title: Comparison of gadoteric acid and gadobutrol for detection as well as morphologic and dynamic characterization of lesions on breast dynamic contrast-enhanced magnetic resonance imaging.
abstract: OBJECTIVE
  In contrast to conventional breast imaging techniques, one major diagnostic benefit of breast magnetic resonance imaging (MRI) is the simultaneous acquisition of morphologic and dynamic enhancement characteristics, which are based on angiogenesis and therefore provide insights into tumor pathophysiology. The aim of this investigation was to intraindividually compare 2 macrocyclic MRI contrast agents, with low risk for nephrogenic systemic fibrosis, in the morphologic and dynamic characterization of histologically verified mass breast lesions, analyzed by blinded human evaluation and a fully automatic computer-assisted diagnosis (CAD) technique.
  
  
  METHODS
  Institutional review board approval and patient informed consent were obtained. In this prospective, single-center study, 45 women with 51 histopathologically verified (41 malignant, 10 benign) mass lesions underwent 2 identical examinations at 1.5 T (mean time interval, 2.1 days) with 0.1-mmol kg doses of gadoteric acid and gadobutrol. All magnetic resonance images were visually evaluated by 2 experienced, blinded breast radiologists in consensus and by an automatic CAD system, whereas the morphologic and dynamic characterization as well as the final human classification of lesions were performed based on the categories of the Breast imaging reporting and data system MRI atlas. Lesions were also classified by defining their probability of malignancy (morpho-dynamic index; 0%-100%) by the CAD system. Imaging results were correlated with histopathology as gold standard.
  
  
  RESULTS
  The CAD system coded 49 of 51 lesions with gadoteric acid and gadobutrol (detection rate, 96.1%); initial signal increase was significantly higher for gadobutrol than for gadoteric acid for all and the malignant coded lesions (P < 0.05). Gadoteric acid resulted in more postinitial washout curves and fewer continuous increases of all and the malignant lesions compared with gadobutrol (CAD hot spot regions, P < 0.05). Morphologically, the margins of the malignancies were different between the 2 agents, whereas gadobutrol demonstrated more spiculated and fewer smooth margins (P < 0.05). Lesion classifications by the human observers and by the morpho-dynamic index compared with the histopathologic results did not significantly differ between gadoteric acid and gadobutrol.
  
  
  CONCLUSIONS
  Macrocyclic contrast media can be reliably used for breast dynamic contrast-enhanced MRI. However, gadoteric acid and gadobutrol differed in some dynamic and morphologic characterization of histologically verified breast lesions in an intraindividual, comparison. Besides the standardization of technical parameters and imaging evaluation of breast MRI, the standardization of the applied contrast medium seems to be important to receive best comparable MRI interpretation.
authors.affiliation: From the *Department of Radiology, Charité University Medicine Berlin, Berlin; †Institute of Diagnostic and Interventional Radiology, SRH Clinic Gera, Gera; ‡Institute of Diagnostic Radiology, St. Joseph Stift, Bremen; §Imaging Science Institute, Berlin; and ∥Department of Internal Medicine III, Friedrich-Schiller-University, Jena University Hospital, Jena, Germany.
authors.forename: Diane M
authors.initials: DM
authors.lastname: Renz
authors.forename: Tahir
authors.initials: T
authors.lastname: Durmus
authors.forename: Joachim
authors.initials: J
authors.lastname: Böttcher
authors.forename: Matthias
authors.initials: M
authors.lastname: Taupitz
authors.forename: Felix
authors.initials: F
authors.lastname: Diekmann
authors.forename: Alexander
authors.initials: A
authors.lastname: Huppertz
authors.forename: Alexander
authors.initials: A
authors.lastname: Pfeil
authors.forename: Martin H
authors.initials: MH
authors.lastname: Maurer
authors.forename: Florian
authors.initials: F
authors.lastname: Streitparth
authors.forename: Ulrich
authors.initials: U
authors.lastname: Bick
authors.forename: Bernd
authors.initials: B
authors.lastname: Hamm
authors.forename: Eva M
authors.initials: EM
authors.lastname: Fallenberg
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D001943:Breast Neoplasms / Q000473:pathology*; D003287:Contrast Media; D005260:Female; D006571:Heterocyclic Compounds; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D009942:Organometallic Compounds; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; D006571:Heterocyclic Compounds; D009942:Organometallic Compounds; C090600:gadobutrol; C050823:gadolinium 1,4,7,10-tetraazacyclododecane-N,N',N'',N'''-tetraacetate