Rationale and Objectives
The aims of this study were to evaluate high spectral and spatial resolution (HiSS) magnetic resonance imaging (MRI) for the diagnosis of breast cancer without the injection of contrast media by comparing the performance of precontrast HiSS images to that of conventional contrast-enhanced, fat-suppressed, T1-weighted images on the basis of image quality and in the task of classifying benign and malignant breast lesions.
Materials and Methods
Ten benign and 44 malignant lesions were imaged at 1.5 T with HiSS (precontrast administration) and conventional fat-suppressed imaging (3–10 minutes after contrast administration). This set of 108 images, after randomization, was evaluated by three experienced radiologists blinded to the imaging technique. Breast Imaging Reporting and Data System morphologic criteria (lesion shape, lesion margin, and internal signal intensity pattern) and final assessment were used to measure reader performance. Image quality was evaluated on the basis of boundary delineation and quality of fat suppression. An overall probability of malignancy was assigned to each lesion for HiSS and conventional images separately.
Results
On boundary delineation and quality of fat suppression, precontrast HiSS scored similarly to conventional postcontrast MRI. On benign versus malignant lesion separation, there was no statistically significant difference in receiver-operating characteristic performance between HiSS and conventional MRI, and HiSS met a reasonable noninferiority condition.
Conclusions
Precontrast HiSS imaging is a promising approach for showing lesion morphology without blooming and other artifacts caused by contrast agents. HiSS images could be used to guide subsequent dynamic contrast-enhanced MRI scans to maximize spatial and temporal resolution in suspicious regions. HiSS MRI without contrast agent injection may be particularly important for patients at risk for contrast-induced nephrogenic systemic fibrosis or allergic reactions.
Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), combined with high-resolution postcontrast anatomic imaging, is an important tool for the routine clinical detection and diagnosis of breast cancer . However, although its sensitivity is reported as consistently high (75%–100%), its specificity has been variable (29%–90%) . A number of factors can reduce the utility of DCE-MRI in assessing lesion morphology: the magnetic susceptibility of contrast agents, as well as contrast agent diffusion and/or convection, causes increased blurring at tissue boundaries . Rapid changes in contrast media concentration during image acquisition can change lesion contrast and thus contribute additional blurring in the phase-encoding direction. These effects can obscure the lesion margin and make morphologic assessment more difficult (see Fig 1 ). In addition, contrast agent administration is contraindicated in a small but significant percentage of the population because of the risk for contrast agent–induced nephrogenic systemic fibrosis or allergic reactions . These issues could be addressed by effective imaging without contrast agents.
Open full size image
Figure 1
A 69-year-old woman with an invasive ductal carcinoma lesion was imaged using high spectral and spatial resolution (HiSS) and conventional imaging. (a) HiSS water peak height (repetition time, 500 ms; echo time, 90 ms; in-plane resolution, 1 mm) and (b) conventional T1-weighted (repetition time, 12.6 ms; echo time, 3.8 ms; in-plane resolution, 1 mm) sagittal images are shown. The lesion is indicated with an arrow . Spiculations surrounding the lesion are much better visualized in the HiSS image, probably because of contrast agent diffusion from the lesion in the dynamic contrast-enhanced magnetic resonance image.
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Materials and methods
Patients
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MRI Protocol
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Table 1
High Spectral and Spatial Resolution Imaging Sequence Parameters
Parameter Philips Achieva ∗ GE Signa † Repetition time (ms) 500 250–500 Effective echo time (ms) 90 96–192 Flip angle (°) 90 60 Echo train length 128 64–128 Echo spacing (ms) 1.4 3 Spectral bandwidth (Hz) 715 333 Spectral resolution (Hz) 5.6 2.6–5.2 Field of view, readout direction (mm) 256 240–360 Field of view, phase encode direction (mm) 256 120–180 Acquisition matrix 256 × 256 384 × 192 In-plane resolution (mm) 1 0.65–0.95 Slice thickness (mm) 3 3–4 Number of slices imaged 1 1–2 Acquisition time 2 min 8 s 1 min 36 s
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HiSS Data Processing
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Radiologist Evaluation
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Table 2
BI-RADS Assessment Categories Used
BI-RADS Category Values Lesion shape Round, oval, lobular, irregular Lesion margin Smooth, irregular, spiculated Internal signal intensity pattern Homogeneous, heterogeneous, dark internal septations, bright internal septations, rim (peripheral hyperintensity), central hyperintensity Final BI-RADS assessment 0–5
BI-RADS, Breast Imaging Reporting and Data System.
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Statistical Analysis
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Results
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Overall
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BI-RADS Measures
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Image Quality Measures
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Probability of Malignancy Measure
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![Figure 5, Receiver-operating characteristic plots with probability of malignancy as a classifier, and proper binormal model fits to the data, are shown for conventional T1-weighted ( solid circles, dotted line ) and high spectral and spatial resolution (HiSS) ( open circles, solid line ) images. The areas under the curves for conventional and HiSS images are 0.81 and 0.84, respectively (difference, 0.036; 95% confidence interval [CI], −0.25 to 0.32), for reader A; 0.86 and 0.83 (difference, −0.028; 95% CI, −0.26, 0.20) for reader B; and 0.76 and 0.91 (difference, 0.16; 95% CI, 0.02 to 0.30) for reader C. There is no statistically significant difference in the overall performance of the two imaging methods.](https://storage.googleapis.com/dl.dentistrykey.com/clinical/NoncontrastEnhancedMRIforEvaluationofBreastLesions/3_1s20S1076633211003928.jpg)
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Discussion
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Conclusions
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