Rasha Mohamed Kamal MD, Presenter: Nothing to Disclose

Maha Hussein Helal MD, Abstract Co-Author: Nothing to Disclose

Dorria Saleh Salem MD, Abstract Co-Author: Nothing to Disclose

Rasha Wessam MD, PhD, Abstract Co-Author: Nothing to Disclose

Sahar Mansour MD, Abstract Co-Author: Nothing to Disclose

Marwa Anas Haggag MSc, Abstract Co-Author: Nothing to Disclose

Radwa Essam MBBS, Abstract Co-Author: Nothing to Disclose

Lamia Adel MD, Abstract Co-Author: Nothing to Disclose

Yassmine Mounir MD, Abstract Co-Author: Nothing to Disclose

Iman Godda MD, Abstract Co-Author: Nothing to Disclose

Nelly Alieldin MD, Abstract Co-Author: Nothing to Disclose

The purpose of the study is to assess the potential impact of using the  standardized MRI ACR BI-RADS lexicon lesion morphology descriptors in the characterization of breast lesions on Contrast Enhanced Spectral Mammography (CESM).

Institutional review board approval and patient informed consent were obtained from 271 patients with 350 breast lesions who underwent CESM. According to the MRI morphology descriptors, lesions were classified into enhancing and non-enhancing. Enhancing lesions were classified into: focus, mass and non mass. For characterization of mass lesions, the shape, margins and internal enhancement characteristics were assessed. For non mass lesions, the distribution and internal enhancement pattern were assessed. The validity of each criterion was tested in correlation with data provided from revision of pathology specimens. The impact of applying the MRI morphology descriptors on the diagnostic performance of CESM was assessed.

The study included 148/350 (42.3%) benign and 202/350 (57.7 %) malignant lesions out of which 261 lesions showed contrast uptake. The number of enhancing lesions were significantly higher  (p value<0.05) in malignant lesions (193/202, 95.5%) than in benign ones (68/148, 45.9%). Enhancing lesions were classified into focus (12/261 cases, 4.6%), mass (168/261, 64.4% cases) and non mass (81/261 cases, 31%). Irregular mass shape (p value: 0.00), un-circumscribed margins (p value: 0.00) and heterogeneous enhancement (p value: 0.027) was significantly indicative of a malignant pathology. Ring pattern of contrast uptake was identified in 24 lesions: 13/24, (54.2%) benign and 11/24 (45.8%) malignant. Segmental and regional non mass enhancement with a heterogeneous or clumped pattern was significantly higher with malignant pathologies (p value: 0.003). Applying the MRI morphology descriptors to CESM yielded a sensitivity, specificity and accuracy of 92.2%, 81.9%and 88% respectively.

The standardized ACR BI-RADS morphology descriptors; with the exception of the ring pattern of contrast uptake, can be applied in the interpretation of  CESM and thus provides accurate characterization of breast lesions.

The current study can be used as a pilot study for constructing a CESM BI-RADS lexicon that is essential for precise lesion characterization and provides pertinent guidance for appropriate management procedures.

Kamal, R, Helal, M, Salem, D, Wessam, R, Mansour, S, Haggag, M, Essam, R, Adel, L, Mounir, Y, Godda, I, Alieldin, N, The Potential Impact of Applying Magnetic Resonance Imaging ACR BI-RADS Lexicon Morphology Descriptors to Characterize Breast Lesions on Contrast Enhanced Spectral Mammography.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14006147.html