Comparison of morphological and kinetic parameters in distinction of benign and malignant breast lesions in dynamic contrast enhanced magnetic resonance imaging

Year 2013, Volume: 40 Issue: 4, 562 - 569, 01.12.2013

Direnç Özlem Aksoy Zeynep Gamze Kılıçoğlu Gökalp Yılmaz Ercüment Kadıoğlu Mehmet Masum Şimşek Seçil Telli

https://doi.org/10.5798/diclemedj.0921.2013.04.0333

Abstract

Objective: To evaluate the value of qualitative morphological and kinetic data and quantitative kinetic data in distinction of malignancy in dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) of the breast. Methods: DCE-MRIs of 49 subjects were evaluated. Morphological and contrast enhancement parameters of 95 lesions were recorded in these subjects. Post-contrast kinetic behavior of these lesions were also investigated. Among the quantitative parameters, relative enhancements (E1, E2, Epeak), time-to-peak (Tpeak), slope of curve (Slope), signal enhancement ratio (SER), and maximum intensity time ratio (MITR) were calculated. These results were compared with the pathological diagnosis. Results: Spiculated contour (100%), rim enhancement (97.87%), irregular shape (95.74%), and irregular margin (91.49%) were the most specific morphological features of malignancy in mass lesions. In non-mass lesions, focal zone (91.49%) was the most specific feature of malignancy. 74.5% of the benign lesions showed type 1, 77.1% of the malignant lesions showed type 2 and 3 curves according to the kinetic curve evaluation. All quantitative parameters except Epeak were found to be statistically significant in distinction of malignancy. Conclusion: None of the morphological features of the benign lesions were found to be significantly specific. More specific features can be described for malignant lesions. Early behavior of the kinetic curve is not useful for diagnosis of malignancy but the intermediate and late behavior gives useful information. Quantitative data involved in this study might be promising.

Keywords

Morphological, kinetic, breast lesions, magnetic resonance imaging, dynamic

Dinamik kontrastlı manyetik rezonans incelemede morfolojik ve kinetik parametrelerin meme lezyonlarının iyi ve kötü huylu ayırımına katkısı

Abstract

Amaç: Memenin dinamik kontrastlı manyetik rezonans görüntülemesinde (DK-MRG) kalitatif morfolojik ve kinetik veriler ile kantitatif kinetik verilerin, lezyonların malign-benign ayırımındaki katkısını değerlendirme. Yöntemler: Dinamik kontrastlı meme manyetik rezonans görüntülemesi yapılan 49 hastada 95 lezyon, önce morfolojik ve kontrastlanma özellikleri bakımından değerlendirildi. Ayrıca, lezyonların kontrast sonrası kinetik davranışları değerlendirildi. Sonra kantitatif parametrelerden relatif enhansmanlar (E1, E2, Epeak), zirve zamanı (time-to-peak, Tpeak), eğri eğimi (Slope), sinyal enhansman oranı (SER) ve azami yoğunluk zaman oranı (MITR) değerleri hesaplandı. Tüm bu veriler patoloji sonuçları ile karşılaştırıldı. Bulgular: Morfolojik özelliklerden malignite için özgünlüğü en yüksek olan parametreler kitlesel lezyonlarda: spiküle kenar (%100), halkasal kontrastlanma (%97,87), düzensiz şekil (%95,74), düzensiz kenar (%91,49), kitlesel formasyon göstermeyen lezyonlarda: fokal alan (%91,49) olarak bulundu. Kinetik eğrinin değerlendirilmesinde, benign lezyonların %74,5\' i tip 1, malign lezyonların %77,1\' i tip 2-3 eğri paterni sergilemekteydi. Değerlendirmeye katılan kantitatif parametrelerden Epeak dışındakiler, lezyonların benign-malign ayırımında istatistiksel olarak anlamlı bulundu. Sonuç: Benign lezyonların morfolojik özelliklerinde karakteristik olarak tanımlayabileceğimiz özgünlüğü belirgin yüksek bir parametreye rastlamadık. Ancak malign lezyonlar için daha spesifik özellikler tanımlanabilmektedir. Malign ve benign lezyonlar, kinetik eğrinin erken dönem davranışı ile ayrılamamakta ancak orta-geç dönem seyrinin değerlendirilmesi ile anlamlı veriler elde edilmektedir. Değerlendirmeye kattığımız kantitatif veriler de lezyonların malign-benign ayırımında umut vaat etmektedir.

