Margarita Louise Zuley MD, Presenter: Research grant, Hologic, Inc

Jules Henry Sumkin DO, Abstract Co-Author: Scientific Advisory Board, Hologic, Inc

Marie Adele Ganott MD, Abstract Co-Author: Nothing to Disclose

Maria Lena Anello MD, Abstract Co-Author: Nothing to Disclose

Gordon Scott Abrams MD, Abstract Co-Author: Nothing to Disclose

Luisa Paula Wallace MD, Abstract Co-Author: Nothing to Disclose

David Gur ScD, Abstract Co-Author: Nothing to Disclose

To compare the diagnostic performance of contrast enhanced cone beam computed tomography (CBCT) to dynamic contrast enhanced breast MRI in classifying breast lesions as benign or malignant, and to perform a subjective comparative quality assessment of the two modalities.

Retrospective analysis of CBCT and MRI images obtained between 05/12/2008 and 2/18/2011 from 50 patients with 57 lesions was performed in this IRB approved study. Five breast imaging radiologists classified every lesion as benign or malignant for each modality then provided a subjective comparative quality assessment score on a 5 point scale, yielding 285 ratings. First mode displayed was balanced. Results were compared to histopathology for cases that had biopsy (n=56) or 1 year negative imaging followup (n=1). For CBCT, patients received iodixanol 320, 100ml via power injector at 3 ml/sec (av) with 90 sec (av) acquisition delay. CBCT series were displayed in the axial, sagittal and coronal planes simultaneously. Four T1-weighted, fat saturated axial and sagittal MRI series were obtained following injection of gadoteridol, 1mmol/kg. A generalized linear mixed model for binary data was used to assess categorization and subjective assessments were analyzed with mixed mode.

Patient ages ranged from 31-60 years (mean 48, median 49 years). The cohort included 24 cancers and 33 benign lesions. Across all readers, CBCT correctly classified 83.6% of the benign lesions and 94.2% of the cancers. MRI correctly classified 86.1% of the benign lesions and 93.3% of the cancers (p>0.63). For the subjective assessment, MRI was significantly better than CBCT in 79 (28%) ratings, slightly better in 91 (32%), and the modes were equal in 102 (36%). CBCT was significantly better than MRI in 1 (<1%) and slightly better than MRI in 12 (4%) ratings. On average across all readers, MRI was subjectively rated as better than CBCT for both benign (p<0.01) and malignant (p<0.01) lesions.

Despite subjective ratings of image quality showing MRI superior to CBCT there was no statistical difference in the actual ability of CBCT and MRI to classify breast lesions as benign or malignant.

CBCT is an emerging technology that may be an alternative to MRI in the evaluation of breast lesions.

Zuley, M, Sumkin, J, Ganott, M, Anello, M, Abrams, G, Wallace, L, Gur, D, Comparison of Contrast-enhanced Cone Beam Computed Tomography to Contrast-enhanced Magnetic Resonance Imaging in the Categorization of Breast Lesions.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11003962.html