The diagnostic value of abbreviated MRI protocol in the surveillance of Branch-Duct intraductal papillary mucinous neoplasm

PURPOSE

To assess the diagnostic value of abbreviated protocol (AP) MRI to detect the degeneration signs in branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) in patients undergoing a routine MRI follow-up.

METHODS

This dual-center retrospective study include patients with BD-IPMN diagnosed on initial comprehensive protocol (CP) MRI who underwent routine MRI follow-up. CP included axial and coronal T2-weighted images (T2WI), axial T1-weighted images (T1WI) before and after contrast administration, 3D MR cholangiopancreatography (MRCP) and diffusion-weighted images (DWI). Two APs, eliminating dynamic sequences ± DWI, were extracted from CP. Two radiologists evaluated the APs separately for IPMN degeneration signs according to Fukuoka criteria and compared the results to the follow-up CP. In patients who underwent EUS, imaging findings were correlated with pathological results. Per-patient and per-lesion sensitivity, specificity, PPV, NPV, and accuracy of APs were calculated. Additionally, the acquisition time for different protocols was calculated.

RESULTS

One hundred-fourteen patients (56.1 % women, median age: 71 years) with 256 lesions were included. Degeneration signs were observed in 24.6 % and 12.1 % per-patient and per-lesion, respectively. Regarding APs, the per patient sensitivity, specificity, PPV, NPV, and accuracy in the detection of the degeneration signs were 100 %, 93.5 %, 83.3 %, 100 %, and 95.1 %, respectively. No additional role for DWI was detected. AP without DWI economized nearly half of CP acquisition time (388 versus 663 s, respectively).

CONCLUSION

AP can confidently replace CP for BD-IPMN follow-up with high sensitivity and PPV while offering benefits such as patient comfort, improved MRI accessibility, and reduced dedicated time for image analysis. DWI necessitates special consideration.

CLINICAL RELEVANCE STATEMENT

Our data suggest that APs safely detect all degeneration signs of IPMN. While there is an overestimation of mural nodules due to the lack of contrast injection, this occurs in a negligible number of patients.

The application of abbreviated MRI protocols in malignant liver lesions surveillance

Cancer is one of the leading public health problems globally. Since time is of the essence in oncology, the sooner an accurate diagnosis is made, the better the prognosis for patients. There is a growing need to find a flawless and fast imaging method for cancer detection, but also for its evaluation during treatment. In this respect, the possibilities and novelties of magnetic resonance imaging are particularly promising. Abbreviated magnetic resonance imaging (AMRI) protocols have aroused universal interest as a compromise between scanning time reduction and preservation of image quality. Shorter protocols focused on the detection of suspicious lesions with the most sensitive sequences could provide a diagnostic performance similar to the one of the standard protocol. The purpose of this article is to review the ongoing accomplishments in the use of AMRI protocols in liver metastases and HCC detection.

High-resolution 3D T2-weighted SPACE sequence with compressed sensing for the prostate gland: diagnostic performance in comparison with conventional T2-weighted images

PURPOSE

To compare the diagnostic performance of high-resolution 3D T2-weighted imaging (T2WI) with compressed sensing (CS) sampling perfection with application-optimized contrasts using different flip angle evolution (SPACE) to that of conventional T2WI with turbo spin echo (TSE) in prostate MRI.

MATERIALS AND METHODS

This study evaluated 179 patients (mean age 69.1 ± 9.3) who underwent prostate biopsy after prostate prebiopsy MRI, including two sets of three-plane T2WI with TSE (thickness: 3 mm, scan time: 10 min 4 s) and CS SPACE (thickness: 0.6 mm, scan time: 4 min 55 s). Two radiologists evaluated two sets of images with the Prostate Imaging-Reporting and Data System (PIRADS) classification and determined the extraprostatic extension (EPE) of the lesion. The diagnostic performance to detect prostate cancer (PIRADS classification) and EPE was compared between the two T2WI sets.

RESULTS

Clinically significant cancer (CSC) was diagnosed in 103 patients (57.5%). Areas under the receiver operating characteristic curve of the PIRADS classification on both image sets with T2 TSE and T2 CS SPACE were higher than 0.7 and did not show significant differences for either radiologist (p > 0.05). EPE was confirmed in 25 of 70 patients underwent prostatectomy. For evaluating EPE on MRI, the sensitivity and specificity did not differ between the two T2WI sequences (p > 0.05).

CONCLUSION

High-resolution 3D T2WI using CS SPACE, which was acquired within a shorter acquisition time than three-plane T2 TSE, showed comparable diagnostic performance to conventional T2 TSE for detecting CSC and evaluating EPE.

