Breast disease: dynamic spiral MR imaging.
OBJECTIVE
To compare various subjective, empiric, and pharmacokinetic methods for interpreting findings at dynamic magnetic resonance (MR) imaging of the breast.


METHODS
Dynamic spiral breast MR imaging was performed in 52 women suspected of having or with known breast disease. Gadolinium-enhanced images were obtained at 12 locations through the whole breast every 7.8 seconds for 8.5 minutes after bolus injection of contrast material. Time-signal intensity curves from regions of interest corresponding to 57 pathologically proved lesions were analyzed by means of a two-compartment pharmacokinetic model, and the diagnostic performance of various parameters was analyzed.


RESULTS
Findings included invasive carcinoma in 17 patients, isolated ductal carcinoma in situ (DCIS) in six, and benign lesions in 34. Although some overlap between carcinomas and benign diagnoses was noted for all parameters, receiver operating characteristic analysis indicated that the exchange rate constant had the greatest overall ability to discriminate benign and malignant disease. The elimination rate constant and washout were the most specific parameters. The exchange rate constant, wash-in, and extrapolation point were the most sensitive parameters. DCIS was not consistently distinguished from benign disease with any method.


CONCLUSIONS
Dynamic spiral breast MR imaging proved an excellent method with which to collect contrast enhancement data rapidly enough that accurate comparisons can be made between many analytic methods.
Daniel
B L
BL
Dept of Radiology, Stanford University School of Medicine, Lucas Magnetic Resonance Imaging Center, CA 94305-5488, USA.
Yen
Y F
YF
Glover
G H
GH
Ikeda
D M
DM
Birdwell
R L
RL
Sawyer-Glover
A M
AM
Black
J W
JW
Plevritis
S K
SK
Jeffrey
S S
SS
Herfkens
R J
RJ
D001940:Breast / Q000473:pathology; D001941:Breast Diseases / Q000175:diagnosis*; D001943:Breast Neoplasms / Q000175:diagnosis*; D002278:Carcinoma in Situ / Q000175:diagnosis; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D012680:Sensitivity and Specificity
D003287:Contrast Media; D019786:Gadolinium DTPA