Skip to main content
Top
Published in: European Radiology 6/2008

Open Access 01-06-2008 | Breast

Contrast-enhanced magnetic resonance imaging of the breast: the value of pharmacokinetic parameters derived from fast dynamic imaging during initial enhancement in classifying lesions

Authors: J. Veltman, M. Stoutjesdijk, R. Mann, H. J. Huisman, J. O. Barentsz, J. G. Blickman, C. Boetes

Published in: European Radiology | Issue 6/2008

Login to get access

Abstract

The value of pharmacokinetic parameters derived from fast dynamic imaging during initial enhancement in characterizing breast lesions on magnetic resonance imaging (MRI) was evaluated. Sixty-eight malignant and 34 benign lesions were included. In the scanning protocol, high temporal resolution imaging was combined with high spatial resolution imaging. The high temporal resolution images were recorded every 4.1 s during initial enhancement (fast dynamic analysis). The high spatial resolution images were recorded at a temporal resolution of 86 s (slow dynamic analysis). In the fast dynamic evaluation pharmacokinetic parameters (Ktrans, Ve and kep) were evaluated. In the slow dynamic analysis, each lesion was scored according to the BI-RADS classification. Two readers evaluated all data prospectively. ROC and multivariate analysis were performed. The slow dynamic analysis resulted in an AUC of 0.85 and 0.83, respectively. The fast dynamic analysis resulted in an AUC of 0.83 in both readers. The combination of both the slow and fast dynamic analyses resulted in a significant improvement of diagnostic performance with an AUC of 0.93 and 0.90 (P = 0.02). The increased diagnostic performance found when combining both methods demonstrates the additional value of our method in further improving the diagnostic performance of breast MRI.
Literature
1.
go back to reference Parkin DM, Bray F, Ferlay J, Pisani P (2005) Global cancer statistics, 2002. CA Cancer J Clin 55:74–108PubMedCrossRef Parkin DM, Bray F, Ferlay J, Pisani P (2005) Global cancer statistics, 2002. CA Cancer J Clin 55:74–108PubMedCrossRef
2.
go back to reference Boetes C, Veltman J, van Die L, Bult P, Wobbes T, Barentsz JO (2004) The role of MRI in invasive lobular carcinoma. Breast Cancer Res Treat 86:31–37PubMedCrossRef Boetes C, Veltman J, van Die L, Bult P, Wobbes T, Barentsz JO (2004) The role of MRI in invasive lobular carcinoma. Breast Cancer Res Treat 86:31–37PubMedCrossRef
3.
go back to reference Kriege M, Brekelmans CT, Boetes C, Besnard PE, Zonderland HM, Obdeijn IM, Manoliu RA, Kok T, Peterse H, Tilanus-Linthorst MM, Muller SH, Meijer S, Oosterwijk JC, Beex LV, Tollenaar RA, de Koning HJ, Rutgers EJ, Klijn JG (2004) Efficacy of MRI and mammography for breast-cancer screening in women with a familial or genetic predisposition. N Engl J Med 351:427–437PubMedCrossRef Kriege M, Brekelmans CT, Boetes C, Besnard PE, Zonderland HM, Obdeijn IM, Manoliu RA, Kok T, Peterse H, Tilanus-Linthorst MM, Muller SH, Meijer S, Oosterwijk JC, Beex LV, Tollenaar RA, de Koning HJ, Rutgers EJ, Klijn JG (2004) Efficacy of MRI and mammography for breast-cancer screening in women with a familial or genetic predisposition. N Engl J Med 351:427–437PubMedCrossRef
4.
