title: Dynamic bilateral contrast-enhanced MR imaging of the breast: trade-off between spatial and temporal resolution.
abstract: OBJECTIVE
  To investigate prospectively the trade-off between temporal and spatial resolution in dynamic contrast material-enhanced bilateral magnetic resonance (MR) imaging of the breast.
  
  
  METHODS
  Informed consent and institutional review board approval were obtained. An intraindividual comparative study was performed in 30 patients (mean age, 53 years; age range, 27-70 years) with a total of 54 enhancing lesions (28 benign and 26 malignant) who underwent dynamic MR imaging of the breast twice, once with a standard dynamic protocol (256 x 256 matrix, 69 seconds per acquisition) and once on a separate day with a modified dynamic protocol (400 x 512 matrix, 116 seconds per acquisition). Systematic qualitative analysis of morphologic features and region-of-interest-based analysis of enhancement kinetics were performed.
  
  
  RESULTS
  A statistically significant difference (generalized linear modeling) in enhancement rates of benign versus malignant lesions was lost when moving from the standard to the modified dynamic protocol. Kinetic information on signal intensity time course patterns was preserved. Delineation of lesion margins and internal architecture was clearly superior with the modified dynamic protocol, which allowed identification of lesion features associated with high positive predictive value or high negative predictive value for breast cancer. Ten benign lesions classified as Breast Imaging Reporting and Data System (BI-RADS) category 3 with the standard protocol were correctly downgraded to BI-RADS category 2 with the modified protocol owing to visualization of internal septations. Thirteen malignant lesions categorized as BI-RADS category 3 or 4 with the standard protocol were correctly upgraded to BI-RADS category 4 or 5 with the modified protocol owing to visualization of spicules or rim enhancement. Receiver operating characteristic analysis revealed a significantly larger area under the curve for results obtained with the modified dynamic protocol.
  
  
  CONCLUSIONS
  Increased spatial resolution significantly improves diagnostic confidence and accuracy at dynamic MR imaging, even if this improvement occurs at the expense of temporal resolution. Loss of kinetic information regarding enhancement rates proved to be not diagnostically relevant because enhancement rates showed broad overlap between benign and malignant lesions and were therefore of only limited diagnostic use in the individual patient. Kinetic information regarding time course pattern was preserved and confirmed as having high specificity and high positive predictive value.
authors.affiliation: Department of Radiology, University of Bonn, Sigmund-Freud-Str 25, D-53105 Bonn, Germany. kuhl@uni-bonn.de
authors.forename: Christiane K
authors.initials: CK
authors.lastname: Kuhl
authors.forename: Hans H
authors.initials: HH
authors.lastname: Schild
authors.forename: Nuschin
authors.initials: N
authors.lastname: Morakkabati
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis*; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007091:Image Processing, Computer-Assisted; D016014:Linear Models; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D013997:Time Factors
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA