1148/radiol.241371.
Background Ultrafast breast MRI promises to improve conspicuity of cancers by avoiding masking due to background parenchymal enhancement (BPE) and to improve classification of enhancing lesions. However, published studies systematically penalized standard dynamic contrast-enhanced (DCE) MRI because they integrated ultrafast MRI into existing DCE protocols, such that postcontrast acquisitions of DCE MRI began only after completion of ultrafast MRI. Purpose To perform an intraindividual comparison of conspicuity and classification of enhancing breast lesions with ultrafast MRI versus standard DCE MRI, where both methods included the early postcontrast phase. Materials and Methods This was a retrospective analysis of 31 women (median age, 48 years [IQR, 39-51 years]) from September 2021 to January 2023. Women underwent DCE MRI at 1.5 T and, within 2 days, a second contrast-enhanced examination using ultrafast MRI, for further diagnostic assessment of difficult-to-interpret enhancing lesions and/or BPE. For DCE MRI, a two-dimensional gradient-echo series (0.61 × 0.61 × 3.0-mm spatial resolution, 60 seconds per dynamic frame) was obtained once before and four times after injection of 0.1 mmol/kg gadobutrol. For ultrafast MRI, a compressed-sense accelerated three-dimensional gradient-echo series (0.92 × 0.97 × 2.5-mm spatial resolution, 4 seconds per keyhole dynamic frame) was obtained over 90 seconds before, during, and after injection of 0.1 mmol/kg gadobutrol. Two breast radiologists independently rated BPE, image quality, and conspicuity and morphology of enhancing lesions, and enhancement kinetics were analyzed (ultrafast MRI: maximum slope and time to enhancement; DCE MRI: wash-in rate and time course pattern). Results A total 59 enhancing lesions were reported in the 62 breasts of the 31 patients. BPE ratings were on average 0.8 points lower at ultrafast versus DCE MRI (mean, 2.5 ± 1.2 [SD] vs 3.3 ± 1.2; < .001). Despite this mild reduction in BPE, lesion conspicuity was rated lower at ultrafast than at DCE MRI (mean, 3.5 ± 1.3 vs 4.1 ± 1.0; = .001), as was image quality (mean, 2.3 ± 0.9 vs 4.1 ± 0.8; < .001). Lesion morphology (shape, margin, internal architecture) was less assessable at ultrafast MRI (all < .05). Kinetic parameters derived from ultrafast MRI did not improve classification of enhancing lesions compared with those derived from DCE MRI: At ultrafast MRI, time to enhancement was shorter for malignant versus benign lesions ( = .01), but maximum slope did not differ, whereas at DCE MRI, both wash-in rate and time course pattern differed between malignant and benign lesions (both = .01). Conclusion In this enriched cohort in which ultrafast MRI was expected to provide diagnostic advantages over DCE MRI, ultrafast MRI in fact led to reduced lesion conspicuity and did not improve lesion classification. © RSNA, 2025 See also the editorial by Cotes and Jacobs in this issue.
超快乳腺磁共振成像（MRI）有望通过避免背景实质强化（BPE）造成的掩盖效应来提高癌症的显影度，并改善强化病变的分类。然而，已发表的研究系统性地贬低了标准动态对比增强（DCE）MRI，因为它们将超快MRI纳入现有的DCE协议中，使得DCE MRI的对比剂注射后采集仅在超快MRI完成后才开始。目的：对超快MRI与标准DCE MRI增强乳腺病变的显影度和分类进行个体内比较，两种方法均包括对比剂注射后的早期阶段。材料与方法：这是一项对2021年9月至2023年1月期间31名女性（年龄中位数48岁[四分位间距，39 - 51岁]）的回顾性分析。这些女性接受了1.5T的DCE MRI检查，并在2天内进行了第二次使用超快MRI的对比增强检查，用于对难以解释的强化病变和/或BPE进行进一步诊断评估。对于DCE MRI，在注射0.1 mmol/kg钆布醇之前获取一次二维梯度回波序列（空间分辨率0.61×0.61×3.0 mm，每个动态帧60秒），注射后获取四次。对于超快MRI，在注射0.1 mmol/kg钆布醇之前、期间和之后的90秒内获取一个压缩感知加速三维梯度回波序列（空间分辨率0.