go back to reference Schnall MD, Blume J, Bluemke DA, DeAngelis GA, DeBruhl N, Harms S, Heywang-Kobrunner SH, Hylton N, Kuhl CK, Pisano ED, Causer P, Schnitt SJ, Thickman D, Stelling CB, Weatherall PT, Lehman C, Gatsonis CA (2006) Diagnostic architectural and dynamic features at breast MR imaging: multicenter study. Radiology 238:42–53PubMedCrossRef Schnall MD, Blume J, Bluemke DA, DeAngelis GA, DeBruhl N, Harms S, Heywang-Kobrunner SH, Hylton N, Kuhl CK, Pisano ED, Causer P, Schnitt SJ, Thickman D, Stelling CB, Weatherall PT, Lehman C, Gatsonis CA (2006) Diagnostic architectural and dynamic features at breast MR imaging: multicenter study. Radiology 238:42–53PubMedCrossRef
5.
go back to reference Van Goethem M, Tjalma W, Schelfout K, Verslegers I, Biltjes I, Parizel P (2006) Magnetic resonance imaging in breast cancer. Eur J Surg Oncol 32:901–910PubMedCrossRef Van Goethem M, Tjalma W, Schelfout K, Verslegers I, Biltjes I, Parizel P (2006) Magnetic resonance imaging in breast cancer. Eur J Surg Oncol 32:901–910PubMedCrossRef
6.
go back to reference Boetes C, Barentsz JO, Mus RD, Van Der Sluis RF, van Erning LJ, Hendriks JH, Holland R, Ruys SH (1994) MR characterization of suspicious breast lesions with a gadolinium-enhanced TurboFLASH subtraction technique. Radiology 193:777–781PubMed Boetes C, Barentsz JO, Mus RD, Van Der Sluis RF, van Erning LJ, Hendriks JH, Holland R, Ruys SH (1994) MR characterization of suspicious breast lesions with a gadolinium-enhanced TurboFLASH subtraction technique. Radiology 193:777–781PubMed
7.
go back to reference Gilles R, Guinebretiere JM, Lucidarme O, Cluzel P, Janaud G, Finet JF, Tardivon A, Masselot J, Vanel D (1994) Nonpalpable breast tumors: diagnosis with contrast-enhanced subtraction dynamic MR imaging. Radiology 191:625–631PubMed Gilles R, Guinebretiere JM, Lucidarme O, Cluzel P, Janaud G, Finet JF, Tardivon A, Masselot J, Vanel D (1994) Nonpalpable breast tumors: diagnosis with contrast-enhanced subtraction dynamic MR imaging. Radiology 191:625–631PubMed
8.
go back to reference Heywang SH, Wolf A, Pruss E, Hilbertz T, Eiermann W, Permanetter W (1989) MR imaging of the breast with Gd-DTPA: use and limitations. Radiology 171:95–103PubMed Heywang SH, Wolf A, Pruss E, Hilbertz T, Eiermann W, Permanetter W (1989) MR imaging of the breast with Gd-DTPA: use and limitations. Radiology 171:95–103PubMed
9.
go back to reference Hulka CA, Smith BL, Sgroi DC, Tan L, Edmister WB, Semple JP, Campbell T, Kopans DB, Brady TJ, Weisskoff RM (1995) Benign and malignant breast lesions: differentiation with echo-planar MR imaging. Radiology 197:33–38PubMed Hulka CA, Smith BL, Sgroi DC, Tan L, Edmister WB, Semple JP, Campbell T, Kopans DB, Brady TJ, Weisskoff RM (1995) Benign and malignant breast lesions: differentiation with echo-planar MR imaging. Radiology 197:33–38PubMed
10.
go back to reference Kaiser WA, Zeitler E (1989) MR imaging of the breast: fast imaging sequences with and without Gd-DTPA. Preliminary observations. Radiology 170:681–686PubMed Kaiser WA, Zeitler E (1989) MR imaging of the breast: fast imaging sequences with and without Gd-DTPA. Preliminary observations. Radiology 170:681–686PubMed
11.
