title: Contrast-enhanced ultrasound in the characterisation of breast masses: utility of quantitative analysis in comparison with MRI.
abstract: OBJECTIVE
  To evaluate the reliability of contrast-enhanced ultrasound quantitative analysis (CE-US) in characterizing breast lesions, in comparison with MRI.
  
  
  METHODS
  Thirty-nine patients with breast lesions BI-RADS 3-5 at US or mammography underwent CE-US and MRI. All lesions underwent histological and quantitative enhancement evaluation with both imaging methods. B-mode US, colour/power Doppler US and CE-US were used; an amplitude and phase modulation technique (CPS) read the signals produced by microbubbles and dedicated software produced the following parameters on time/intensity (T/I) curves: peak %, time to peak (TTP), mean transit time (MTT), regional blood volume (RBV) and regional blood flow (RBF). Student's t test was used to calculate the diagnostic accuracy of CE-US parameters compared with histological results. MRI (1.5 T) was performed before and after bolus gadolinium enhancement. Time/intensity curves were generated for all nodules and Fischer's multimodal score was used to classify them.
  
  
  RESULTS
  Pathology showed 43 nodules (11 benign; 32 malignant). Peak and RBF were the most significant parameters in differential diagnosis, with p values of 0.02 and 0.004, respectively. Positive predictive value (PPV) of CE-US evaluation was 91%, negative predictive value (NPV) was 73% with a high concordance index (k = 0.59) with MRI.
  
  
  CONCLUSIONS
  CE-US quantitative analysis offers an objective and reproducible assessment of lesion vascularisation, with good correlation with the results of MRI.
authors.affiliation: Department of Radiology, Az Ospedaliero-universitaria Policlinico, via del pozzo 71, 41100 Modena, Italy. ncaproni@sirm.org
authors.forename: Natalia
authors.initials: N
authors.lastname: Caproni
authors.forename: Francesca
authors.initials: F
authors.lastname: Marchisio
authors.forename: Annarita
authors.initials: A
authors.lastname: Pecchi
authors.forename: Barbara
authors.initials: B
authors.lastname: Canossi
authors.forename: Rachele
authors.initials: R
authors.lastname: Battista
authors.forename: Piero
authors.initials: P
authors.lastname: D'Alimonte
authors.forename: Pietro
authors.initials: P
authors.lastname: Torricelli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001943:Breast Neoplasms / Q000175:diagnosis*; D003287:Contrast Media; 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; D010743:Phospholipids; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013459:Sulfur Hexafluoride; D016217:Ultrasonography, Mammary / Q000379:methods*
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride