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Bode M, Morscheid S, Iordanishvili E, Huck LC, Zhang S, Lemainque T, Kuhl CK. Intraindividual Comparison of Ultrafast versus Standard Two-dimensional Dynamic Contrast-enhanced Breast MRI. Radiology 2025; 315:e241371. [PMID: 40326874 DOI: 10.1148/radiol.241371] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2025]
Abstract
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; P < .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; P = .001), as was image quality (mean, 2.3 ± 0.9 vs 4.1 ± 0.8; P < .001). Lesion morphology (shape, margin, internal architecture) was less assessable at ultrafast MRI (all P < .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 (P = .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 P = .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 Supplemental material is available for this article. See also the editorial by Cotes and Jacobs in this issue.
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Affiliation(s)
- Maike Bode
- Department of Diagnostic and Interventional Radiology, University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Stephanie Morscheid
- Department of Diagnostic and Interventional Radiology, University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Elene Iordanishvili
- Department of Diagnostic and Interventional Radiology, University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Luisa C Huck
- Department of Diagnostic and Interventional Radiology, University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Shuo Zhang
- Department of Diagnostic and Interventional Radiology, University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
- Philips, Hamburg, Germany
| | - Teresa Lemainque
- Department of Diagnostic and Interventional Radiology, University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Christiane K Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
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Kuhl CK. Abbreviated Breast MRI: State of the Art. Radiology 2024; 310:e221822. [PMID: 38530181 DOI: 10.1148/radiol.221822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Abbreviated MRI is an umbrella term, defined as a focused MRI examination tailored to answer a single specific clinical question. For abbreviated breast MRI, this question is: "Is there evidence of breast cancer?" Abbreviated MRI of the breast makes maximum use of the fact that the kinetics of breast cancers and of benign tissue differ most in the very early postcontrast phase; therefore, abbreviated breast MRI focuses on this period. The different published approaches to abbreviated MRI include the following three subtypes: (a) short protocols, consisting of a precontrast and either a single postcontrast acquisition (first postcontrast subtracted [FAST]) or a time-resolved series of postcontrast acquisitions with lower spatial resolution (ultrafast [UF]), obtained during the early postcontrast phase immediately after contrast agent injection; (b) abridged protocols, consisting of FAST or UF acquisitions plus selected additional pulse sequences; and (c) noncontrast protocols, where diffusion-weighted imaging replaces the contrast information. Abbreviated MRI was proposed to increase tolerability of and access to breast MRI as a screening tool. But its widening application now includes follow-up after breast cancer and even diagnostic assessment. This review defines the three subtypes of abbreviated MRI, highlighting the differences between the protocols and their clinical implications and summarizing the respective evidence on diagnostic accuracy and clinical utility.
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Affiliation(s)
- Christiane K Kuhl
- From the Department of Diagnostic and Interventional Radiology, University Hospital Aachen, RWTH Pauwelsstr 30, 52074 Aachen, Germany
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Hellgren R, Tolocka E, Saracco A, Wilczek B, Sundbom A, Hall P, Dickman PW. Comparing the diagnostic accuracy, reading time, and inter-rater agreement of breast MRI abbreviated and full protocols: a multi-reader study. Acta Radiol 2024; 65:195-201. [PMID: 38115682 PMCID: PMC10903132 DOI: 10.1177/02841851231216552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 11/02/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Earlier studies have shown that abbreviated protocol magnetic resonance imaging (AB-MRI) has similar diagnostic accuracy as the full protocol (Full MRI). PURPOSE To compare the diagnostic accuracy, reading time, and inter-rater agreement of AB-MRI to Full MRI among women without known increased familial risk of breast cancer or prior biopsy. MATERIAL AND METHODS In total, 395 MRI examinations were included in this study. Three readers were blinded to all patient information. The AB-MRI and Full MRI were read separately and in a different random order for each of the readers. Scores 1-2 were considered test negative while scores 3-5 were test positive. A positive reference test was the diagnosis of malignancy; a negative reference test was the absence of a diagnosis of breast cancer within a two-year follow-up. We used a generalized estimating equations approach to compare sensitivity and specificity between the two protocols. We used t-tests to compare the average reading time and Krippendorff's alpha to compare inter-rater agreement. RESULTS MRI examinations of 395 women (median age=56 years) were evaluated. For AB-MRI and Full MRI, respectively, the sensitivity was 93.0% (95% CI=90.6-95.0) vs. 92.0% (95% CI=89.4-94.1), the specificity was 91.7% (95% CI=90.3-92.9) vs. 94.3% (95% CI=93.2-95.3), average reading time was 67 vs. 126 s, and the inter-rater agreement 0.79 vs. 0.83. The difference in sensitivity was not statistically significant (P=0.840), but the difference in specificity was significant (P=0.003). CONCLUSION AB-MRI has similar sensitivity, but somewhat lower specificity. The average reading time for the abbreviated protocol is lower, as is inter-rater agreement.
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Affiliation(s)
- Roxanna Hellgren
- Department of Medical Imaging, Division of Breast Imaging, Södersjukhuset, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ernst Tolocka
- Department of Medical Imaging, Division of Breast Imaging, Södersjukhuset, Stockholm, Sweden
| | - Ariel Saracco
- Department of Mammography, Evidia, Stockholm, Sweden
| | - Brigitte Wilczek
- Department of Medical Imaging, Division of Breast Imaging, Södersjukhuset, Stockholm, Sweden
| | - Ann Sundbom
- Department of Medical Imaging, Division of Breast Imaging, Södersjukhuset, Stockholm, Sweden
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paul W Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Marshall H, Burkard-Mandel L, Hsu J, Durieux J, Shikhman R, Plecha D. Abbreviated Breast MRI: Our Two-Year Initial Experience. JOURNAL OF BREAST IMAGING 2023; 5:318-328. [PMID: 38416894 DOI: 10.1093/jbi/wbad017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Indexed: 03/01/2024]
Abstract
OBJECTIVE The aim of this study was to retrospectively evaluate and present our two-year experience with abbreviated breast MRI at our academic institution as a screening tool to identify primary breast cancers. METHODS Employing eight specialty trained breast radiologists, studies were interpreted using the BI-RADS MRI lexicon in this IRB-approved retrospective study. The protocol utilized T1-weighted, fat-saturated, pre- and post-contrast, short T1 inversion recovery images, and was completed within 10 minutes. Abbreviated breast MRI was offered to asymptomatic women of all breast densities, whose ages ranged from 24 to 90 years. Statistical analysis was performed for comparative data utilizing estimated odds ratios. RESULTS Of 1338 patients that met inclusion criteria, 83% (1111/1338) were BI-RADS 1 or 2, 9.0% (121/1338) were BI-RADS 3, and 8% (106/1338) were categorized as either BI-RADS 4 or 5 with recommended biopsy. Biopsy of BI-RADS 4 and 5 categorized patients yielded 15 cancers for a positive predictive value (PPV) 2 of 14.2% and a PPV3 of 18.5%, with 76% (81/106) of patients undergoing the recommended biopsy. An additional cancer was detected in a BI-RADS 3 finding. All cancers detected were in women with heterogeneously dense or extremely dense breasts. Therefore, 16 cancers were detected, yielding a cancer detection rate of 12.0 per 1000. Over the next 12 to 24 months, no interval cancers were detected. CONCLUSION Abbreviated breast MRI demonstrates a higher cancer detection rate compared with mammography only and may provide a supplemental screening method to detect breast cancers in patients with varying risk factors.
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Affiliation(s)
- Holly Marshall
- University Hospitals Cleveland Medical Center, Department of Radiology, Cleveland, OH, USA
| | - Lauren Burkard-Mandel
- University Hospitals Cleveland Medical Center, Department of Radiology, Cleveland, OH, USA
| | - Jerry Hsu
- University Hospitals Cleveland Medical Center, Department of Radiology, Cleveland, OH, USA
| | - Jared Durieux
- University Hospitals Cleveland Medical Center, Department of Radiology, Cleveland, OH, USA
| | | | - Donna Plecha
- University Hospitals Cleveland Medical Center, Department of Radiology, Cleveland, OH, USA
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Shahraki Z, Ghaffari M, Nakhaie Moghadam M, Parooie F, Salarzaei M. Preoperative evaluation of breast cancer: Contrast-enhanced mammography versus contrast-enhanced magnetic resonance imaging: A systematic review and meta-analysis. Breast Dis 2022; 41:303-315. [PMID: 35754256 DOI: 10.3233/bd-210034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Breast cancer is the most common cancer in women worldwide. It is responsible for about 23% of cancer in females in both developed and developing countries. This study aimed to compare the diagnostic performance of contrast-enhanced mammography (CEM) and contrast-enhanced magnetic resonance imaging (CEMRI) in preoperative evaluations of breast lesions. METHODS We searched for published literature in the English language in MEDLINE via PubMed and EMBASETM via Ovid, The Cochrane Library, and Trip database. For literature published in other languages, we searched national databases (Magiran and SID), KoreaMed, and LILACS. Metadisc1.4 software was used for statistical analysisRESULTS:A total of 1225 patients were included. The pooled sensitivity of CEM and CEMRI was 0.946 (95% CI, 0.931-0.958) and 0.935 (95% CI, 0.920-0.949), respectively. The pooled specificity of CEM and CEMRI was 0.783 (95% CI, 0.758-0.807) and 0.715 (95% CI, 0.688-0.741), respectively. The sensitivity of CEM was the most in the United States (97%) and the specificity of CEM was the most in Brazil (88%). MRI sensitivity was the most in USA and Egypt (99%) and China had the most MRI specificity (81%) in diagnosis of breast lesions. CONCLUSION Contrast-enhanced mammography, a combination of high energy image and low energy image, can well display breast lesions and has the diagnostic efficacy equivalent to MRI. Importantly, CEM imaging shows higher specificity, positive predictive value, and diagnostic conformance rate than MRI. Despite some drawbacks such as higher irradiation and iodine usage, CEM has such advantages as convenient and fast examination, strong applicability, and low costs; thus, it can be popularized as a useful tool in breast disease.