go back to reference Kelcz F, Santyr GE, Cron GO, Mongin SJ (1996) Application of a quantitative model to differentiate benign from malignant breast lesions detected by dynamic, gadolinium-enhanced MRI. J Magn Reson Imaging 6:743–752PubMedCrossRef Kelcz F, Santyr GE, Cron GO, Mongin SJ (1996) Application of a quantitative model to differentiate benign from malignant breast lesions detected by dynamic, gadolinium-enhanced MRI. J Magn Reson Imaging 6:743–752PubMedCrossRef
12.
go back to reference Kuhl CK, Mielcareck P, Klaschik S, Leutner C, Wardelmann E, Gieseke J, Schild HH (1999) Dynamic breast MR imaging: are signal intensity time course data useful for differential diagnosis of enhancing lesions? Radiology 211:101–110PubMed Kuhl CK, Mielcareck P, Klaschik S, Leutner C, Wardelmann E, Gieseke J, Schild HH (1999) Dynamic breast MR imaging: are signal intensity time course data useful for differential diagnosis of enhancing lesions? Radiology 211:101–110PubMed
13.
go back to reference Nunes LW, Schnall MD, Orel SG, Hochman MG, Langlotz CP, Reynolds CA, Torosian MH (1997) Breast MR imaging: interpretation model. Radiology 202:833–841PubMed Nunes LW, Schnall MD, Orel SG, Hochman MG, Langlotz CP, Reynolds CA, Torosian MH (1997) Breast MR imaging: interpretation model. Radiology 202:833–841PubMed
14.
go back to reference Perman WH, Heiberg EM, Grunz J, Herrmann VM, Janney CG (1994) A fast 3D-imaging technique for performing dynamic Gd-enhanced MRI of breast lesions. Magn Reson Imaging 12:545–551PubMedCrossRef Perman WH, Heiberg EM, Grunz J, Herrmann VM, Janney CG (1994) A fast 3D-imaging technique for performing dynamic Gd-enhanced MRI of breast lesions. Magn Reson Imaging 12:545–551PubMedCrossRef
15.
go back to reference Fischer U, Kopka L, Brinck U, Korabiowska M, Schauer A, Grabbe E (1997) Prognostic value of contrast-enhanced MR mammography in patients with breast cancer. Eur Radiol 7:1002–1005PubMedCrossRef Fischer U, Kopka L, Brinck U, Korabiowska M, Schauer A, Grabbe E (1997) Prognostic value of contrast-enhanced MR mammography in patients with breast cancer. Eur Radiol 7:1002–1005PubMedCrossRef
16.
go back to reference Bedrosian I, Mick R, Orel SG, Schnall M, Reynolds C, Spitz FR, Callans LS, Buzby GP, Rosato EF, Fraker DL, Czerniecki BJ (2003) Changes in the surgical management of patients with breast carcinoma based on preoperative magnetic resonance imaging. Cancer 98:468–473PubMedCrossRef Bedrosian I, Mick R, Orel SG, Schnall M, Reynolds C, Spitz FR, Callans LS, Buzby GP, Rosato EF, Fraker DL, Czerniecki BJ (2003) Changes in the surgical management of patients with breast carcinoma based on preoperative magnetic resonance imaging. Cancer 98:468–473PubMedCrossRef
17.
go back to reference Fischer U, Zachariae O, Baum F, von Heyden D, Funke M, Liersch T (2004) The influence of preoperative MRI of the breasts on recurrence rate in patients with breast cancer. Eur Radiol 14:1725–1731PubMed Fischer U, Zachariae O, Baum F, von Heyden D, Funke M, Liersch T (2004) The influence of preoperative MRI of the breasts on recurrence rate in patients with breast cancer. Eur Radiol 14:1725–1731PubMed
18.
go back to reference Furman-Haran E, Schechtman E, Kelcz F, Kirshenbaum K, Degani H (2005) Magnetic resonance imaging reveals functional diversity of the vasculature in benign and malignant breast lesions. Cancer 104:708–718PubMedCrossRef Furman-Haran E, Schechtman E, Kelcz F, Kirshenbaum K, Degani H (2005) Magnetic resonance imaging reveals functional diversity of the vasculature in benign and malignant breast lesions. Cancer 104:708–718PubMedCrossRef
19.
go back to reference Heywang SH, Hahn D, Schmidt H, Krischke I, Eiermann W, Bassermann R, Lissner J (1986) MR imaging of the breast using gadolinium-DTPA. J Comput Assist Tomogr 10:199–204PubMedCrossRef Heywang SH, Hahn D, Schmidt H, Krischke I, Eiermann W, Bassermann R, Lissner J (1986) MR imaging of the breast using gadolinium-DTPA. J Comput Assist Tomogr 10:199–204PubMedCrossRef
20.
go back to reference Kuhl CK, Schild HH, Morakkabati N (2005) Dynamic bilateral contrast-enhanced MR imaging of the breast: trade-off between spatial and temporal resolution. Radiology 236:789–800PubMedCrossRef Kuhl CK, Schild HH, Morakkabati N (2005) Dynamic bilateral contrast-enhanced MR imaging of the breast: trade-off between spatial and temporal resolution. Radiology 236:789–800PubMedCrossRef
21.
go back to reference Wedegärtner U, Bick U, Wörtler K, Rummeny E, Bongartz G (2001) Differentiation between benign and malignant findings on MR-mammography: usefulness of morphological criteria. Eur Radiol 11:1645–1650PubMedCrossRef Wedegärtner U, Bick U, Wörtler K, Rummeny E, Bongartz G (2001) Differentiation between benign and malignant findings on MR-mammography: usefulness of morphological criteria. Eur Radiol 11:1645–1650PubMedCrossRef
22.
go back to reference Sardanelli F, Rescinito G, Giordano GD, Calabrese M, Parodi RC (2000) MR dynamic enhancement of breast lesions: high temporal resolution during the first-minute versus eight-minute study. J Comput Assist Tomogr 24:724–731PubMedCrossRef Sardanelli F, Rescinito G, Giordano GD, Calabrese M, Parodi RC (2000) MR dynamic enhancement of breast lesions: high temporal resolution during the first-minute versus eight-minute study. J Comput Assist Tomogr 24:724–731PubMedCrossRef
23.
go back to reference Helbich TH, Roberts TP, Gossmann A, Wendland MF, Shames DM, Adachi M, Yang S, Huber S, Daldrup H, Brasch RC (2000) Quantitative gadopentetate-enhanced MRI of breast tumors: testing of different analytic methods. Magn Reson Med 44:915–924PubMedCrossRef Helbich TH, Roberts TP, Gossmann A, Wendland MF, Shames DM, Adachi M, Yang S, Huber S, Daldrup H, Brasch RC (2000) Quantitative gadopentetate-enhanced MRI of breast tumors: testing of different analytic methods. Magn Reson Med 44:915–924PubMedCrossRef
24.
go back to reference Gibbs P, Liney GP, Lowry M, Kneeshaw PJ, Turnbull LW (2004) Differentiation of benign and malignant sub-1 cm breast lesions using dynamic contrast enhanced MRI. Breast 13:115–121PubMedCrossRef Gibbs P, Liney GP, Lowry M, Kneeshaw PJ, Turnbull LW (2004) Differentiation of benign and malignant sub-1 cm breast lesions using dynamic contrast enhanced MRI. Breast 13:115–121PubMedCrossRef
25.
go back to reference Kopans DB (1994) Mammographic follow-up to detect breast cancer recurrence after conservative treatment. Radiology 190:286PubMed Kopans DB (1994) Mammographic follow-up to detect breast cancer recurrence after conservative treatment. Radiology 190:286PubMed
26.
