3-T Dynamic Contrast-Enhanced MRI of the Breast: Pharmacokinetic Parameters Versus Conventional Kinetic Curve Analysis

Riham H. El Khouli, Katarzyna J. Macura, Ihab R. Kamel, Michael A. Jacobs, David A. Bluemke
2011 American Journal of Roentgenology  
Purpose-To evaluate the incremental value of pharmacokinetic analysis of dynamic contrast enhanced (DCE) magnetic resonance imaging (MRI) compared to conventional breast MRI (morphology plus kinetic curve type analysis) in characterizing breast lesions as malignant or benign. Patients and Methods-The study was approved by our institutional review board. Patients underwent 3D high resolution T1 (3DT1) contrast enhanced MRI and dynamic contrast enhancement (DCE) MRI at 3T, and had pathology
more » ... diagnosis (95%) or more than 2 years follow up confirming lesion stability (5%). Lesions were identified using the high-spatial resolution post-contrast MRI. Morphologic features (margin, enhancement pattern) and conventional DCE-MRI results (kinetic curve types I, II or III) or pharmacokinetic parameters (wash-in rate K trans , washout rate K ep , and leakage space volume V e ), were included in multivariate models for prediction of benign versus malignant diagnosis. Results-95 patients with 101 lesions were included: 52% of patients were pre-menopausal and 48% post-menopausal. Sixty eight lesions (67.3%) were malignant and 33 (32.7%) were benign. There was a significant association between K trans and K ep and the diagnosis of benign versus malignant (p<0.001). The AUC for morphologic features (lesion margin and enhancement pattern) was 0.85, while inclusion of K trans or K ep in the model showed similar modest improvement in performance (AUC, 0.88-0.89). Conclusion-The use of kinetic curve type assessment or pharmacokinetic modeling in conjunction with high resolution 3D breast MRI appears to offer similar improvement in diagnostic performance.. NIH Public Access
doi:10.2214/ajr.10.4665 pmid:22109308 pmcid:PMC3496793 fatcat:qveky4asmveg7lc6alan5kqqjm