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Affiliation(s)
- Zahra Shahraki
- Department of Obstetrics and Gynecology, Zabol University of Medical Science, Zabol, Iran
| | - Mehrangiz Ghaffari
- Department of Pathology, Zabol University of Medical Science, Zabol, Iran
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Naranjo ID, Sogani J, Saccarelli C, Horvat JV, Sevilimedu V, Hughes MC, Gullo RL, Jochelson MS, Reiner J, Pinker K. MRI Screening of BRCA Mutation Carriers: Comparison of Standard Protocol and Abbreviated Protocols With and Without T2-Weighted Images. AJR Am J Roentgenol 2022; 218:810-820. [PMID: 34935399 PMCID: PMC9422039 DOI: 10.2214/ajr.21.27022] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND. Increasing evidence supports the role of abbreviated MRI protocols for breast cancer detection. However, abbreviated protocols have been poorly studied in patients who are BRCA1 or BRCA2 mutation carriers. Furthermore, the need for T2-weighted sequences in abbreviated protocols remains controversial. OBJECTIVE. The purpose of this study was to compare, in the evaluation of patients with BRCA mutations, the diagnostic performance of a standard full breast MRI protocol with the performance of abbreviated protocols that included and did not include a T2-weighted sequence. METHODS. This retrospective study included 292 patients (mean age, 47.9 years) who were BRCA1 or BRCA2 mutation carriers who underwent 427 screening breast MRI examinations according to a standard full protocol who could be classified as having benign (n = 407) or malignant (n = 20) findings based on histopathology or imaging follow-up. Four readers independently assessed examinations in three separate sessions (theoretic abbreviated protocol, which included the first postcontrast acquisition; theoretic abbreviated protocol with addition of a T2-weighted sequence; and the standard full protocol) and assigned BI-RADS categories. Categories 3-5 were considered to represent positive examinations. Interreader agreement was assessed, and diagnostic performance was compared by use of pooled reader data. RESULTS. Interreader agreement on BI-RADS category, expressed as kappa values, was 0.55 for the standard, 0.45 for the abbreviated, and 0.57 for the abbreviated plus T2-weighted protocols. Pooled sensitivity was 94% for the standard, 92% for the abbreviated, and 90% for the abbreviated plus T2-weighted protocols (all p > .001). Pooled specificity was 80% for the standard, 71% for the abbreviated, and 83% for the abbreviated plus T2-weighted protocols (p < .001 for abbreviated plus T2-weighted compared with both standard and abbreviated). Pooled PPV was 19% for the standard, 14% for the abbreviated, and 20% for the abbreviated plus T2-weighted protocols (p < .001 for abbreviated compared with both standard and abbreviated). Pooled NPV was 100% for the standard, 99% for the abbreviated, and 99% for the abbreviated plus T2-weighted (all p > .001) protocols. Pooled accuracy was 80% for the standard, 73% for the abbreviated, and 83% for the abbreviated plus T2-weighted protocols (p < .001 for abbreviated compared with both standard and abbreviated plus T2-weighted). CONCLUSION. The abbreviated protocol without T2-weighted imaging had suboptimal performance. However, addition of the T2-weighted sequence yielded comparable sensitivity and accuracy and a small increase in specificity compared with the full protocol. CLINICAL IMPACT. The findings support implementation of abbreviated MRI with T2-weighted imaging for breast cancer screening of patients with BRCA mutations.
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Affiliation(s)
- Isaac Daimiel Naranjo
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th St, New York, NY 10065
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Julie Sogani
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th St, New York, NY 10065
| | - Carolina Saccarelli
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th St, New York, NY 10065
| | - Joao V Horvat
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th St, New York, NY 10065
| | - Varadan Sevilimedu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mary C Hughes
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th St, New York, NY 10065
| | - Roberto Lo Gullo
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th St, New York, NY 10065
| | - Maxine S Jochelson
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th St, New York, NY 10065
| | - Jeffrey Reiner
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th St, New York, NY 10065
| | - Katja Pinker
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th St, New York, NY 10065
- Department of Biomedical Imaging and Image-Guided Therapy, Molecular and Structural Preclinical Imaging, Medical University Vienna, Vienna, Austria
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Al Ewaidat H, Ayasrah M. A Concise Review on the Utilization of Abbreviated Protocol Breast MRI over Full Diagnostic Protocol in Breast Cancer Detection. Int J Biomed Imaging 2022; 2022:8705531. [PMID: 35528224 PMCID: PMC9071885 DOI: 10.1155/2022/8705531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 04/12/2022] [Indexed: 11/21/2022] Open
Abstract
Breast MRI possesses high sensitivity for detecting breast cancer among the current clinical modalities and is an indispensable imaging practice. Breast MRI comprises diffusion-weighted imaging, ultrafast, and T2 weighted and T1 weighted CE (contrast-enhanced) imaging that may be utilized for improving the characterization of the lesions. This multimodal evaluation of breast lesions enables outstanding discrimination between the malignant and benign and malignant lesions. The expanding indications of breast MRI confirm the far superiority of MRI in preoperative staging, especially in the estimation of tumour size and identifying tumour foci in the contralateral and ipsilateral breast. Recent studies depicted that experts can meritoriously utilize this tool for improving breast cancer surgery despite their existence of no significant long term outcomes. For managing the, directly and indirectly, associated screening cost, abbreviated protocols are found to be more beneficial. Further, in some of the patients who were treated with neoadjuvant chemotherapy, breast MRI is utilized for documenting response. It is therefore essential to realise that oncological screening must be easily available, cost-effective, and time-consuming. Earlier detection of this short sequence protocol leads to prior and early breast cancer disease in high risky female populations like women with dense breasts, prehistoric evidence, etc. This proper utilization of AP reduces unnecessary mastectomies. Hence, this review focused on the explorative information for strongly suggesting the benefits of AP breast MRI compared to full diagnostic protocol MRI.
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Affiliation(s)
- Haytham Al Ewaidat
- Department of Allied Medical Sciences-Radiologic Technology, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Jordan
| | - Mohammad Ayasrah
- Jordan University of Science and Technology, Department of Allied Medical Sciences-Radiologic Technology, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Jordan
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Bougias H, Stogiannos N. Breast MRI: Where are we currently standing? J Med Imaging Radiat Sci 2022; 53:203-211. [DOI: 10.1016/j.jmir.2022.03.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/22/2022] [Accepted: 03/31/2022] [Indexed: 01/07/2023]
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Moraes MO, Forte GC, Guimarães ADSG, Grando MBFDP, Junior SA, Kepler C, Hochhegger B. Breast MRI: Simplifying protocol and BI-RADS categories. Clin Breast Cancer 2022; 22:e615-e622. [DOI: 10.1016/j.clbc.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/21/2022] [Indexed: 11/28/2022]
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Liu Z, Liang K, Zhang L, Lai C, Li R, Yi L, Li R, Zhang L, Long W. Small lesion classification on abbreviated breast MRI: training can improve diagnostic performance and inter-reader agreement. Eur Radiol 2022; 32:5742-5751. [PMID: 35212772 DOI: 10.1007/s00330-022-08622-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/25/2021] [Accepted: 01/29/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine whether the diagnostic performance and inter-reader agreement for small lesion classification on abbreviated breast MRI (AB-MRI) can be improved by training, and can achieve the level of full diagnostic protocol MRI (FDP-MRI). METHODS This retrospective study enrolled 1165 breast lesions (≤ 2 cm; 409 malignant and 756 benign) from 1165 MRI examinations for reading test. Twelve radiologists were assigned into a trained group and a non-trained group. They interpreted each AB-MRI twice, which was extracted from FDP-MRI. After the first read, the trained group received a structured training for AB-MRI interpretation while the non-trained group did not. FDP-MRIs were interpreted by the trained group after the second read. BI-RADS category for each lesion was compared to the standard of reference (histopathological examination or follow-up) to calculate diagnostic accuracy. Inter-reader agreement was assessed using multirater k analysis. Diagnostic accuracy and inter-reader agreement were compared between the trained and non-trained groups, between the first and second reads, and between AB-MRI and FDP-MRI. RESULTS After training, the diagnostic accuracy of AB-MRI increased from 77.6 to 84.4%, and inter-reader agreement improved from 0.410 to 0.579 (both p < 0.001), which were higher than those of the non-trained group (accuracy, 84.4% vs 78.0%; weighted k, 0.579 vs 0.461; both p < 0.001). The post-training accuracy and inter-reader agreement of AB-MRI were lower than those of FDP-MRI (accuracy, 84.4% vs 92.8%; weighted k, 0.579 vs 0.602; both p < 0.001). CONCLUSIONS Training can improve the diagnostic performance and inter-reader agreement for small lesion classification on AB-MRI; however, it remains inferior to those of FDP-MRI. KEY POINTS • Training can improve the diagnostic performance for small breast lesions on AB-MRI. • Training can reduce inter-observer variation for breast lesion classification on AB-MRI, especially among junior radiologists. • The post-training diagnostic performance and inter-reader agreement of AB-MRI remained inferior to those of FDP-MRI.
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Affiliation(s)
- Zhuangsheng Liu
- Department of Medical Imaging Center, The First Affiliated Hospital, Jinan University, 601 West Huangpu Street, Tianhe District, Guangzhou, 510630, Guangdong, China.,Department of Radiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen, 529000, China
| | - Keming Liang
- Department of Radiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen, 529000, China
| | - Ling Zhang
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Chan Lai
- Department of Radiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen, 529000, China
| | - Ruqiong Li
- Department of Radiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen, 529000, China
| | - Lilei Yi
- Department of Radiology, Foshan Hospital of Traditional Chinese Medicine, Foshan, 528000, China
| | - Ronggang Li
- Department of Pathology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen, 529000, China
| | - Ling Zhang
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou, 510060, China.
| | - Wansheng Long
- Department of Medical Imaging Center, The First Affiliated Hospital, Jinan University, 601 West Huangpu Street, Tianhe District, Guangzhou, 510630, Guangdong, China. .,Department of Radiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen, 529000, China.
