Claudia Reuben Seuss MD, Presenter: Nothing to Disclose

Ana Paula Klautau Leite MD, Abstract Co-Author: Nothing to Disclose

James S. Babb PhD, Abstract Co-Author: Nothing to Disclose

Melanie Freed PhD, Abstract Co-Author: Nothing to Disclose

Kai Tobias Block, Abstract Co-Author: Nothing to Disclose

Sungheon Kim, Abstract Co-Author: Nothing to Disclose

Linda Moy MD, Abstract Co-Author: Nothing to Disclose

To determine if a quantitative analysis of the contrast enhancement from an indeterminate lesion and its background parenchyma (BP) improves the differentiation between benign and malignant lesions.  

This IRB approved retrospective review was performed on 45 women who underwent an MRI guided biopsy between November 2011 and January 2013. The MR biopsy imaging was performed using a temporal resolution of 55 sec/frame for 5 consecutive frames. A single reader manually drew a region of interest (ROI) around the lesion. A second ROI was drawn around the entire breast on 3 separate images that did not contain the lesion. The quantitative analysis of dynamic signal enhancement in the BP was performed using a linear principal component analysis (PCA) method. The quantitative analysis for the lesion was calculated using the initial enhancement ratio (IER), defined as the percent increase of the signal between the first and third frames, and the delayed enhancement ratio (DER), defined as the percent increase of the signal between the first and fifth frames. IER and DER were measured for the lesion and BP. Correlation was made to the kinetic curve, mammographic breast density (BD) and background parenchymal enhancement (BPE).  

Our cohort consisted of 45 women: 13 with invasive ductal carcinoma (IDC), 12 with ductal carcinoma in situ (DCIS) and 20 with benign lesions. The IER and DER for the lesion was able to discriminate between benign lesions and IDC (p value 0.017 and 0.039). The area under the ROC curve (AUC) for BD was 0.671, kinetic curve was 0.669, IER 0.719 and DER 0.719. The quantitative measures had better ability than the ordinal measures to discriminate between benign and malignant lesions in that each of the lesion’s IER and DER had a higher AUC than the BD and kinetic curves. There was no significant difference however, between any pair of measures in terms of AUC (p>0.69). A trend was noted with IDC being associated with increased BP (0.82) but not with BPE (p=.228).

IDC had higher IER and DER values consistent with the rapid initial rise seen in malignant lesions. Higher BD but not BPE was seen in the patients with cancers compared to those with benign lesions.

Quantitative analysis of enhancement curves can distinguish between benign and malignant lesions more accurately than ordinal measures. There was no increased incidence of cancer with increased BPE.

Seuss, C, Klautau Leite, A, Babb, J, Freed, M, Block, K, Kim, S, Moy, L, Utility of a Quantitative Analysis of Contrast Enhancement to Discriminate between Benign and Malignant Entities Using a Linear Principal Component Analysis (PCA) Method.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13044271.html