The diagnostic performance in clinically significant prostate cancer with PI-RADS version 2.1: simplified bpMRI versus standard mpMRI

OBJECTIVES

To compare the diagnostic performance for the detection of clinically significant prostate cancer (csPCa) between bpMRI with only axial T2WI (simplified bpMRI) and standard-multiparametric MRI (mpMRI).

METHODS

A total of 569 patients who underwent mpMRI followed by biopsy or prostatectomy were enrolled in this retrospective study. According to PI-RADS v2.1, three radiologists (A, B, C) from three centers blinded to clinical variables were assigned scores on lesions with simplified bpMRI and then with mpMRI 2 weeks later. Diagnostic performance of simplified bpMRI was compared with mpMRI using histopathology as reference standard.

RESULTS

For all the three radiologists, the diagnostic sensitivity was significantly higher with mpMRI than with simplified bpMRI (P < 0.001 to P = 0.035); and although specificity was also higher with mpMRI than with simplified bpMRI for radiologist B and radiologist C, it was statistically significant only for radiologist B (P = 0.011, P = 0.359, respectively). On the contrary, for radiologist A, specificity was higher with simplified bpMRI than with mpMRI (P = 0.001). The area under the receiver operating characteristic curve (AUC) was significantly higher for mpMRI than for simplified bpMRI except for radiologist A (radiologist A: 0.903 vs 0.913, P = 0.1542; radiologist B: 0.861 vs 0.834 P = 0.0013; and radiologist C: 0.884 vs 0.848, P = 0.0003). Interobserver reliability of PI-RADS v2.1 showed good agreement for both simplified bpMRI (kappa = 0.665) and mpMRI (kappa = 0.739).

CONCLUSION

Although the detection of csPCa with simplified bpMRI was comparatively lower than that with mpMRI, the diagnostic performance was still high in simplified bpMRI. Our data justify using mpMRI outperforms simplified bpMRI for prostate cancer screening and imply simplified bpMRI as a potential screening tool.

MRI follow-up for pancreatic intraductal papillary mucinous neoplasm: an ultrashort versus long protocol

Purpose

To evaluate whether an ultrashort-protocol (USP) MRI including only T2-weighted HASTE axial and 3D MRCP SPACE sequences adequately measures the largest diameter of the largest cyst and the main pancreatic duct (MPD) and identifies worrisome features (WF) and high-risk stigmata (HRS) when compared to longer protocols (LP, long protocol; SP, short protocol; S-LP, short or long protocol). We also calculated reductions in costs associated with USP.

Methods

This retrospective study included 183 IPMN patients. Two radiologists compared two imaging sets (USP versus S-LP) per patient, comparing the mean values of the largest cyst and MPD and agreement regarding the presence or absence of cystic or MPD mural nodules and solid pancreatic tumors. The interobserver agreement for cystic mural nodules and WF/HRS was evaluated, using the Bland-Altman plot and Cohen’s Kappa.

Results

A total of 112 IPMN patients were evaluated. For detecting cysts or MPD nodules, WF/HRS, and solid pancreatic tumors, USP and S-LP coincided in 94.9%, 99.1%, 92.4%, and 99.1% of cases, respectively. Both USP and S-LP identified all true cystic mural nodules. The mean size of the largest cyst and MPD was 19.48/19.67 mm and 3.24/3.33 mm using USP versus S-LP, while the mean differences for USP versus S-LP were 0.19 mm and 0.08 mm. The USP cost was 39% of LP cost and 77% of SP. Interobserver agreement was moderate to strong.

Conclusions

For IPMN surveillance, an ultrashort-protocol MRI provides nearly identical information to the more expensive longer protocols.

Graphical abstract

Supplementary Information

The online version contains supplementary material available at 10.1007/s00261-021-03382-4.

Postoperative single-sequence (PoSSe) MRI: imaging work-up for CT-guided or endoscopic drainage indication of collections after hepatopancreaticobiliary surgery

Purpose

Fluid collections due to anastomotic leakage are a common complication after hepatopancreaticobiliary (HPB) surgery and are usually treated with drainage. We conducted a study to evaluate imaging work-up with a postoperative single-sequence (PoSSe) MRI for the detection of collections and indication of drainage.