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Verburg E, van Gils CH, van der Velden BHM, Bakker MF, Pijnappel RM, Veldhuis WB, Gilhuijs KGA. Deep Learning for Automated Triaging of 4581 Breast MRI Examinations from the DENSE Trial. Radiology 2021; 302:29-36. [PMID: 34609196 DOI: 10.1148/radiol.2021203960] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Supplemental screening with MRI has proved beneficial in women with extremely dense breasts. Most MRI examinations show normal anatomic and physiologic variation that may not require radiologic review. Thus, ways to triage these normal MRI examinations to reduce radiologist workload are needed. Purpose To determine the feasibility of an automated triaging method using deep learning (DL) to dismiss the highest number of MRI examinations without lesions while still identifying malignant disease. Materials and Methods This secondary analysis of data from the Dense Tissue and Early Breast Neoplasm Screening, or DENSE, trial evaluated breast MRI examinations from the first screening round performed in eight hospitals between December 2011 and January 2016. A DL model was developed to differentiate between breasts with lesions and breasts without lesions. The model was trained to dismiss breasts with normal phenotypical variation and to triage lesions (Breast Imaging Reporting and Data System [BI-RADS] categories 2-5) using eightfold internal-external validation. The model was trained on data from seven hospitals and tested on data from the eighth hospital, alternating such that each hospital was used once as an external test set. Performance was assessed using receiver operating characteristic analysis. At 100% sensitivity for malignant disease, the fraction of examinations dismissed from radiologic review was estimated. Results A total of 4581 MRI examinations of extremely dense breasts from 4581women (mean age, 54.3 years; interquartile range, 51.5-59.8 years) were included. Of the 9162 breasts, 838 had at least one lesion (BI-RADS category 2-5, of which 77 were malignant) and 8324 had no lesions. At 100% sensitivity for malignant lesions, the DL model considered 90.7% (95% CI: 86.7, 94.7) of the MRI examinations with lesions to be nonnormal and triaged them to radiologic review. The DL model dismissed 39.7% (95% CI: 30.0, 49.4) of the MRI examinations without lesions. The DL model had an average area under the receiver operating characteristic curve of 0.83 (95% CI: 0.80, 0.85) in the differentiation between normal breast MRI examinations and MRI examinations with lesions. Conclusion Automated analysis of breast MRI examinations in women with dense breasts dismissed nearly 40% of MRI scans without lesions while not missing any cancers. ClinicalTrials.gov: NCT01315015 © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Joe in this issue.
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Affiliation(s)
- Erik Verburg
- From the Image Sciences Institute (E.V., B.H.M.v.d.V., K.G.A.G.), Julius Center for Health Sciences and Primary Care (C.H.v.G., M.F.B.), and Department of Radiology (R.M.P., W.B.V.), University Medical Center Utrecht, Utrecht University, Utrecht 3584 CX, the Netherlands
| | - Carla H van Gils
- From the Image Sciences Institute (E.V., B.H.M.v.d.V., K.G.A.G.), Julius Center for Health Sciences and Primary Care (C.H.v.G., M.F.B.), and Department of Radiology (R.M.P., W.B.V.), University Medical Center Utrecht, Utrecht University, Utrecht 3584 CX, the Netherlands
| | - Bas H M van der Velden
- From the Image Sciences Institute (E.V., B.H.M.v.d.V., K.G.A.G.), Julius Center for Health Sciences and Primary Care (C.H.v.G., M.F.B.), and Department of Radiology (R.M.P., W.B.V.), University Medical Center Utrecht, Utrecht University, Utrecht 3584 CX, the Netherlands
| | - Marije F Bakker
- From the Image Sciences Institute (E.V., B.H.M.v.d.V., K.G.A.G.), Julius Center for Health Sciences and Primary Care (C.H.v.G., M.F.B.), and Department of Radiology (R.M.P., W.B.V.), University Medical Center Utrecht, Utrecht University, Utrecht 3584 CX, the Netherlands
| | - Ruud M Pijnappel
- From the Image Sciences Institute (E.V., B.H.M.v.d.V., K.G.A.G.), Julius Center for Health Sciences and Primary Care (C.H.v.G., M.F.B.), and Department of Radiology (R.M.P., W.B.V.), University Medical Center Utrecht, Utrecht University, Utrecht 3584 CX, the Netherlands
| | - Wouter B Veldhuis
- From the Image Sciences Institute (E.V., B.H.M.v.d.V., K.G.A.G.), Julius Center for Health Sciences and Primary Care (C.H.v.G., M.F.B.), and Department of Radiology (R.M.P., W.B.V.), University Medical Center Utrecht, Utrecht University, Utrecht 3584 CX, the Netherlands
| | - Kenneth G A Gilhuijs
- From the Image Sciences Institute (E.V., B.H.M.v.d.V., K.G.A.G.), Julius Center for Health Sciences and Primary Care (C.H.v.G., M.F.B.), and Department of Radiology (R.M.P., W.B.V.), University Medical Center Utrecht, Utrecht University, Utrecht 3584 CX, the Netherlands
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12
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Wahab RA, Albasha H, Martin J, Lee SJ, Zhang B, Brown AL, Vijapura C, Lewis K, Sobel LD, Mahoney MC. Characterization of common breast MRI abnormalities: comparison between abbreviated and full MRI protocols. Clin Imaging 2021; 79:125-132. [PMID: 33940489 DOI: 10.1016/j.clinimag.2021.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 04/06/2021] [Accepted: 04/25/2021] [Indexed: 01/21/2023]
Abstract
RATIONALE AND OBJECTIVES To evaluate the diagnostic performance of abbreviated MRI (AB-MRI) in comparison to a full protocol MRI (FP-MRI) when evaluating common MRI abnormalities of a mass, non-mass enhancement and focus. MATERIALS AND METHODS This retrospective reader study was Institutional Review Board approved and Health Insurance Portability and Accountability Act (HIPAA) compliant. AB-MRIs were reviewed from May 2018-December 2019 to identify women with an abnormal AB-MRI, FP-MRI within six months of the AB-MRI and an elevated risk for breast cancer. Six breast radiologists initially interpreted and recorded findings from the AB-MRI. Immediately after reviewing the AB-MRI, the same radiologists interpreted and recorded findings from the FP-MRI. Findings were recorded in an electronic data collection form. Cohen's Kappa test was used to calculate agreement. P < 0.05 was considered statistically significant. RESULTS Of 119 patients who had an AB-MRI, our final study comprised of 32 patients who had 64 breast MRIs (32 AB-MRI and 32 FP-MRI). The amount of fibroglandular tissue for AB-MRI and FP-MRI showed excellent intra-reader agreement [Kappa: 0.89-1.00 (P < 0.0001)]. Substantial to excellent intra-reader agreement [Kappa: 0.74-0.93 (P < 0.0001)] was demonstrated for all 6 readers when identifying abnormalities seen on AB-MRI and FP-MRI. Moderate to excellent intra-reader agreement [Kappa: 0.41-0.87(P < 0.0001)] was demonstrated between the AB-MRI and FP-MRI for the final BI-RADS assessment. CONCLUSION AB-MRI has acceptable intra-reader agreement with FP-MRI when characterizing common MRI abnormalities such as a mass, non-mass enhancement and focus suggesting that subsequent FP-MRI may not be needed.
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Affiliation(s)
- Rifat A Wahab
- Department of Radiology, University of Cincinnati Medical Center, 234 Goodman Street ML 0772, Cincinnati, OH 45219-0772, United States of America.
| | - Heba Albasha
- Department of Radiology, University of Cincinnati Medical Center, 234 Goodman Street ML 0772, Cincinnati, OH 45219-0772, United States of America.
| | - Jessica Martin
- One Kenwood Place, 9825 Kenwood Road, Suite 105, Cincinnati, OH 45242, United States of America.
| | - Su-Ju Lee
- Department of Radiology, University of Cincinnati Medical Center, 234 Goodman Street ML 0772, Cincinnati, OH 45219-0772, United States of America.
| | - Bin Zhang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, United States of America.
| | - Ann L Brown
- Department of Radiology, University of Cincinnati Medical Center, 234 Goodman Street ML 0772, Cincinnati, OH 45219-0772, United States of America.
| | - Charmi Vijapura
- Department of Radiology, University of Cincinnati Medical Center, 234 Goodman Street ML 0772, Cincinnati, OH 45219-0772, United States of America.
| | - Kyle Lewis
- Department of Radiology, University of Cincinnati Medical Center, 234 Goodman Street ML 0772, Cincinnati, OH 45219-0772, United States of America.
| | - Lawrence D Sobel
- Department of Radiology, University of Cincinnati Medical Center, 234 Goodman Street ML 0772, Cincinnati, OH 45219-0772, United States of America.
| | - Mary C Mahoney
- Department of Radiology, University of Cincinnati Medical Center, 234 Goodman Street ML 0772, Cincinnati, OH 45219-0772, United States of America.
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13
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Baxter GC, Selamoglu A, Mackay JW, Bond S, Gray E, Gilbert FJ. A meta-analysis comparing the diagnostic performance of abbreviated MRI and a full diagnostic protocol in breast cancer. Clin Radiol 2021; 76:154.e23-154.e32. [PMID: 33032820 DOI: 10.1016/j.crad.2020.08.036] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 08/07/2020] [Indexed: 12/18/2022]
Abstract
AIM To undertake a meta-analysis of the diagnostic performance of abbreviated (ABB) magnetic resonance imaging (MRI) and full diagnostic protocol MRI (FDP-MRI) in breast cancer. MATERIALS AND METHODS This meta-analysis was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Diagnostic Test Accuracy (PRISMA-DTA) guidelines. The PubMed and EMBASE databases were searched through August 2019 for studies comparing the diagnostic performance of ABB-MRI and FDP-MRI in the breast. Studies were reviewed by two authors independently according to eligibility and exclusion criteria and split into two subgroups (screening population studies and studies using cohorts enriched with known cancers) to avoid bias. Quality assessment and bias for diagnostic accuracy was determined with Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). The diagnostic accuracy for each subgroup was pooled using a bivariate random effects model and summary receiver operating characteristic (sROC) curves produced. Sensitivities and specificities were compared using a paired t-test. RESULTS Five screening (62/2,588 cancers/patients) and eight enriched cohort (540/1,432 cancers/patients) studies were included in the meta-analysis. QUADAS-2 assessment showed a low risk of bias in most studies. The pooled sensitivity/specificity/area under the receiver operating characteristic curve (AUC) for screening studies was 0.90/0.92/0.94 for ABB-MRI and 0.92/0.95/0.97 for FDP-MRI. The pooled sensitivity/specificity/AUC for enriched cohort studies was 0.93/0.83/0.94 for ABB-MRI and 0.93/0.84/0.95 for FDP-MRI. There was no significant difference in sensitivity or specificity using ABB-MRI or FDP-MRI (p=0.18 and 0.27, p=0.18 and 0.93, respectively). CONCLUSION The diagnostic performances of the ABB-MRI and FDP-MRI protocols used in either screening or enriched cohorts were comparable. There was a large variation in patient population, study methodology, and abbreviated protocols reported.
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Affiliation(s)
- G C Baxter
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - A Selamoglu
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - J W Mackay
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - S Bond
- National Institute for Health Research, Cambridge Clinical Trials Unit, Cambridge, UK
| | - E Gray
- University of Edinburgh, Edinburgh, UK
| | - F J Gilbert
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK; National Institute for Health Research, Cambridge Clinical Trials Unit, Cambridge, UK.
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14
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Abstract
Breast MR imaging is the most sensitive imaging method for the detection of breast cancer and detects more aggressive malignancies than mammography and ultrasound examination. Despite these advantages, breast MR imaging has low use rates for breast cancer screening. Abbreviated breast MR imaging, in which a limited number of breast imaging sequences are obtained, has been proposed as a way to solve cost and patient tolerance issues while preserving the high cancer detection rate of breast MR imaging. This review discusses abbreviated breast MR imaging, including protocols, multicenter clinical trial results, clinical workflow implementation challenges, and future directions.
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Affiliation(s)
- Laura Heacock
- Department of Radiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY 10016, USA.
| | - Alana A Lewin
- Department of Radiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY 10016, USA
| | - Hildegard K Toth
- Department of Radiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY 10016, USA
| | - Linda Moy
- Department of Radiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY 10016, USA
| | - Beatriu Reig
- Department of Radiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY 10016, USA
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15
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Hernández ML, Osorio S, Florez K, Ospino A, Díaz GM. Abbreviated magnetic resonance imaging in breast cancer: A systematic review of literature. Eur J Radiol Open 2020; 8:100307. [PMID: 33364260 PMCID: PMC7750142 DOI: 10.1016/j.ejro.2020.100307] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND : magnetic resonance imaging (MRI) has been increasingly used to study breast cancer for screening high-risk cases, pre-operative staging, and problem-solving because of its high sensitivity. However, its cost-effectiveness is still debated. Thus, the concept of abbreviated MRI (ABB-MRI) protocols was proposed as a possible solution for reducing MRI costs. PURPOSE : to investigate the role of the abbreviated MRI protocols in detecting and staging breast cancer. METHODS : a systematic search of the literature was carried out in the bibliographic databases: Scopus, PubMed, Medline, and Science Direct. RESULTS : forty-one articles were included, which described results of the assessment of fifty-three abbreviated protocols for screening, staging, recurrence assessing, and problem-solving or clarification. CONCLUSIONS : the use of ABB-MRI protocols allows reducing the acquisition and reading times, maintaining a high concordance with the final interpretation, in comparison to a complete protocol. However, larger prospective and multicentre trials are necessary to validate the performance in specific clinical environments.
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Affiliation(s)
- María Liliana Hernández
- Grupo de Investigación del Instituto de Alta Tecnología Médica (IATM), Ayudas Diagnósticas Sura, Medellín, Colombia
| | - Santiago Osorio
- Grupo de Investigación del Instituto de Alta Tecnología Médica (IATM), Ayudas Diagnósticas Sura, Medellín, Colombia
- Especialización en Radiología, Universidad CES, Medellín, Colombia
| | - Katherine Florez
- Grupo de Investigación del Instituto de Alta Tecnología Médica (IATM), Ayudas Diagnósticas Sura, Medellín, Colombia
- Especialización en Radiología, Universidad CES, Medellín, Colombia
| | - Alejandra Ospino
- Grupo de Investigación del Instituto de Alta Tecnología Médica (IATM), Ayudas Diagnósticas Sura, Medellín, Colombia
| | - Gloria M. Díaz
- MIRP Lab–Parque i, Instituto Tecnológico Metropolitano (ITM), Medellín, Colombia
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16
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Kim ES, Cho N, Kim SY, Kwon BR, Yi A, Ha SM, Lee SH, Chang JM, Moon WK. Comparison of Abbreviated MRI and Full Diagnostic MRI in Distinguishing between Benign and Malignant Lesions Detected by Breast MRI: A Multireader Study. Korean J Radiol 2020; 22:297-307. [PMID: 33289355 PMCID: PMC7909852 DOI: 10.3348/kjr.2020.0311] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 09/11/2020] [Accepted: 09/14/2020] [Indexed: 12/16/2022] Open
Abstract
Objective To compare the performance of simulated abbreviated breast MRI (AB-MRI) and full diagnostic (FD)-MRI in distinguishing between benign and malignant lesions detected by MRI and investigate the features of discrepant lesions of the two protocols. Materials and Methods An AB-MRI set with single first postcontrast images was retrospectively obtained from an FD-MRI cohort of 111 lesions (34 malignant, 77 benign) detected by contralateral breast MRI in 111 women (mean age, 49.8. ± 9.8; range, 28–75 years) with recently diagnosed breast cancer. Five blinded readers independently classified the likelihood of malignancy using Breast Imaging Reporting and Data System assessments. McNemar tests and area under the receiver operating characteristic curve (AUC) analyses were performed. The imaging and pathologic features of the discrepant lesions of the two protocols were analyzed. Results The sensitivity of AB-MRI for lesion characterization tended to be lower than that of FD-MRI for all readers (58.8–82.4% vs. 79.4–100%), although the findings of only two readers were significantly different (p < 0.05). The specificity of AB-MRI for lesion characterization was higher than that of FD-MRI for 80% of readers (39.0–74.0% vs. 19.5–45.5%, p ≤ 0.001). The AUC of AB-MRI was comparable to that of FD-MRI for all readers (p > 0.05). Fifteen percent (5/34) of the cancers were false-negatives on AB-MRI. More suspicious margins or internal enhancement on the delayed phase images were related to the discrepancies. Conclusion The overall performance of AB-MRI was similar to that of FD-MRI in distinguishing between benign and malignant lesions. AB-MRI showed lower sensitivity and higher specificity than FD-MRI, as 15% of the cancers were misclassified compared to FD-MRI.
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Affiliation(s)
- Eun Sil Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Nariya Cho
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.
| | - Soo Yeon Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Bo Ra Kwon
- Department of Radiology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Ann Yi
- Department of Radiology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Su Min Ha
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Su Hyun Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Jung Min Chang
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Woo Kyung Moon
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
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17
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Fujioka T, Yashima Y, Oyama J, Mori M, Kubota K, Katsuta L, Kimura K, Yamaga E, Oda G, Nakagawa T, Kitazume Y, Tateishi U. Deep-learning approach with convolutional neural network for classification of maximum intensity projections of dynamic contrast-enhanced breast magnetic resonance imaging. Magn Reson Imaging 2020; 75:1-8. [PMID: 33045323 DOI: 10.1016/j.mri.2020.10.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 08/27/2020] [Accepted: 10/06/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE We aimed to evaluate deep learning approach with convolutional neural networks (CNNs) to discriminate between benign and malignant lesions on maximum intensity projections of dynamic contrast-enhanced breast magnetic resonance imaging (MRI). METHODS We retrospectively gathered maximum intensity projections of dynamic contrast-enhanced breast MRI of 106 benign (including 22 normal) and 180 malignant cases for training and validation data. CNN models were constructed to calculate the probability of malignancy using CNN architectures (DenseNet121, DenseNet169, InceptionResNetV2, InceptionV3, NasNetMobile, and Xception) with 500 epochs and analyzed that of 25 benign (including 12 normal) and 47 malignant cases for test data. Two human readers also interpreted these test data and scored the probability of malignancy for each case using Breast Imaging Reporting and Data System. Sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve (AUC) were calculated. RESULTS The CNN models showed a mean AUC of 0.830 (range, 0.750-0.895). The best model was InceptionResNetV2. This model, Reader 1, and Reader 2 had sensitivities of 74.5%, 72.3%, and 78.7%; specificities of 96.0%, 88.0%, and 80.0%; and AUCs of 0.895, 0.823, and 0.849, respectively. No significant difference arose between the CNN models and human readers (p > 0.125). CONCLUSION Our CNN models showed comparable diagnostic performance in differentiating between benign and malignant lesions to human readers on maximum intensity projection of dynamic contrast-enhanced breast MRI.
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Affiliation(s)
- Tomoyuki Fujioka
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuka Yashima
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Jun Oyama
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mio Mori
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Kazunori Kubota
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo, Japan; Department of Radiology, Dokkyo Medical University, Tochigi, Japan
| | - Leona Katsuta
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Koichiro Kimura
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Emi Yamaga
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Goshi Oda
- Department of Surgery, Breast Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tsuyoshi Nakagawa
- Department of Surgery, Breast Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshio Kitazume
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ukihide Tateishi
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo, Japan
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18
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Geach R, Jones LI, Harding SA, Marshall A, Taylor-Phillips S, McKeown-Keegan S, Dunn JA. The potential utility of abbreviated breast MRI (FAST MRI) as a tool for breast cancer screening: a systematic review and meta-analysis. Clin Radiol 2020; 76:154.e11-154.e22. [PMID: 33010932 DOI: 10.1016/j.crad.2020.08.032] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/04/2020] [Indexed: 12/28/2022]
Abstract
AIM To synthesise evidence comparing abbreviated breast magnetic resonance imaging (abMRI) to full-protocol MRI (fpMRI) in breast cancer screening. MATERIALS AND METHODS A systematic search was undertaken in multiple databases. Cohort studies without enrichment, presenting accuracy data of abMRI in screening, for any level of risk (population, moderate, high risk) were included. Level of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Meta-analyses (bivariate random effects model) were performed for abMRI, with fpMRI and histology from fpMRI-positive cases as reference standard, and with follow-up to symptomatic detection added to the fpMRI. The review also covers evidence comparing abMRI with mammographic techniques. RESULTS The title and abstract review retrieved 23 articles. Five studies (six articles) were included (2,763 women, 3,251 screening rounds). GRADE assessment of the evidence was very low because the reference standard was interpreted with knowledge of the index test and biopsy was not obtained for all abMRI positives. The overall sensitivity for abMRI, with fpMRI (and histology for fpMRI positives) as reference standard, was 94.8% (95% confidence interval [CI] 85.5-98.2) and specificity as 94.6% (95% CI: 91.5-96.6). Three studies (1,450 women, 1,613 screening rounds) presented follow-up data, enabling comparison between abMRI and fpMRI. Sensitivities and specificities for abMRI did not differ significantly from those for fpMRI (p=0.83 and p=0.37, respectively). CONCLUSION A very low level of evidence suggests abMRI could be accurate for breast cancer screening. Research is required, with follow-up to interval cancer, to determine the effect its use could have on clinical outcome.
