title: Improved diagnostic accuracy with multiparametric magnetic resonance imaging of the breast using dynamic contrast-enhanced magnetic resonance imaging, diffusion-weighted imaging, and 3-dimensional proton magnetic resonance spectroscopic imaging.
abstract: BACKGROUND
  The purpose of this study was to compare the diagnostic accuracy of dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) as a single parameter to multiparametric (MP) MRI with 2 (DCE MRI and diffusion-weighted imaging [DWI]) and 3 (DCE MRI, DWI, and 3-dimensional proton magnetic resonance spectroscopic imaging [3D H-MRSI]) parameters in breast cancer diagnosis.
  
  
  METHODS
  This prospective study was approved by the institutional review board. Written informed consent was obtained in all patients. One hundred thirteen female patients (mean age, 52 years; range, 22-86 years) with an imaging abnormality (Breast Imaging Reporting and Data System 0, 4-5) were included in this study. Multiparametric MRI of the breast at 3 T with DCE MRI, DWI, and 3D H-MRSI was performed. The likelihood of malignancy was assessed for DCE MRI and MP MRI with 2 (DCE MRI and DWI) and 3 (DCE MRI, DWI, and 3D H-MRSI) parameters separately. Histopathology was used as the standard of reference. Appropriate statistical tests were used to assess sensitivity, specificity, and diagnostic accuracy for each assessment combination.
  
  
  RESULTS
  There were 74 malignant and 39 benign breast lesions. Multiparametric MRI with 3 MRI parameters yielded significantly higher areas under the curve (0.936) in comparison with DCE MRI alone (0.814) (P<0.001). Multiparametric MRI with just 2 parameters at 3 T did not yield higher areas under the curve (0.808) than did DCE MRI alone (0.814). Multiparametric MRI with 3 parameters resulted in elimination of false-negative lesions and significantly reduced the false-positives ones (P=0.002).
  
  
  CONCLUSIONS
  Multiparametric MRI with 3 parameters increases the diagnostic accuracy of breast cancer in comparison with DCE-MRI alone and MP MRI with 2 parameters.
authors.affiliation: From the Departments of *Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, †Biomedical Imaging and Image-guided Therapy, MR Centre of Excellence, ‡Surgery, §Pathology, and ∥Internal Medicine, Division of Oncology, Medical University of Vienna, Vienna, Austria.
authors.forename: Katja
authors.initials: K
authors.lastname: Pinker
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Bogner
authors.forename: Pascal
authors.initials: P
authors.lastname: Baltzer
authors.forename: Stephan
authors.initials: S
authors.lastname: Gruber
authors.forename: Hubert
authors.initials: H
authors.lastname: Bickel
authors.forename: Benedikt
authors.initials: B
authors.lastname: Brueck
authors.forename: Siegfried
authors.initials: S
authors.lastname: Trattnig
authors.forename: Michael
authors.initials: M
authors.lastname: Weber
authors.forename: Peter
authors.initials: P
authors.lastname: Dubsky
authors.forename: Zsuzsanna
authors.initials: Z
authors.lastname: Bago-Horvath
authors.forename: Rupert
authors.initials: R
authors.lastname: Bartsch
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Helbich
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis*; D003287:Contrast Media; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008536:Meglumine; D008875:Middle Aged; D009942:Organometallic Compounds; D011446:Prospective Studies; D058996:Quality Improvement
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; D008536:Meglumine; C072417:gadoterate meglumine