Material and methods

Forty-six patients who developed signs of leakage (fever, pain, laboratory findings) after HPB surgery were prospectively enrolled. Each patient was examined by abdominal sonography and our PoSSe MRI protocol (axial T2-weighted HASTE only). PoSSe MRI examination time (from entering to leaving the MR scanner room) was measured. Sonography and MRI were evaluated regarding the detection and localization of fluid collections. Each examination was classified for diagnostic sufficiency and an imaging-based recommendation if CT-guided or endoscopic drainage is reasonable or not was proposed. Imaging work-up was evaluated in terms of feasibility and the possibility of drainage indication.

Results

Sonography, as first-line modality, detected 21 focal fluid collections and allowed to decide about the need for drainage in 41% of patients. The average time in the scanning room for PoSSe MRI was 9:23 min [7:50–13:32 min]. PoSSe MRI detected 46 focal collections and allowed therapeutic decisions in all patients. Drainage was suggested based on PoSSe MRI in 25 patients (54%) and subsequently indicated and performed in 21 patients (100% sensitivity and 84% specificity). No patient needed further imaging to optimize the treatment.

Conclusions

The PoSSe MRI approach is feasible in the early and intermediate postoperative setting after HPB surgery and shows a higher detection rate than sonography. Imaging work-up regarding drainage of collections was successful in all patients and our proposed PoSSe MRI algorithm provides an alternative to the standard work-up.

An abbreviated MRI protocol for surveillance of cystic pancreatic lesions

PURPOSE

Cystic pancreatic lesions (CPLs) are common and increasingly encountered in clinical radiology practice. The appropriate imaging surveillance strategy for lower-risk CPLs (branch duct-intraductal papillary mucinous neoplasms and indeterminant small cystic lesions) has been a topic of intense study and debate in recent years. MRI is considered the investigation of choice for initial characterisation and follow-up of CPLs. Follow-up intervals for CPLs vary from 6 months to 2 years and surveillance may be lifelong or until the patient is no longer considered fit for potential surgical intervention. This creates a significant burden on MRI resources as a standard protocol pancreatic MRI may have an acquisition time of up to 35-50 min. However, the necessity of contrast-enhanced sequences and diffusion weighted imaging (DWI) for routine follow-up of CPLs has been questioned in recent years.

METHODS

We reviewed the available evidence to determine whether an abbreviated MRI (A-MRI) protocol may be safely adopted for surveillance of CPLs, as has been implemented in other clinical scenarios.

RESULTS

A number of recent retrospective studies have indicated that an A-MRI, omitting contrast-enhanced and DWI, may be used for CPL surveillance without any suspicious features or cases of malignancy being missed. Although small number of cases may need to be recalled for additional MR sequences based on the A-MRI findings, there is still a significant overall timesaving.

CONCLUSION

The best available evidence currently suggests that an A-MRI protocol should be considered for routine surveillance of CPLs. Prospective studies are required to ensure the findings reported in these retrospective case studies are backed up in ongoing clinical practice.

Lung Ultrasound to Diagnose Pulmonary Congestion Among Patients on Hemodialysis: Comparison of Full Versus Abbreviated Scanning Protocols

RATIONALE & OBJECTIVE

Pulmonary congestion contributes to morbidity and mortality in patients with kidney failure on hemodialysis, but physical assessment is an insensitive approach to its detection. Lung ultrasound is useful for assessing the presence and severity of pulmonary congestion, but the most widely validated 28-zone study is cumbersome. We sought to compare abbreviated 4-, 6-, and 8-zone studies to 28-zone studies.

STUDY DESIGN

Diagnostic test study.

SETTING & PARTICIPANTS

Convenience sample of 98 patients with kidney failure on hemodialysis presenting to an emergency department in the United States.

TESTS COMPARED

4-, 6-, and 8-zone lung ultrasound studies versus a 28-zone lung ultrasound.

OUTCOME

Prediction of pulmonary congestion and 30-day mortality.

RESULTS

All patients completed a 28-zone lung ultrasound. Correlation coefficients (nonparametric Spearman) between each of the studies were high (all values > 0.84). Bland-Altman analysis showed good agreement. Each of the short-form studies discriminated well with area under the receiver-operator characteristic curve > 0.83 for no-to-mild versus moderate-to-severe pulmonary congestion. During a median follow-up period of 778 days, 46 (47%) died. Patients with moderate-to-severe pulmonary congestion on lung ultrasound had a 30-day mortality rate similar to that observed among patients with no-to-mild pulmonary congestion (OR, 0.95 [95% CI, 0.70-1.29]).

LIMITATIONS

Single-center study conducted in an emergency care setting, convenience sample of patients, and lack of long-term follow-up data.

CONCLUSIONS

Among hemodialysis patients presenting to an emergency department, 4-, 6-, or 8-zone lung ultrasounds were comparable to 28-zone studies for the assessment of pulmonary congestion. The mortality rates did not differ between those with no-to-mild and moderate-to-severe pulmonary congestion.

"PENS" approach for breaking bad news-a short and sweet way!

India has a distinct pattern of cancer care delivery, with unique sociocultural milieu and patient characteristics. In the current era of patient-centered and personalized care, there is an unmet need for an abbreviated protocol for breaking bad news to cancer patients suitable for the Indian outpatient setting. We propose a short four-step protocol for breaking bad news effectively and caringly, in the outpatient department of oncology clinics.

Should abbreviated breast MRI be compliant with American College of Radiology requirements for MRI accreditation?

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.

Fast MRI breast cancer screening - Ready for prime time

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.

Value of an abbreviated protocol of breast magnetic resonance imaging for screening high-risk patients

OBJECTIVE

Value the utility of breast MRI abbreviated protocols for the screening of breast cancer in high-risk patients compared to the full protocol.

METHODS

We performed a retrospective review of 157 breast MRI of 82 high-risk patients practiced in our hospital between January 2011 and January 2017. Clinical, radiological and anatomopathological parameters were analyzed. Reading of the different protocols (MIP, abbreviated and full) was made by an expert radiologist. Subsequent statistical analysis was done.

RESULTS

A total amount of 12 findings classified as BI-RADS 4 and 5 were identified and performed a biopsy, resulting 11 of them to be malignant (91.67%) and 1 benign (8.33%). The malignant wounds included 4 intraductal carcinoma (33.33%) and 7 infiltrating ductal carcinoma (58.33%). All injuries were detected with the three protocols and no significant differences were found between their respective area under the ROC curve (p=0.0650).

CONCLUSIONS

In our study there are no significant differences between the different protocols (MIP, abbreviated and full), which places the abbreviated protocol as a promising tool for breast cancer screening in high-risk patients.

Evaluation of a short protocol for indirect calorimetry in females with eating disorders and healthy controls

BACKGROUND AND AIMS

To enable clinicians to identify the clinical picture and treatment progress and to adjust eating plans according to personal energy needs, it is important to know the patient's correct resting metabolic rate (RMR). Indirect calorimetry (IC) is the preferred method for assessment of RMR, but long duration of measurement increases the load on the patients, and reduces the effectiveness in clinical and scientific settings. Further; not all patients reach a valid RMR according to the suggested best practice protocol, with 5 min of steady state (SS) where respiratory gas volume exchange varies less than 10%. The aim of this study was to evaluate the possibility for an abbreviated RMR protocol and SS criterion.

METHODS

Forty two women diagnosed with bulimia nervosa or binge eating disorder (eating disorder group, ED), originally recruited for an outpatient treatment study, and 26 age and gender matched healthy controls (HC) were studied during a single, prolonged IC measurement. Participants rested for 10 min in supine position wearing a two-way breathing facemask, before a continuous measurement period of 20 min. Results from a standard 5 min SS criterion was compared to an abbreviated 3 min SS criterion. Both SS-criteria were evaluated through three different SS protocols (<10% variation in respiratory gas exchange), being: 1) measurement during the first 3 or 5 min, 2) measurement after discarding the first 5 min, and 3) the lowest identified RMR during the 20 min of measurement.

RESULTS

About 50% of the participants reached an early SS in both the defined SS minute criteria. Participants reaching a valid SS throughout the 20 min of measurement increased from ∼90% to 100% with an abbreviated 3 min SS. With a 5 min SS criterion, the median (range) RMR for the 3 protocols were 1639.9 (1239.2), 1508.8 (1457.6) and 1500.6 (1328.8) respectively for the ED group, and 1702.2 (1239.4), 1608.4 (1076.4) and 1594.8 (1029.2) respectively for the HC group, (p > 0.05 for all between-group analysis). With a 3 min SS criterion, the median (range) RMR were 1533.6 (1298.2), 1461.2 (1406.1), and 1395.8 (1447.3) respectively for the ED group and 1681.7 (1332.4), 1613.7 (1266.0) and 1523.1 (1050.3), respectively for the HC group, (p > 0.05 for all between-group analysis). Lowest measured RMR was different compared to the other two SS protocols in both the ED- and the HC group, and for both the 5 min- and the 3 min SS criteria, respectively (p < 0.04). Furthermore, a SS of 3 min resulted in lower RMR compared to 5 min SS (p < 0.00) and an increased number of participants classified as hypo-metabolic (RMRmeasured/RMRcalculated < 0.9).