go back to reference Kuhl CK, Bieling HB, Gieseke J, Kreft BP, Sommer T, Lutterbey G, Schild HH (1997) Healthy premenopausal breast parenchyma in dynamic contrast-enhanced MR imaging of the breast: normal contrast medium enhancement and cyclical-phase dependency. Radiology 203:137–144PubMed Kuhl CK, Bieling HB, Gieseke J, Kreft BP, Sommer T, Lutterbey G, Schild HH (1997) Healthy premenopausal breast parenchyma in dynamic contrast-enhanced MR imaging of the breast: normal contrast medium enhancement and cyclical-phase dependency. Radiology 203:137–144PubMed
27.
go back to reference Wiener JI, Schilling KJ, Adami C, Obuchowski NA (2005) Assessment of suspected breast cancer by MRI: a prospective clinical trial using a combined kinetic and morphologic analysis. AJR Am J Roentgenol 184:878–886PubMed Wiener JI, Schilling KJ, Adami C, Obuchowski NA (2005) Assessment of suspected breast cancer by MRI: a prospective clinical trial using a combined kinetic and morphologic analysis. AJR Am J Roentgenol 184:878–886PubMed
28.
go back to reference American College of Radiology (2003) ACR BI-RADS: magnetic resonance imaging. In: ACR Breast imaging reporting and data System. American College of Radiology, Reston American College of Radiology (2003) ACR BI-RADS: magnetic resonance imaging. In: ACR Breast imaging reporting and data System. American College of Radiology, Reston
29.
go back to reference Fütterer JJ, Engelbrecht MR, Huisman HJ, Jager GJ, Hulsbergen-van de Kaa CA, Witjes JA, Barentsz JO (2005) Staging prostate cancer with dynamic contrast-enhanced endorectal MR imaging prior to radical prostatectomy: experienced versus less experienced readers. Radiology 237:541–549PubMedCrossRef Fütterer JJ, Engelbrecht MR, Huisman HJ, Jager GJ, Hulsbergen-van de Kaa CA, Witjes JA, Barentsz JO (2005) Staging prostate cancer with dynamic contrast-enhanced endorectal MR imaging prior to radical prostatectomy: experienced versus less experienced readers. Radiology 237:541–549PubMedCrossRef
30.
go back to reference Fütterer JJ, Heijmink SW, Scheenen TW, Veltman J, Huisman HJ, Vos P, Hulsbergen-van de Kaa CA, Witjes JA, Krabbe PF, Heerschap A, Barentsz JO (2006) Prostate cancer localization with dynamic contrast-enhanced MR imaging and proton MR spectroscopic imaging. Radiology 241:449–458PubMedCrossRef Fütterer JJ, Heijmink SW, Scheenen TW, Veltman J, Huisman HJ, Vos P, Hulsbergen-van de Kaa CA, Witjes JA, Krabbe PF, Heerschap A, Barentsz JO (2006) Prostate cancer localization with dynamic contrast-enhanced MR imaging and proton MR spectroscopic imaging. Radiology 241:449–458PubMedCrossRef
31.
go back to reference Huisman HJ, Engelbrecht MR, Barentsz JO (2001) Accurate estimation of pharmacokinetic contrast-enhanced dynamic MRI parameters of the prostate. J Magn Reson Imaging 13:607–614PubMedCrossRef Huisman HJ, Engelbrecht MR, Barentsz JO (2001) Accurate estimation of pharmacokinetic contrast-enhanced dynamic MRI parameters of the prostate. J Magn Reson Imaging 13:607–614PubMedCrossRef
32.
go back to reference Hittmair K, Gomiscek G, Langenberger K, Recht M, Imhof H, Kramer J (1994) Method for the quantitative assessment of contrast agent uptake in dynamic contrast-enhanced MRI. Magn Reson Med 31:567–571PubMedCrossRef Hittmair K, Gomiscek G, Langenberger K, Recht M, Imhof H, Kramer J (1994) Method for the quantitative assessment of contrast agent uptake in dynamic contrast-enhanced MRI. Magn Reson Med 31:567–571PubMedCrossRef
33.