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Affiliation(s)
- R Geach
- North Bristol NHS Trust, Southmead Hospital, Southmead Road, Westbury on Trym, Bristol, BS10 5NB, UK
| | - L I Jones
- North Bristol NHS Trust, Southmead Hospital, Southmead Road, Westbury on Trym, Bristol, BS10 5NB, UK.
| | - S A Harding
- North Bristol NHS Trust, Southmead Hospital, Southmead Road, Westbury on Trym, Bristol, BS10 5NB, UK
| | - A Marshall
- Warwick Clinical Trials Unit, University of Warwick, Coventry, CV4 7AL, UK
| | - S Taylor-Phillips
- Warwick Clinical Trials Unit, University of Warwick, Coventry, CV4 7AL, UK
| | - S McKeown-Keegan
- North Bristol NHS Trust, Southmead Hospital, Southmead Road, Westbury on Trym, Bristol, BS10 5NB, UK
| | - J A Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry, CV4 7AL, UK
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19
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Weinstein SP, Korhonen K, Cirelli C, Schnall MD, McDonald ES, Pantel AR, Zuckerman S, Borthakur A, Conant EF. Abbreviated Breast Magnetic Resonance Imaging for Supplemental Screening of Women With Dense Breasts and Average Risk. J Clin Oncol 2020; 38:3874-3882. [PMID: 32931396 DOI: 10.1200/jco.19.02198] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Although mammography is the standard of care for breast cancer screening, dense breast tissue decreases mammographic sensitivity. We report the prevalent cancer detection rate (CDR) from the first clinical implementation of abbreviated breast magnetic resonance imaging (AB-MR) as a supplemental screening test in women with dense breasts. METHODS The study was approved by the institutional review board and is Health Insurance Portability and Accountability Act complaint. This retrospective review includes women who were imaged between January 1, 2016 and February 28, 2019. On a 1.5 Tesla magnet, the imaging protocol consisted of three sequences: Short-TI Inversion Recovery (STIR), precontrast, and postcontrast. A subtraction sequence and a maximum intensity projection were generated. We report the patient-level CDR and the positive predictive value of AB-MR examinations after negative/benign digital breast tomosynthesis (DBT). RESULTS Out of 511 prevalent rounds of AB-MR examinations, 36 women were excluded. The remaining 475 asymptomatic women with dense breasts had negative/benign DBT examinations before the AB-MR. There were 420 of 475 (88.4%) benign/negative examinations, 13 of 475 (2.7%) follow-up recommendations, and 42 biopsy recommendations. Thirty-nine biopsies were completed, resulting in 12/39 (30.8%) malignancies in 12 women: seven invasive carcinomas and five ductal carcinoma in situ. One additional patient was diagnosed with invasive ductal carcinoma at the time of 6-month follow-up. The CDR was 27.4 per 1,000 (13 of 475; 95% CI, 16.1 to 46.3). The size of invasive carcinomas ranged from 0.6-1.0 cm (mean, 0.5 cm). Of the seven women who underwent surgical evaluation of the axilla, zero of seven patients had positive nodes. There were no interval cancers at 1-year follow-up. CONCLUSION Preliminary results from clinical implementation of screening AB-MR resulted in a CDR of 27.4/1,000 at the patient level after DBT in women with dense breasts. Additional evaluation is warranted.
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Affiliation(s)
- Susan P Weinstein
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Katrina Korhonen
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Claire Cirelli
- Department of Computer Science, Arizona State University, Tempe, AZ
| | - Mitchell D Schnall
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Elizabeth S McDonald
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Austin R Pantel
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Samantha Zuckerman
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ari Borthakur
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Emily F Conant
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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20
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Scoggins ME, Arun BK, Candelaria RP, Dryden MJ, Wei W, Son JB, Ma J, Dogan BE. Should abbreviated breast MRI be compliant with American College of Radiology requirements for MRI accreditation? Magn Reson Imaging 2020; 72:87-94. [PMID: 32622851 DOI: 10.1016/j.mri.2020.06.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 06/01/2020] [Accepted: 06/24/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate non-inferiority and diagnostic performance of an American College of Radiology compliant abbreviated MRI protocol (AB-MRI) compared with standard-of-care breast MRI (SOC-BMRI) in patients with increased breast cancer risk. MATERIAL AND METHODS Women with increased lifetime breast cancer risk by American Cancer Society guidelines underwent breast MRI at a single institution between October 2015 and February 2018. AB-MRI was acquired at 3.0 T with T2-weighted extended fast spin echo triple-echo Dixon and pre- and post-contrast 3D dual-echo fast spoiled gradient echo two-point Dixon sequences with an 8-channel breast coil 1-7 days after SOC-BMRI. Three readers independently reviewed AB-MRI and assigned BI-RADS categories for maximum intensity projection images (AB1), dynamic contrast-enhanced (DCE) images (AB2), and DCE and non-contrast T2 and fat-only images (AB3). These scores were compared to those from SOC-BMRI. RESULTS Cancer yield was 14 per 1000 (women-years) in 73 women aged 26-75 years (mean 53.5 years). AB-MRI acquisition times (mean 9.63 min) and table times (mean 15.07 min) were significantly shorter than those of SOC-BMRI (means 19.46 and 36.3 min, respectively) (p < .001). Accuracy, sensitivity, specificity, and positive and negative predictive values were identical for AB3 and SOC-BMRI (93%, 100%, 93%, 16.7%, and 100%, respectively). AB-MRI with AB1 and AB2 had significantly lower specificity (AB1 = 73.6%, AB2 = 77.8%), positive predictive values (AB1 = 5%, AB2 = 5.9%), and accuracy (AB1 = 74%, AB2 = 78%) than those of SOC-BMRI (p = .002 for AB1, p = .01 for AB2). CONCLUSION AB-MRI was acquired significantly faster than SOC-BMRI and its diagnostic performance was non-inferior. Inclusion of T2 and fat-only images was necessary to achieve non-inferiority by multireader evaluation.
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Affiliation(s)
- Marion E Scoggins
- Department of Diagnostic Radiology, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, Texas 77030, United States of America.
| | - Banu K Arun
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1354, Houston, TX 77030-4009, United States of America.
| | - Rosalind P Candelaria
- Department of Diagnostic Radiology, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, Texas 77030, United States of America.
| | - Mark J Dryden
- Department of Diagnostic Radiology, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, Texas 77030, United States of America.
| | - Wei Wei
- Taussig Cancer Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, United States of America.
| | - Jong Bum Son
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1472, Houston, TX 77030-4009, United States of America.
| | - Jingfei Ma
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1472, Houston, TX 77030-4009, United States of America.
| | - Basak E Dogan
- Department of Diagnostic Radiology, UT Southwestern Medical Center, 2201 Inwood Rd, Dallas, TX 75390-8585, United States of America.
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21
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Heacock L, Reig B, Lewin AA, Toth HK, Moy L, Lee CS. Abbreviated Breast MRI: Road to Clinical Implementation. JOURNAL OF BREAST IMAGING 2020; 2:201-214. [PMID: 38424988 DOI: 10.1093/jbi/wbaa020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Indexed: 03/02/2024]
Abstract
Breast MRI offers high sensitivity for breast cancer detection, with preferential detection of high-grade invasive cancers when compared to mammography and ultrasound. Despite the clear benefits of breast MRI in cancer screening, its cost, patient tolerance, and low utilization remain key issues. Abbreviated breast MRI, in which only a select number of sequences and postcontrast imaging are acquired, exploits the high sensitivity of breast MRI while reducing table time and reading time to maximize availability, patient tolerance, and accessibility. Worldwide studies of varying patient populations have demonstrated that the comparable diagnostic accuracy of abbreviated breast MRI is comparable to a full diagnostic protocol, highlighting the emerging role of abbreviated MRI screening in patients with an intermediate and high lifetime risk of breast cancer. The purpose of this review is to summarize the background and current literature relating to abbreviated MRI, highlight various protocols utilized in current multicenter clinical trials, describe workflow and clinical implementation issues, and discuss the future of abbreviated protocols, including advanced MRI techniques.
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Affiliation(s)
- Laura Heacock
- New York University Langone Health, Department of Radiology, New York, NY
| | - Beatriu Reig
- New York University Langone Health, Department of Radiology, New York, NY
| | - Alana A Lewin
- New York University Langone Health, Department of Radiology, New York, NY
| | - Hildegard K Toth
- New York University Langone Health, Department of Radiology, New York, NY
| | - Linda Moy
- New York University Langone Health, Department of Radiology, New York, NY
- New York University Langone, Center for Advanced Imaging Innovation and Research (CAI2R), New York, NY
| | - Cindy S Lee
- New York University Langone Health, Department of Radiology, New York, NY
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22
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Detection and Diagnosis of Breast Cancer Using Artificial Intelligence Based assessment of Maximum Intensity Projection Dynamic Contrast-Enhanced Magnetic Resonance Images. Diagnostics (Basel) 2020; 10:diagnostics10050330. [PMID: 32443922 PMCID: PMC7277981 DOI: 10.3390/diagnostics10050330] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 12/24/2022] Open
Abstract
We aimed to evaluate an artificial intelligence (AI) system that can detect and diagnose lesions of maximum intensity projection (MIP) in dynamic contrast-enhanced (DCE) breast magnetic resonance imaging (MRI). We retrospectively gathered MIPs of DCE breast MRI for training and validation data from 30 and 7 normal individuals, 49 and 20 benign cases, and 135 and 45 malignant cases, respectively. Breast lesions were indicated with a bounding box and labeled as benign or malignant by a radiologist, while the AI system was trained to detect and calculate possibilities of malignancy using RetinaNet. The AI system was analyzed using test sets of 13 normal, 20 benign, and 52 malignant cases. Four human readers also scored these test data with and without the assistance of the AI system for the possibility of a malignancy in each breast. Sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were 0.926, 0.828, and 0.925 for the AI system; 0.847, 0.841, and 0.884 for human readers without AI; and 0.889, 0.823, and 0.899 for human readers with AI using a cutoff value of 2%, respectively. The AI system showed better diagnostic performance compared to the human readers (p = 0.002), and because of the increased performance of human readers with the assistance of the AI system, the AUC of human readers was significantly higher with than without the AI system (p = 0.039). Our AI system showed a high performance ability in detecting and diagnosing lesions in MIPs of DCE breast MRI and increased the diagnostic performance of human readers.
