title: Dynamic contrast-enhanced MRI of the breast: quantitative method for kinetic curve type assessment.
abstract: OBJECTIVE
  The type of contrast enhancement kinetic curve (i.e., persistently enhancing, plateau, or washout) seen on dynamic contrast-enhanced MRI (DCE-MRI) of the breast is predictive of malignancy. Qualitative estimates of the type of curve are most commonly used for interpretation of DCE-MRI. The purpose of this study was to compare qualitative and quantitative methods for determining the type of contrast enhancement kinetic curve on DCE-MRI.
  
  
  METHODS
  Ninety-six patients underwent breast DCE-MRI. The type of DCE-MRI kinetic curve was assessed qualitatively by three radiologists on two occasions. For quantitative assessment, the slope of the washout curve was calculated. Kappa statistics were used to determine inter- and intraobserver agreement for the qualitative method. Matched sample tables, the McNemar test, and receiver operating characteristic (ROC) curve statistics were used to compare quantitative versus qualitative methods for establishing or excluding malignancy.
  
  
  RESULTS
  Seventy-eight lesions (77.2%) were malignant and 23 (22.8%) were benign. For the qualitative assessment, the intra- and interobserver agreement was good (kappa = 0.76-0.88), with an area under the ROC curve (AUC) of 0.73-0.77. For the quantitative method, the highest AUC was 0.87, reflecting significantly higher diagnostic accuracies compared with qualitative assessment (p < 0.01 for the difference between the two methods).
  
  
  CONCLUSIONS
  Quantitative assessment of the type of contrast enhancement kinetic curve on breast DCE-MRI resulted in significantly higher diagnostic performance for establishing or excluding malignancy compared with assessment based on the standard qualitative method.
authors.affiliation: Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Riham H
authors.initials: RH
authors.lastname: El Khouli
authors.forename: Katarzyna J
authors.initials: KJ
authors.lastname: Macura
authors.forename: Michael A
authors.initials: MA
authors.lastname: Jacobs
authors.forename: Tarek H
authors.initials: TH
authors.lastname: Khalil
authors.forename: Ihab R
authors.initials: IR
authors.lastname: Kamel
authors.forename: Andrew
authors.initials: A
authors.lastname: Dwyer
authors.forename: David A
authors.initials: DA
authors.lastname: Bluemke
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000378:metabolism*; D003198:Computer Simulation; D003287:Contrast Media / Q000493:pharmacokinetics*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D008954:Models, Biological; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media