CONCLUSIONS

An abbreviated measurement protocol to identify the lowest RMR using IC was not successful. Abbreviating the SS criteria from 5 to 3 min, resulted in a lower RMR, hence encouraging further examination of the validity of shorter SS criterion than practiced today. Registered in Clinical Trials by id-number NCT02079935, and approved by the Norwegian Regional Committee for Medical and Health Research Ethics with id-number 2013/1871. The trial in which control persons were recruited, is approved by the Norwegian Regional Committees for Medical and Health Research Ethics with the id-number 2016/1718, and prospectively registered in Clinical Trials with the id-number NCT03007459.

3D T2-weighted imaging to shorten multiparametric prostate MRI protocols

Objectives

To determine whether 3D acquisitions provide equivalent image quality, lesion delineation quality and PI-RADS v2 performance compared to 2D acquisitions in T2-weighted imaging of the prostate at 3 T.

Methods

This IRB-approved, prospective study included 150 consecutive patients (mean age 63.7 years, 35–84 years; mean PSA 7.2 ng/ml, 0.4–31.1 ng/ml). Two uroradiologists (R1, R2) independently rated image quality and lesion delineation quality using a five-point ordinal scale and assigned a PI-RADS score for 2D and 3D T2-weighted image data sets. Data were compared using visual grading characteristics (VGC) and receiver operating characteristics (ROC)/area under the curve (AUC) analysis.

Results

Image quality was similarly good to excellent for 2D T2w (mean score R1, 4.3 ± 0.81; R2, 4.7 ± 0.83) and 3D T2w (mean score R1, 4.3 ± 0.82; R2, 4.7 ± 0.69), p = 0.269. Lesion delineation was rated good to excellent for 2D (mean score R1, 4.16 ± 0.81; R2, 4.19 ± 0.92) and 3D T2w (R1, 4.19 ± 0.94; R2, 4.27 ± 0.94) without significant differences (p = 0.785). ROC analysis showed an equivalent performance for 2D (AUC 0.580–0.623) and 3D (AUC 0.576–0.629) T2w (p > 0.05, respectively).

Conclusions

Three-dimensional acquisitions demonstrated equivalent image and lesion delineation quality, and PI-RADS v2 performance, compared to 2D in T2-weighted imaging of the prostate. Three-dimensional T2-weighted imaging could be used to considerably shorten prostate MRI protocols in clinical practice.

Key points

• 3D shows equivalent image quality and lesion delineation compared to 2D T2w.

• 3D T2w and 2D T2w image acquisition demonstrated comparable diagnostic performance.

• Using a single 3D T2w acquisition may shorten the protocol by 40%.

• Combined with short DCE, multiparametric protocols of 10 min are feasible.

Abbreviated breast magnetic resonance protocol: Value of high-resolution temporal dynamic sequence to improve lesion characterization

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.

Abbreviated MRI Protocols for Detecting Breast Cancer in Women with Dense Breasts

Objective

To evaluate the validity of two abbreviated protocols (AP) of MRI in breast cancer screening of dense breast tissue.

Materials and Methods

This was a retrospective study in 356 participants with dense breast tissue and negative mammography results. The study was approved by the Nanjing Medical University Ethics Committee. Patients were imaged with a full diagnostic protocol (FDP) of MRI. Two APs (AP-1 consisting of the first post-contrast subtracted [FAST] and maximum-intensity projection [MIP] images, and AP-2 consisting of AP-1 combined with diffusion-weighted imaging [DWI]) and FDP images were analyzed separately, and the sensitivities and specificities of breast cancer detection were calculated.

Results

Of the 356 women, 67 lesions were detected in 67 women (18.8%) by standard MR protocol, and histological examination revealed 14 malignant lesions and 53 benign lesions. The average interpretation time of AP-1 and AP-2 were 37 seconds and 54 seconds, respectively, while the average interpretation time of the FDP was 3 minutes and 25 seconds. The sensitivities of the AP-1, AP-2, and FDP were 92.9, 100, and 100%, respectively, and the specificities of the three MR protocols were 86.5, 95.0, and 96.8%, respectively. There was no significant difference among the three MR protocols in the diagnosis of breast cancer (p > 0.05). However, the specificity of AP-1 was significantly lower than that of AP-2 (p = 0.031) and FDP (p = 0.035), while there was no difference between AP-2 and FDP (p > 0.05).

Conclusion

The AP may be efficient in the breast cancer screening of dense breast tissue. FAST and MIP images combined with DWI of MRI are helpful to improve the specificity of breast cancer detection.