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Choudhery S, Chou SHS, Chang K, Kalpathy-Cramer J, Lehman CD. Kinetic Analysis of Lesions Identified on a Rapid Abridged Multiphase (RAMP) Breast MRI Protocol. Acad Radiol 2020; 27:672-681. [PMID: 31147233 PMCID: PMC6879810 DOI: 10.1016/j.acra.2019.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 04/26/2019] [Accepted: 05/02/2019] [Indexed: 11/16/2022]
Abstract
RATIONALE AND OBJECTIVES We implemented a rapid abridged multiphase (RAMP) breast magnetic resonance imaging (MRI) protocol to reduce scan time and increase workflow efficiency. In this study, we compared delayed-phase kinetic analyses of benign and malignant lesions on the RAMP protocol versus a full dynamic contrast-enhanced (DCE) MRI protocol. MATERIALS AND METHODS Consecutive breast MRI examinations obtained from October 2015 to August 2016 with tissue diagnoses of suspicious MRI lesions were identified. RAMP MRI included one precontrast and two postcontrast phases. Full DCE MRI included one precontrast and at least three postcontrast phases. Lesion kinetic analyses including mean delayed-phase volume percentage of washout, predominant curve type, and worst curve type were assessed. Kinetic analyses assessed on RAMP and DCE MRI protocols were compared using Wilcoxon rank-sum test and Chi-Square test. Receiver operating characteristic analysis was performed to discriminate benign and malignant lesions based on delayed-phase parameters. RESULTS The study included 177 consecutive breast lesions (50 benign, 127 malignant) in 162 women. RAMP MRI (23 benign, 61 malignant) and DCE MRI examinations (27 benign, 66 malignant) demonstrated 8.4% vs 9.3% washout (p = 0.36) for benign lesions and 18.5% vs 17% washout (p = 0.66) for malignancies, respectively. There was no difference in the predominant and worst curve types for malignant and benign lesions or in area under the receiver operating characteristic curves for delayed-phased parameters between the two protocols (p > 0.05). CONCLUSION Lesion kinetic analyses from the RAMP MRI protocol can achieve the same discriminatory ability as the full DCE protocol. By reducing scan time, the RAMP MRI protocol improves patient comfort and enhances workflow efficiency and can be easily implemented in any clinical setting.
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Affiliation(s)
- Sadia Choudhery
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Shinn-Huey S Chou
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, WAC 240, Boston, Massachusetts.
| | - Ken Chang
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jayashree Kalpathy-Cramer
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Constance D Lehman
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, WAC 240, Boston, Massachusetts
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Kwon MR, Ko EY, Han BK, Ko ES, Choi JS, Park KW. Diagnostic performance of abbreviated breast MRI for screening of women with previously treated breast cancer. Medicine (Baltimore) 2020; 99:e19676. [PMID: 32311941 PMCID: PMC7220756 DOI: 10.1097/md.0000000000019676] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
RATIONALE AND OBJECTIVES To evaluate the diagnostic performance of abbreviated screening breast magnetic resonance imaging (AB-MRI) for screening in women with previously treated breast cancer. MATERIALS AND METHODS This retrospective study included consecutive AB-MRI from September 2015 to December 2016 in patients with previously treated breast cancer. Longitudinal medical record of patients' demographics, outcomes of imaging surveillance and results of biopsy was reviewed. Protocol consisted of T2-weighted scanning and dynamic contrast-enhanced imaging including one pre-contrast and two post-contrast scans. A positive examination was defined as final assessment of BI-RADS 4 or 5 and negative was defined as BI-RADS 1, 2, or 3. Abnormal interpretation rate, cancer detection rate (CDR), sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were analyzed. RESULTS Among total 1043 AB-MRI, 29 (2.8%) AB-MRI had suspicious findings including 26 (2.5%) BI-RADS 4 and 3 (0.3%) BI-RADS 5 assessments. CDR was 9.59 per 1000. Performance outcomes were as follows: sensitivity, 71.4%; specificity, 98.2%; accuracy, 97.8%; PPV 1, 35.7%; PPV3 50%; and NPV 99.6%. Four cancers with false negative MRI were all early cancers of <1.0 cm with node negative. One was palpable interval cancer while the others were alternative screening modality-detected asymptomatic cancers before the next MRI screening. CONCLUSION AB-MRI showed high accuracy and NPV for detecting cancer recurrence in women with previously treated breast cancer. Missed cancers were all minimal cancers with node negative.
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Affiliation(s)
- Mi-ri Kwon
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Young Ko
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Boo-Kyung Han
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Eun Sook Ko
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Ji Soo Choi
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Ko Woon Park
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine
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25
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Pediconi F, Galati F. Breast cancer screening programs: does one risk fit all? Quant Imaging Med Surg 2020; 10:886-890. [PMID: 32355656 DOI: 10.21037/qims.2020.03.14] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Federica Pediconi
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Francesca Galati
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy
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26
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Lee-Felker S, Joines M, Storer L, Li B, DeBruhl N, Sayre J, Hoyt A. Abbreviated Breast MRI for Estimating Extent of Disease in Newly Diagnosed Breast Cancer. JOURNAL OF BREAST IMAGING 2020; 2:43-49. [PMID: 38424993 DOI: 10.1093/jbi/wbz071] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 10/01/2019] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To evaluate extent of disease estimation of abbreviated protocol (ap) magnetic resonance imaging (MRI) compared with full protocol (fp) MRI in newly diagnosed breast cancer. METHODS In this institutional review board-approved, Health Insurance Portability and Accountability Act-compliant, retrospective study of women with breast cancer who underwent pretreatment fpMRI on a 3 Tesla MRI in 2013, axial fat-saturated pre- and first postcontrast T1, maximum-intensity projection, and subtraction sequences were interpreted independently by three breast radiologists in two sessions, without and with prior imaging, respectively. Agreement was calculated using Cohen's kappa. Interpretations were compared with histology or clinical stability. Diagnostic performances were compared using Bennett's statistic. P < 0.05 was significant. RESULTS Eighty-one women (mean age 56 years, range 32-92 years), 116 lesions, and 95 cancers (mean size 27 mm, range 4-110 mm) were included. Agreement among radiologists for lesion assessment was excellent (0.83). apMRI cancer detection improved with prior imaging (mean sensitivity from 95% to 99%, specificity from 91% to 97%, positive predictive value [PPV] from 92% to 98%, and negative predictive value [NPV] from 95% to 99%) versus fpMRI (sensitivity 98% [93/95], specificity 94% [76/81], PPV 95% [93/98], and NPV 97% [76/78]). apMRI detected all multifocal, multicentric, and contralateral disease seen in 19% (15/81) of women to the same extent as fpMRI. apMRI axillary metastases detection improved with prior imaging (mean sensitivity from 78% to 86%, specificity from 90% to 92%, PPV from 76% to 82%, and NPV from 89% to 94%) versus fpMRI (sensitivity 71% [17/24], specificity 88% [51/58]), PPV 71% [17/24], and NPV 88% [51/58]). CONCLUSION apMRI may be acceptable for women with newly diagnosed cancer.
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Affiliation(s)
- Stephanie Lee-Felker
- David Geffen School of Medicine at the University of California, Los Angeles, Department of Radiological Sciences, Los Angeles, CA
| | - Melissa Joines
- David Geffen School of Medicine at the University of California, Los Angeles, Department of Radiological Sciences, Los Angeles, CA
| | - Lindsey Storer
- David Geffen School of Medicine at the University of California, Los Angeles, Department of Radiological Sciences, Los Angeles, CA
| | - Bo Li
- David Geffen School of Medicine at the University of California, Los Angeles, Department of Radiological Sciences, Los Angeles, CA
| | - Nanette DeBruhl
- David Geffen School of Medicine at the University of California, Los Angeles, Department of Radiological Sciences, Los Angeles, CA
| | - James Sayre
- University of California, Los Angeles, Fielding School of Public Health, Department of Biostatistics, Los Angeles, CA
| | - Anne Hoyt
- David Geffen School of Medicine at the University of California, Los Angeles, Department of Radiological Sciences, Los Angeles, CA
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27
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Park KW, Han SB, Han BK, Ko ES, Choi JS, Rhee SJ, Ko EY. MRI surveillance for women with a personal history of breast cancer: comparison between abbreviated and full diagnostic protocol. Br J Radiol 2020; 93:20190733. [PMID: 31868524 DOI: 10.1259/bjr.20190733] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To compare the diagnostic performance of breast MRI with abbreviated protocol (AB-MRI) and full ddiagnostic protocol (FDP-MRI) for surveillance of females with a personal history of breast cancer. METHODS In this retrospective study, we analyzed the outcomes of total 1312 post-operative screening breast MRI matched from 1045 AB-MRI and 677 FDP-MRI, which had histologic confirmation for suspicious MRI findings or 1 year negative follow-up images. This study was approved by the institutional review board and informed patient consent was waved. AB-MRI consists of T2 weighted scanning and dynamic contrast-enhanced imaging including one pre-contrast and two post-contrast scans. We compared the diagnostic performance for recurrent breast cancer in terms of sensitivity, specificity, positive-predictive value, negative-predictive value, and accuracy and area under the curve between the screening AB-MRI and FDP-MRI. RESULTS Overall, 13 recurrent tumors among 1312 post-operative cases screened with breast MRI (1.0%) were detected including 8 invasive cancer, 2 cases of in situ cancer, and 3 cases of metastatic lymph nodes. The sensitivity and negative predictive value were 70 vs 100 and 99.5% vs 100% in AB-MRI and FDP-MRI. Specificity, positive predictive value, accuracy, and area under the curve of AB-MRI and FDP-MRI were 98.0% vs 96.9%, 35.0% vs 23.1%, 97.6% vs 97.0%, and 0.840 vs 0.985, respectively. CONCLUSION The performance of AB-MRI was comparable to that of FDP-MRI in detecting recurrent breast cancer and decreased false positive cases. ADVANCES IN KNOWLEDGE AB-MRI provides a reliable alternative with similar diagnostic performance and shorter MRI acquisition time.
