title: Gadobenate dimeglumine as a contrast agent for dynamic breast magnetic resonance imaging: effect of higher initial enhancement thresholds on diagnostic performance.
abstract: OBJECTIVE
  Gadobenate dimeglumine (Gd-BOPTA), a high-relaxivity contrast agent, has been recently proposed for dynamic MR imaging of the breast. The objective of this study was to optimize the diagnostic performance of Gd-BOPTA-enhanced dynamic breast MR imaging by using adjusted initial enhancement thresholds.
  
  
  METHODS
  Thirty-four patients with 36 breast lesions (malignant/benign = 28/8) underwent dynamic breast MRI with 0.1 mmol/kg Gd-BOPTA and 120-second time resolution. A score system based on shape (round/oval/lobular = 0; linear/dendritic/stellate = 1), margins (defined = 0; undefined = 1), pattern (homogeneous = 0; inhomogeneous = 1; rim = 2), kinetics (continuous = 0; plateau = 1; washout = 2), and initial enhancement was used. Initial enhancement was determined with standard (<50% = 0; 50%-100% = 1; >100% = 2) and adjusted (<100% = 0; 100%-240% = 1; >240% = 2) thresholds. Scores of 0 to 3 indicated benign lesions and scores of 4 to 8 malignant lesions. Diagnostic performance was assessed in terms of sensitivity, specificity, positive and negative predictive values, and overall accuracy.
  
  
  RESULTS
  The initial enhancement was >100% for 26 malignant and 7 benign lesions and >240% for 16 and 1 lesions, respectively. The overall score was 5.89 +/- 1.34 with standard thresholds and 5.50 +/- 1.53 with adjusted thresholds (P = 0.003) for cancers, 4.00 +/- 1.93 and 3.25 +/- 1.75 (P = 0.028) for benign lesions, respectively. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy was 96%, 13%, 79%, 50%, and 78%, respectively, with standard thresholds and 96%, 75%, 93%, 86%, and 92%, respectively, with adjusted thresholds. A ductal carcinoma in situ was false negative whereas a fat necrosis and a papilloma were false positive with both thresholds. Three fibroadenomas, 1 adenosis, and 1 fibrosis were false positive with standard thresholds but true negatives with adjusted thresholds.
  
  
  CONCLUSIONS
  Lesion characterization with Gd-BOPTA requires higher thresholds for initial enhancement than those used with conventional Gd-chelates, leading to improved specificity, predictive values, and accuracy.
authors.affiliation: University of Milan School of Medicine, Department of Medical and Surgical Sciences, Unit of Radiology, IRCCS Policlinico San Donato, Milan, Italy. f.sardanelli@grupposandonato.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Sardanelli
authors.forename: Alfonso
authors.initials: A
authors.lastname: Fausto
authors.forename: Anastassia
authors.initials: A
authors.lastname: Esseridou
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Leo
authors.forename: Miles A
authors.initials: MA
authors.lastname: Kirchin
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis*; D017322:Clinical Trials, Phase II as Topic; D003287:Contrast Media; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008536:Meglumine / Q000031:analogs & derivatives*; D008875:Middle Aged; D009942:Organometallic Compounds; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C064572:gadobenic acid; D008536:Meglumine