The value of "constant sharpness" as a diagnostic sign in MR-Mammography.
OBJECTIVE
To examine "constant lesion sharpness" as a morphological diagnostic sign in the differential diagnosis between benign and malignant lesions.


METHODS
This prospective study had institutional review board approval and was HIPAA compliant. In total 1014 consecutive patients were examined (mean age 55 years ± 13 years) and evaluated in our University hospital towards the morphological shape of the lesion borders. The "Constant sharpness Sign" was defined as a lesion remaining continuously sharp for the duration of the dynamic scan. Inclusion criteria were unclear findings (e.g. BIRADS III/IV), Preoperative staging (BRIDAS IV/V), and referred patients from local clinic of gynecology. Exclusion criteria were MRM-examination ≤1 year before, status after surgery and/or biopsy, chemotherapy and/or radiation therapy. Reference Standard was histological verification. Images were diagnosed by two experienced radiologists in consensus, blinded to the standard of reference.


RESULTS
1014 patients with 1084 lesions (436 benign, 648 malignant lesions) were included into the study. 41.5% of benign lesions and 6.8% (181/436) of malignant lesions displayed a constant sharpness as an accompanying morphological sign (P < 0.001). This resulted in a sensitivity of 41.5%, specificity of 93.2%, a positive likelihood ratio of 6.1%, a negative likelihood ratio of 0.63 and an odd's ratio of 9,7%.


CONCLUSIONS
The constant sharpness sign seems to be an accurate predictor of benign breast lesions, which may help to increase the accuracy of MRM as a morphological sign.
Institute of Clinical Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany.
Clemens G
CG
Kaiser
Department of Biomedical Imaging and Image-guided therapy, Medical University Vienna, Austria.
Pascal
P
Baltzer
School of Social Science, University of Mannheim, Germany.
Anna K
AK
Kaiser
Institute of Clinical Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany.
Julia
J
Krammer
Institute of Diagnostic Radiology, University of Erlangen-Nuremberg, Erlangen, Germany; Department of Neuroradiology, Friedrich-Alexander-University Hospital Erlangen-Nürnberg, Germany.
Michael
M
Uder
Institute of Diagnostic Radiology, University of Erlangen-Nuremberg, Erlangen, Germany; Department of Neuroradiology, Friedrich-Alexander-University Hospital Erlangen-Nürnberg, Germany.
Werner A
WA
Kaiser
Institute of Diagnostic Radiology, University of Erlangen-Nuremberg, Erlangen, Germany; Department of Neuroradiology, Friedrich-Alexander-University Hospital Erlangen-Nürnberg, Germany.
Matthias
M
Dietzel
Breast-MR; Constant sharpness; MR-Mammography; Morphology