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Affiliation(s)
- Ko Woon Park
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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28
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Kuhl CK. Abbreviated Magnetic Resonance Imaging (MRI) for Breast Cancer Screening: Rationale, Concept, and Transfer to Clinical Practice. Annu Rev Med 2019; 70:501-519. [PMID: 30691370 DOI: 10.1146/annurev-med-121417-100403] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Given the increasing understanding of cancer as a heterogeneous group of diseases, detection methods should offer a sensitivity profile that ensures perfect sensitivity for biologically important cancers while screening out self-limiting pseudocancers. However, mammographic screening is biased toward detection of ductal carcinoma in situ and slowly growing cancers-and thus frequently fails to detect biologically aggressive cancers. This explains the persistently high rates of interval cancers and high rates of breast cancer mortality observed in spite of decades of mammographic screening. Magnetic resonance imaging (MRI), in contrast, has a sensitivity profile that matches clinical needs. Conventional MRI is not suitable for population-wide screening due to high cost, limited tolerability, and lack of availability. We introduced abbreviated MRI in 2014. Abbreviated MRI will change the way MRI is used in clinical medicine. This article describes the rationale to use MRI in general, and abbreviated MRI in particular, for breast cancer screening.
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Affiliation(s)
- Christiane K Kuhl
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University, 52074 Aachen, Germany;
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29
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Partovi S, Sin D, Lu Z, Sieck L, Marshall H, Pham R, Plecha D. Fast MRI breast cancer screening - Ready for prime time. Clin Imaging 2019; 60:160-168. [PMID: 31927171 DOI: 10.1016/j.clinimag.2019.10.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 10/14/2019] [Accepted: 10/29/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The manuscript discusses landmark studies using abbreviated MRI for breast cancer screening. This includes abbreviated dynamic contrast enhanced MRI and diffusion weighted imaging. Our institutional experience with abbreviated MR protocol for breast cancer screening is also described. CONCLUSION Abbreviated MRI protocols were found to demonstrate value for screening of breast cancer. It has been shown that abbreviated protocol MRI provides similar diagnostic sensitivities to full protocol MRI for breast cancer in women with increased lifetime risk. Our institutional abbreviated MRI protocol for breast cancer offers improved time and workflow efficiencies and has the potential to increase the number of breast cancers detected and the detection of pathologically relevant invasive breast cancer at earlier stages.
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Affiliation(s)
- Sasan Partovi
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, United States of America.
| | - David Sin
- School of Medicine, Case Western Reserve University, Cleveland, OH, United States of America
| | - Ziang Lu
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, United States of America
| | - Leah Sieck
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, United States of America
| | - Holly Marshall
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, United States of America
| | - Ramya Pham
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, United States of America
| | - Donna Plecha
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, United States of America
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30
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Implementing Abbreviated MRI Screening Into a Breast Imaging Practice. AJR Am J Roentgenol 2019; 213:234-237. [DOI: 10.2214/ajr.18.20396] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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31
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Oldrini G, Henrot P, Marchal F. Protocole d’IRM abrégée pour le diagnostic et le dépistage du cancer du sein. ONCOLOGIE 2019. [DOI: 10.3166/onco-2019-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Le cancer du sein est le premier cancer féminin en France, et sa détection précoce est indispensable. L’IRM mammaire est un élément de choix dans son diagnostic mais présente des coûts directs et indirects élevés, notamment du fait de sa durée qui ralentit son utilisation plus large. Compte tenu de ses éléments, l’utilisation d’un protocole abrégé se développe pour pallier ces inconvénients. Les premières données de la littérature tendent à penser que cet examen plus rapide permet également une durée d’interprétation plus courte. De plus, la sensibilité et la spécificité de l’examen ne sont pas inférieures à celles du protocole complet. Cet article explique ce nouveau concept et son intérêt, le compare au protocole complet et évoque les perspectives futures et notamment à l’adjonction de séquences à haute résolution temporelle.
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32
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Girometti R, Nitti A, Lorenzon M, Greco F, Londero V, Zuiani C. Comparison between an abbreviated and full MRI protocol for detecting additional disease when doing breast cancer staging. J Magn Reson Imaging 2018; 49:e222-e230. [DOI: 10.1002/jmri.26339] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 08/25/2018] [Accepted: 08/27/2018] [Indexed: 01/17/2023] Open
Affiliation(s)
- Rossano Girometti
- Institute of Radiology, Department of MedicineUniversity of Udine – “S. Maria della Misericordia” University Hospital Udine Italy
| | - Adriana Nitti
- Institute of Radiology, Department of MedicineUniversity of Udine – “S. Maria della Misericordia” University Hospital Udine Italy
| | - Michele Lorenzon
- Institute of Radiology, Department of MedicineUniversity of Udine – “S. Maria della Misericordia” University Hospital Udine Italy
| | - Franco Greco
- Institute of Radiology, Department of MedicineUniversity of Udine – “S. Maria della Misericordia” University Hospital Udine Italy
| | - Viviana Londero
- Institute of Radiology, Department of MedicineUniversity of Udine – “S. Maria della Misericordia” University Hospital Udine Italy
| | - Chiara Zuiani
- Institute of Radiology, Department of MedicineUniversity of Udine – “S. Maria della Misericordia” University Hospital Udine Italy
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Deike-Hofmann K, Koenig F, Paech D, Dreher C, Delorme S, Schlemmer HP, Bickelhaupt S. Abbreviated MRI Protocols in Breast Cancer Diagnostics. J Magn Reson Imaging 2018; 49:647-658. [PMID: 30328180 DOI: 10.1002/jmri.26525] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 09/11/2018] [Accepted: 09/12/2018] [Indexed: 12/12/2022] Open
Abstract
Oncologic imaging focused on the detection of breast cancer is of increasing importance, with over 1.7 million new cases detected each year worldwide. MRI of the breast has been described to be one of the most sensitive imaging modalities in breast cancer detection; however, clinical use is limited due to high costs. In the past, the objective and clinical routine of oncologic imaging was to provide one extended imaging protocol covering all potential needs and clinical implications regardless of the specific clinical indication or question. Future protocols might be more focused according to a "keep it short and simple" approach, with a reduction of patient magnet time and a limited number of images to review. Rather than replacing conventional full-diagnostic breast MRI protocols, these approaches aim at introducing a new thinking in oncologic imaging using a diversification of available imaging approaches targeted to the dedicated clinical needs of the individual patient. Here we review current approaches on using abbreviated protocols that aim to increase the clinical availability and use of breast MRI for improved early detection of breast cancer. Level of Evidence: 2 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019;49:647-658.
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Affiliation(s)
| | - Franziska Koenig
- German Cancer Research Center (dkfz), Department of Radiology, Heidelberg, Germany
| | - Daniel Paech
- German Cancer Research Center (dkfz), Department of Radiology, Heidelberg, Germany
| | - Constantin Dreher
- German Cancer Research Center (dkfz), Department of Radiology, Heidelberg, Germany
| | - Stefan Delorme
- German Cancer Research Center (dkfz), Department of Radiology, Heidelberg, Germany
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34
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Kuhl CK. Abbreviated breast MRI for screening women with dense breast: the EA1141 trial. Br J Radiol 2018; 91:20170441. [PMID: 28749202 PMCID: PMC6350487 DOI: 10.1259/bjr.20170441] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 07/13/2017] [Accepted: 07/19/2017] [Indexed: 11/22/2022] Open
Abstract
Early diagnosis improves survival of females with breast cancer. Mammographic screening improves early diagnosis of breast cancer. And yet, there appears to be room for improvement. Major shortcomings of mammographic screening are overdiagnosis of prognostically unimportant cancer, as well as underdiagnosis of cancers that are indeed relevant. Failure to detect biologically relevant breast cancer with mammographic screening is driven not only by host-related factors, i.e. breast tissue density, but also by tumour-related factors: Biologically relevant cancers may exhibit imaging features that render them indistinguishable from normal or benign breast tissue on mammography. These cancers will then progress to become the advanced-stage interval cancers observed in females undergoing mammographic screening. Since breast cancer continues to represent a major cause of cancer death in females, the search for improved breast cancer screening method continues. Abbreviated breast MRI has been proposed for this purpose because it will greatly reduce the cost associated with this method, due to a greatly reduced magnet time (down to 3 min), but especially also due to a greatly abridged image interpretation time, i.e. radiologist reading time. This commentary reviews the current situation and presents the EA1141 trial designed to investigate the utility of abbreviated breast MRI for screening average-risk females with dense breast tissue.
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Affiliation(s)
- Christiane K Kuhl
- Department of Diagnostic and Interventional Radiology, University of Aachen, RWTH, Aachen, Germany
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35
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Leithner D, Moy L, Morris EA, Marino MA, Helbich TH, Pinker K. Abbreviated MRI of the Breast: Does It Provide Value? J Magn Reson Imaging 2018; 49:e85-e100. [PMID: 30194749 PMCID: PMC6408315 DOI: 10.1002/jmri.26291] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/26/2018] [Accepted: 07/26/2018] [Indexed: 12/13/2022] Open
Abstract
MRI of the breast is the most sensitive test for breast cancer detection and outperforms conventional imaging with mammography, digital breast tomosynthesis, or ultrasound. However, the long scan time and relatively high costs limit its widespread use. Hence, it is currently only routinely implemented in the screening of women at an increased risk of breast cancer. To overcome these limitations, abbreviated dynamic contrast‐enhanced (DCE)‐MRI protocols have been introduced that substantially shorten image acquisition and interpretation time while maintaining a high diagnostic accuracy. Efforts to develop abbreviated MRI protocols reflect the increasing scrutiny of the disproportionate contribution of radiology to the rising overall healthcare expenditures. Healthcare policy makers are now focusing on curbing the use of advanced imaging examinations such as MRI while continuing to promote the quality and appropriateness of imaging. An important cornerstone of value‐based healthcare defines value as the patient's outcome over costs. Therefore, the concept of a fast, abbreviated MRI exam is very appealing, given its high diagnostic accuracy coupled with the possibility of a marked reduction in the cost of an MRI examination. Given recent concerns about gadolinium‐based contrast agents, unenhanced MRI techniques such as diffusion‐weighted imaging (DWI) are also being investigated for breast cancer diagnosis. Although further larger prospective studies, standardized imaging protocol, and reproducibility studies are necessary, initial results with abbreviated MRI protocols suggest that it seems feasible to offer screening breast DCE‐MRI to a broader population. This article aims to give an overview of abbreviated and fast breast MRI protocols, their utility for breast cancer detection, and their emerging role in the new value‐based healthcare paradigm that has replaced the fee‐for‐service model. Level of Evidence: 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:e85–e100.