go back to reference Kovar DA, Lewis M, Karczmar GS (1998) A new method for imaging perfusion and contrast extraction fraction: input functions derived from reference tissues. J Magn Reson Imaging 8:1126–1134PubMedCrossRef Kovar DA, Lewis M, Karczmar GS (1998) A new method for imaging perfusion and contrast extraction fraction: input functions derived from reference tissues. J Magn Reson Imaging 8:1126–1134PubMedCrossRef
34.
go back to reference Tofts PS, Brix G, Buckley DL, Evelhoch JL, Henderson E, Knopp MV, Larsson HB, Lee TY, Mayr NA, Parker GJ, Port RE, Taylor J, Weisskoff RM (1999) Estimating kinetic parameters from dynamic contrast-enhanced T(1)-weighted MRI of a diffusable tracer: standardized quantities and symbols. J Magn Reson Imaging 10:223–232PubMedCrossRef Tofts PS, Brix G, Buckley DL, Evelhoch JL, Henderson E, Knopp MV, Larsson HB, Lee TY, Mayr NA, Parker GJ, Port RE, Taylor J, Weisskoff RM (1999) Estimating kinetic parameters from dynamic contrast-enhanced T(1)-weighted MRI of a diffusable tracer: standardized quantities and symbols. J Magn Reson Imaging 10:223–232PubMedCrossRef
35.
go back to reference Leach MO, Boggis CR, Dixon AK, Easton DF, Eeles RA, Evans DG, Gilbert FJ, Griebsch I, Hoff RJ, Kessar P, Lakhani SR, Moss SM, Nerurkar A, Padhani AR, Pointon LJ, Thompson D, Warren RM (2005) Screening with magnetic resonance imaging and mammography of a UK population at high familial risk of breast cancer: a prospective multicentre cohort study (MARIBS). Lancet 365:1769–1778PubMedCrossRef Leach MO, Boggis CR, Dixon AK, Easton DF, Eeles RA, Evans DG, Gilbert FJ, Griebsch I, Hoff RJ, Kessar P, Lakhani SR, Moss SM, Nerurkar A, Padhani AR, Pointon LJ, Thompson D, Warren RM (2005) Screening with magnetic resonance imaging and mammography of a UK population at high familial risk of breast cancer: a prospective multicentre cohort study (MARIBS). Lancet 365:1769–1778PubMedCrossRef
36.
go back to reference Liney GP, Gibbs P, Hayes C, Leach MO, Turnbull LW (1999) Dynamic contrast-enhanced MRI in the differentiation of breast tumors: user-defined versus semi-automated region-of-interest analysis. J Magn Reson Imaging 10:945–949PubMedCrossRef Liney GP, Gibbs P, Hayes C, Leach MO, Turnbull LW (1999) Dynamic contrast-enhanced MRI in the differentiation of breast tumors: user-defined versus semi-automated region-of-interest analysis. J Magn Reson Imaging 10:945–949PubMedCrossRef
37.
go back to reference Kelcz F, Furman-Haran E, Grobgeld D, Degani H (2002) Clinical testing of high-spatial-resolution parametric contrast-enhanced MR imaging of the breast. AJR Am J Roentgenol 179:1485–1492PubMed Kelcz F, Furman-Haran E, Grobgeld D, Degani H (2002) Clinical testing of high-spatial-resolution parametric contrast-enhanced MR imaging of the breast. AJR Am J Roentgenol 179:1485–1492PubMed
Metadata
Title
Contrast-enhanced magnetic resonance imaging of the breast: the value of pharmacokinetic parameters derived from fast dynamic imaging during initial enhancement in classifying lesions
Authors
J. Veltman
M. Stoutjesdijk
R. Mann
H. J. Huisman
J. O. Barentsz
J. G. Blickman
C. Boetes
Publication date
01-06-2008
Publisher
Springer-Verlag
Published in
European Radiology / Issue 6/2008
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-008-0870-8

Other articles of this Issue 6/2008

European Radiology 6/2008 Go to the issue

EFOMP News

EFOMP News