title: Differentiation between benign and malignant findings on MR-mammography: usefulness of morphological criteria.
abstract: The purpose of this study was to evaluate the usefulness of morphological criteria in differentiating between benign and malignant lesions on MR-mammography. Fifty-three women (18-82 years) with 62 lesions scheduled for excisional biopsy underwent dynamic contrast-enhanced MR-mammography using fast 3D Gradient-Echo sequences in coronal orientation (axial orientation in seven patients). Histology revealed 44 malignant and 18 benign lesions. For each lesion, five radiologists evaluated four morphological features: lesion shape, irregularity of contour, homogeneity of contrast enhancement and presence of ring enhancement. For each feature a receiver operating characteristic (ROC) curve was generated with calculation of the area under the curve (AUC). Interobserver variability was evaluated by the kappa-coefficient. The most reliable morphological feature indicating malignancy was an irregular lesion contour with a sensitivity/specificity/AUC of 83%/76%/0.9 followed by inhomogeneous contrast enhancement (85%/42%/0.7) and the presence of ring enhancement (71%/53%/0.64). The average interobserver agreement for the different features ranged between 0.35 and 0.4. Morphological criteria are useful features in MR-mammography for differentiating between benign and malignant lesions. However, due to the relatively high interobserver variability, standardization of terminology is important.
authors.affiliation: Abteilung für Röntgendiagnostik, Radiologische Klinik, Universitäts-Krankenhaus Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany. u.wedeg@gmx.de
authors.forename: U
authors.initials: U
authors.lastname: Wedegärtner
authors.forename: U
authors.initials: U
authors.lastname: Bick
authors.forename: K
authors.initials: K
authors.lastname: Wörtler
authors.forename: E
authors.initials: E
authors.lastname: Rummeny
authors.forename: G
authors.initials: G
authors.lastname: Bongartz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001706:Biopsy; D001940:Breast / Q000473:pathology; D001941:Breast Diseases / Q000175:diagnosis*; D001943:Breast Neoplasms / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007089:Image Enhancement; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008327:Mammography; D008875:Middle Aged; D015588:Observer Variation; D012372:ROC Curve; D012680:Sensitivity and Specificity