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Affiliation(s)
- Doris Leithner
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Linda Moy
- Department of Radiology, Center for Biomedical Imaging, NYU School of Medicine, New York, New York, USA
| | - Elizabeth A Morris
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Maria A Marino
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Biomedical Sciences and Morphologic and Functional Imaging, University of Messina, Messina, Italy
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University Vienna, Vienna, Austria
| | - Katja Pinker
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University Vienna, Vienna, Austria
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36
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Heller SL, Heacock L, Moy L. Developments in Breast Imaging: Update on New and Evolving MR Imaging and Molecular Imaging Techniques. Magn Reson Imaging Clin N Am 2018; 26:247-258. [PMID: 29622129 DOI: 10.1016/j.mric.2017.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This article reviews new developments in breast imaging. There is growing interest in creating a shorter, less expensive MR protocol with broader applicability. There is an increasing focus on and consideration for the additive impact that functional analysis of breast pathology have on identifying and characterizing lesions. These developments apply to MR imaging and molecular imaging. This article reviews evolving breast imaging techniques with attention to strengths, weaknesses, and applications of these approaches. We aim to give the reader familiarity with the state of current developments in the field and to increase awareness of what to expect in breast imaging.
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Affiliation(s)
- Samantha Lynn Heller
- NYU School of Medicine, NYU Laura and Isaac Perlmutter Cancer Center, 3rd Floor, New York, NY 10016, USA
| | - Laura Heacock
- NYU School of Medicine, NYU Laura and Isaac Perlmutter Cancer Center, 3rd Floor, New York, NY 10016, USA
| | - Linda Moy
- NYU School of Medicine, NYU Laura and Isaac Perlmutter Cancer Center, 3rd Floor, New York, NY 10016, USA.
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37
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Gilbert FJ, Selamoglu A. Personalised screening: is this the way forward? Clin Radiol 2018; 73:327-333. [PMID: 29273223 DOI: 10.1016/j.crad.2017.11.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 11/20/2017] [Indexed: 11/30/2022]
Abstract
Screening with mammography has been implemented in many countries across the world with most offering 2-yearly examinations between the ages of 50-69 years. Robust modelling tools that include breast density and single nucleotide polymorphisms (SNPs) have been developed to predict which women are most likely to develop breast cancer. Mammographic sensitivity is poor in women with the densest category of breast tissue, and even women with heterogeneously dense tissue may benefit from additional supplemental imaging. Digital breast tomosynthesis (DBT), automated breast ultrasound (ABUS), contrast-enhanced mammography (CESM) or abbreviated (ABB) magnetic resonance imaging (MRI) all offer the opportunity to increase cancer detection, especially in women with dense breasts at increased risk of cancer. DBT increases cancer detection by around 15% with a corresponding reduction in recall rates; ABUS has been shown to increase cancer detection by between 2-4/1,000 depending on the cohort being examined and results in increased recalls, which tend to fall in subsequent screening rounds; CESM has very high sensitivity almost matching MRI with slightly improved specificity; ABB-MRI has been shown to be virtually equivalent to standard protocol MRI examinations, making this a technique that could be considered as a screening tool in high-risk women. This article reviews the literature to establish the current status of these techniques. The cost-effectiveness of these techniques requires further investigation and screening trials should report the nature of any additional tumours that are found.
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Affiliation(s)
- F J Gilbert
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Box 218, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK.
| | - A Selamoglu
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Box 218, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
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38
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Comparison of detectability of breast cancer by abbreviated breast MRI based on diffusion-weighted images and postcontrast MRI. Jpn J Radiol 2018; 36:331-339. [PMID: 29582348 DOI: 10.1007/s11604-018-0731-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 03/21/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE To compare the detectability of unenhanced abbreviated magnetic resonance imaging (MRI) based on diffusion-weighted imaging (DWI) and abbreviated postcontrast MRI for breast cancer. METHODS The study population consisted of 87 patients undergoing breast MRI between December 2016 and March 2017 in a clinical setting. All breast MRIs were performed using a 1.5-T MRI scanner with a 16-channel breast radiofrequency coil. The abbreviated protocols based on DWI (AP1) and postcontrast MRI (AP2) were assessed independently by two radiologists. Sensitivity and specificity were calculated. Receiver operating characteristic analysis was performed and the areas under the curves (AUCs) were compared between AP1 and AP2. RESULTS The study included 87 patients with 89 breast cancer lesions ≤ 2 cm in diameter. The sensitivity/specificity for AP1 and AP2 for reader 1 was 89.9/97.6% and 95.5/90.6%, respectively, and those for reader 2 was 95.5/94.1% and 98.9/94.1%, respectively. The AUCs for AP1 and AP2 for reader 1 were 0.9629 and 0.9640 (p = 0.95), respectively, and those for reader 2 were 0.9755 and 0.9843 (p = 0.46), respectively. CONCLUSIONS The detectability of the unenhanced abbreviated protocol based on DWI would be comparable to that of abbreviated postcontrast MRI for breast cancer.
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Romeo V, Cuocolo R, Liuzzi R, Riccardi A, Accurso A, Acquaviva A, Buonocore R, Imbriaco M. Preliminary Results of a Simplified Breast MRI Protocol to Characterize Breast Lesions: Comparison with a Full Diagnostic Protocol and a Review of the Current Literature. Acad Radiol 2017; 24:1387-1394. [PMID: 28579267 DOI: 10.1016/j.acra.2017.04.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 04/05/2017] [Accepted: 04/17/2017] [Indexed: 01/09/2023]
Abstract
RATIONALE AND OBJECTIVES This study aimed to investigate whether a simplified breast magnetic resonance imaging (MRI) protocol consisting of a localizer, one precontrast sequence, and three time-point postcontrast sequences (at 28 seconds, 84 seconds and 252 seconds after the contrast agent administration) is suitable for the characterization of breast lesions as compared to a full diagnostic protocol (FDP). This study also aimed to review the current literature concerning abbreviated breast MRI protocols and offer an alternative protocol. MATERIALS AND METHODS Breast magnetic resonance (MR) examinations with detected breast lesions of 98 patients were retrospectively evaluated. Two expert radiologists in consensus reviewed the simplified breast protocol (SBP) first and only thereafter the regular FDP, recording a diagnosis for each detected lesion for both protocols. Receiver operating characteristic curve analysis was performed to determine the diagnostic performance of the SBP compared to the standard FDP. A revision of the previously reported abbreviated breast magnetic resonance protocols was also carried out. RESULTS A total of 180 lesions were identified; of these, 110 (61%) were malignant and 70 (39%) were benign. Of the 110 malignant lesions, 86 (78%) were invasive ductal carcinoma, 18 (16%) were invasive lobular carcinoma, and 6 (6%) were ductal carcinoma in situ. Areas under the curve for the receiver operating characteristic curves for the SBP vs the FDP were equivalent (0.98 vs 0.99, respectively; P = 0.76). The SBP could be performed in approximately 6 minutes and 58 seconds, compared to 14 minutes and 48 seconds for the FDP. CONCLUSIONS An SBP protocol including a late postcontrast time point is accurate for the characterization of breast lesions and was comparable to the standard FDP protocol, allowing a potential reduction of the total acquisition and interpretation times.
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40
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Oldrini G, Fedida B, Poujol J, Felblinger J, Trop I, Henrot P, Darai E, Thomassin-Naggara I. Abbreviated breast magnetic resonance protocol: Value of high-resolution temporal dynamic sequence to improve lesion characterization. Eur J Radiol 2017; 95:177-185. [PMID: 28987664 DOI: 10.1016/j.ejrad.2017.07.025] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 07/25/2017] [Accepted: 07/31/2017] [Indexed: 01/03/2023]
Abstract
PURPOSE To evaluate the added value of ULTRAFAST-MR sequence to an abbreviated FAST protocol in comparison with FULL protocol to distinguish benign from malignant lesions in a population of women, regardless of breast MR imaging indication. MATERIALS AND METHODS From March 10th to September 22th, 2014, we retrospectively included a total of 70 consecutive patients with 106 histologically proven lesions (58 malignant and 48 benign) who underwent breast MR imaging for preoperative breast staging (n=38), high-risk screening (n=7), problem solving (n=18), and nipple discharge (n=4) with 12 time resolved imaging of contrast kinetics (TRICKS) acquisitions during contrast inflow interleaved in a regular high-resolution dynamic MRI protocol (FULL protocol). Two readers scored MR exams as either positive or negative and described significant lesions according to Bi-RADS lexicon with a TRICKS images (ULTRAFAST), an abbreviated protocol (FAST) and all images (FULL protocol). Sensitivity, specificity, positive and negative predictive values, and accuracy were calculated for each protocol and compared with McNemar's test. RESULTS For all readers, the combined FAST-ULTRAFAST protocol significantly improved the reading with a specificity of 83.3% and 70.8% in comparison with FAST protocol or FULL protocol, respectively, without change in sensitivity. By adding ULTRAFAST protocol to FAST protocol, readers 1 and 2 were able to correctly change the diagnosis in 22.9% (11/48) and 10.4% (5/48) of benign lesions, without missing any malignancy, respectively. Both interpretation and image acquisition times for combined FAST-ULTRAFAST protocol and FAST protocol were shorter compared to FULL protocol (p<0.001). CONCLUSION Compared to FULL protocol, adding ULTRAFAST to FAST protocol improves specificity, mainly in correctly reclassifying benign masses and reducing interpretation and acquisition time, without decreasing sensitivity.
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Affiliation(s)
- Guillaume Oldrini
- Service d'imagerie, Institut de cancérologie de Lorraine, Nancy, France
| | - Benjamin Fedida
- Sorbonne Universités, UPMC Univ Paris 06, Institut Universitaire de Cancérologie, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Tenon, Service d'Imagerie, 4 rue de la Chine, Paris 75020, France
| | - Julie Poujol
- IADI U947, INSERM, Université de Lorraine, Nancy, France
| | | | - Isabelle Trop
- Department of Radiology, Hôtel-Dieu de Montréal, Centre Hospitalier de l'Université de Montréal, Montréal, QC H2W 1T8, Canada
| | | | - Emile Darai
- Sorbonne Universités, UPMC Univ Paris 06, CALG Cancer Associé à La Grossesse, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Tenon, Service de Gynécologie et Obstétrique, 4 rue de la Chine, Paris, France
| | - Isabelle Thomassin-Naggara
- Sorbonne Universités, UPMC Univ Paris 06, Institut Universitaire de Cancérologie, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Tenon, Service d'Imagerie, 4 rue de la Chine, Paris 75020, France.
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