Ultrafast Bilateral DCE-MRI of the Breast with Conventional Fourier Sampling

Rationale and Objectives

The study aimed to evaluate the feasibility and advantages of a combined high temporal and high spatial resolution protocol for dynamic contrast-enhanced magnetic resonance imaging of the breast.

Materials and Methods

Twenty-three patients with enhancing lesions were imaged at 3T. The acquisition protocol consisted of a series of bilateral, fat-suppressed “ultrafast” acquisitions, with 6.9- to 9.9-second temporal resolution for the first minute following contrast injection, followed by four high spatial resolution acquisitions with 60- to 79.5-second temporal resolution. All images were acquired with standard uniform Fourier sampling. A filtering method was developed to reduce noise and detect significant enhancement in the high temporal resolution images. Time of arrival (TOA) was defined as the time at which each voxel first satisfied all the filter conditions, relative to the time of initial arterial enhancement.

Results

Ultrafast images improved visualization of the vasculature feeding and draining lesions. A small percentage of the entire field of view (<6%) enhanced significantly in the 30 seconds following contrast injection. Lesion conspicuity was highest in early ultrafast images, especially in cases with marked parenchymal enhancement. Although the sample size was relatively small, the average TOA for malignant lesions was significantly shorter than the TOA for benign lesions. Significant differences were also measured in other parameters descriptive of early contrast media uptake kinetics ( P < 0.05).

Conclusions

Ultrafast imaging in the first minute of dynamic contrast-enhanced magnetic resonance imaging of the breast has the potential to add valuable information on early contrast dynamics. Ultrafast imaging could allow radiologists to confidently identify lesions in the presence of marked background parenchymal enhancement.

Introduction

Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) of the breast is a valuable tool for the detection and diagnosis of breast cancer . The kinetics of contrast media uptake and washout yield important markers for malignancy . Typically, malignant tumors exhibit fast uptake of contrast media followed by washout in the delayed phase . Standard clinical contrast-enhanced scans are generally performed with high spatial resolution to enable morphologic evaluation of lesions and detect small cancers . The high spatial resolution required, combined with the large fields of view necessary to acquire bilateral images, leads to low temporal resolution, typically in the range of 60–75 seconds. As a result, important kinetic information is obscured.

Acquiring DCE-MRI with high temporal resolution is important, as it allows accurate classification of contrast media dynamics in suspicious lesions, and thus has the potential to aid discrimination between malignant and benign lesions. In addition, high temporal resolution allows accurate measurement of the arterial input function for each patient, a critical step in quantitative pharmacokinetic analysis . However, the early events in contrast media uptake in normal breast and breast lesions have not been well characterized; thus, it is difficult to know what temporal resolution is optimal for breast MRI.

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Materials and Methods

Patient Recruitment

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MRI Acquisitions

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Table 1

Acquisition Parameters for Ultrafast and High Spatial Resolution Sequences

Parameters Ultrafast High Spatial Resolution TR/TE (ms) 3.2/1.6 4.8/2.4 Acquisition voxel size (mm 3 ) 1.5 × 1.5 × 3.0 0.8 × 0.8 × 1.6 SENSE acceleration factor (RL) 4 2.5 SENSE acceleration factor (FH) 2 2 Half scan (partial Fourier) factor 0.75 (ky); 0.85 (kz) 0.85 (ky); 1 (kz) Temporal resolution range (s) 6.9–9.9 60–79.5 Number of slices 100–120 187–225 Flip angle 10° Field of view (mm) 300–370 Fat suppression method SPAIR (TR: 155 ms; inversion delay: 80 ms)

TR, repetition time; TE, echo time; SENSE, sensitivity encoding; RL, right-left; FH, foot-head; SPAIR, spectral attenuated inversion recovery.

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Data Analysis

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PSE(t)=A(1−exp(−αt)) P

(

)

(

−

exp

(

−

)

where A is the upper limit of percent enhancement, and α is the uptake rate (sec −1 ). A truncated EMM was used to evaluate the potential diagnostic value of early kinetic data as measured with the proposed protocol. From the EMM parameters, three secondary parameters were calculated: initial area under the contrast enhancement versus time curve (iAUC) , time to 90% of maximum enhancement (T90), and initial slope (defined as the product of the uptake rate and the upper limit of enhancement). T90 was used as a surrogate for time-to-peak enhancement.

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r(t)=(S(t)−S0)lesion(S(t)−S0)parenchyma r

(

)

(

)

−

)

lesion

(

)

−

)

parenchyma

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Results

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Table 2

Average Values (and Standard Deviations) of Kinetic Parameters Derived From the EMM Fits for Both Benign and Malignant Lesions and the Malignant to Benign Ratio for the Mean Value of Each Parameter

Parameters Malignant Benign Ratio (M:B) A (%) 152 ± 48 106 ± 60 1.4:1 α (%/s) \* 23 ± 35 6.5 ± 3.3 3.6:1 Initial slope \* 0.42 ± 0.73 0.07 ± 0.05 6.3:1 iAUC (30 s) \* 33.3 ± 14.3 15.6 ± 10.1 2.5:1 TOA (s) \* 6.9 ± 4.6 15.5 ± 13.6 0.4:1 T90 (s) \* 27.3 ± 13.9 90.5 ± 139.8 0.3:1

EMM, empirical mathematical model; iAUC, initial area under the contrast enhancement versus time curve; T90, time to 90% of maximum enhancement; TOA, time of arrival.

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Discussion

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Acknowledgments

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Ultrafast Bilateral DCE-MRI of the Breast with Conventional Fourier Sampling

Rationale and Objectives

Materials and Methods

Results

Conclusions

Introduction

Materials and Methods

Patient Recruitment

MRI Acquisitions

Data Analysis

Results

Discussion

Acknowledgments

References

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