Keywords

Morfolojik, kinetik, meme lezyonları, manyetik rezonans görüntüleme, dinamik

References

• Siegmann KC, Müller-Schimpfle MM, Schick F, et al. MR imaging–detected breast lesions: histopathological correla- tion of lesion characteristics and signal intensity data. AJR Am J Roentgenol 2002;178:1403-1409.
• Heywang SH, Wolf A, Pruss E, et al. MR imaging of breast with Gd-DTPA: use and limitations. Radiology 1993;171:95-103.
• Heywang-Kobrunner SH, Viehweg P, Heinig A, Kuchler C. Contrast-enhanced MRI of the breast: accuracy, value, con- troversies, solutions. Eur J Radiol 1997;24:94–108.
• Gribbestad IS, Nilsen G, Fjosne H, et al. Contrast enhanced magnetic rezonance imaging of the breast. Acta Oncol 1992; 31:833-842.
• Hrung JM, Sonnad SS, Schwartz JS, Langlotz CP. Accuracy of MR imaging in the work-up of suspicious breast lesions: a diagnostic meta-analysis. Acad Radiol 1999;6:387-397.
• Gilles R, Guinebretiere JM, Lucidarme O, et al. Nonpalpable breast tumors: diagnosis with contrast-enhanced subtrac- tion dynamic MR imaging. Radiology 1994; 191:625 631.
• Bluemke DA, Gatsonis CA, Chen MH, et al. Magnetic reso- nance imaging of the breast prior to biopsy. JAMA 2004; 292:2735–2742.
• Huang W, Fisher PR, Dulaimy K, et al. Detection of breast malignancy: diagnostic MR protocol for improved specific- ity. Radiology 2004; 232:585–591.
• Nunes LW, Schnall MD, Orel SG, et al. Breast MR imaging: interpretation model. Radiology 1997; 202: 833–841.
• Nunes LW, Schnall MD, Siegelman ES, et al. Diagnostic performance characteristics of architectural features re- vealed by high spatial-resolution MR imaging of the breast. AJR Am J Roentgenol. 1997; 169:409-415.
• Goto M, Ito H, Akazawa K, Kubota T, Kizu O, Yamada K, Nishimura T. Diagnosis of breast tumors enhancement patterns and morphologic features. J Magn Reson Imaging 2007; 25:104–112.
• Kuhl CK, Schild HH, Morakkabati N. Dynamic bilat- eral contrast enhanced MR imaging of the breast: trade- off between spatial and temporal resolution. Radiology 2005;236:789–800.
• Orel SG, Schnall MD, LiVolsi VA, Troupin RH. Suspicious breast lesions: MR imaging with radiologic-pathologic cor- relation. Radiology 1994; 190:485-493.
• Kaiser WA, Zeitler E. MR imaging of the breast: fast im- aging sequences with and without Gd-DTPA-preliminary observations. Radiology 1989; 170:681-686.
• Kuhl CK, Mielcareck P, Klaschik S, et al. Dynamic breast MR imaging: are signal intensity time course data useful for differential diagnosis of enhancing lesions? Radiology 1999; 211:101-110.
• Boetes C, Barentsz JO, Mus RD, et al. MR characteriza- tion of suspicious breast lesions with a gadolinium-en- hanced Turbo FLASH subtraction technique. Radiology 1994;193:777-781.
• Fischer U, Kopka L, Grabbe E. Breast carcinoma: effect of preoperative contrast enhanced MR imaging on the thera- peutic approach. Radiology 1999;213:881-888.
• U Sivarjan, KJ Jayapragasam, YF Abdul Aziz, K Rahmat, SI Bux. Dynamic contrast enhancement magnetic rezonance Imaging Evaluation of Breast Lesions: a morphological and quantitative analysis. JHK Coll Radiol 2009;12:43-52.
• T. Schlossbauer, et al. Classification of small contrast en- hancing breast lesions in dynamic magnetic resonance im- aging using a combination of morphological criteria and dynamic analysis based on unsupervised vector-quantiza- tion. Invest Radiol 2008;43:56-64.
• Kinkel K, Helbich TH, Esserman LJ, et al. Dynamic high- spatial-resolution MR imaging of suspicious breast lesions: diagnostic criteria and interobserver variability. AJR Am J Roentgenol 2000; 175:35–43.
• Wedegartner U, Bick U, Wortler K, et al. Differentiation between benign and malignant findings on MR-mammog- raphy: usefulness of morphological criteria. Eur Radiol 2001;11:1645–1650.
• Fischer DR, Wurdinger S, Boettcher J, et al. Related ar- ticles, links further signs in the evaluation of magnetic reso- nance mammography: a retrospective study. Invest Radiol 2005; 40:430–435.
• Szabó BK, Aspelin P, Wiberg MK, Boné B. Dynamic MR imaging of the breast. Analysis of kinetic and morphologic diagnostic criteria. Acta Radiol 2003;44:379–386.
• Jansen SA, Newstead GM, Abe H, et al. Pure ductal carci- noma in situ: kinetic and morphologic MR characteristics compared with mammographic appearance and nuclear grade. Radiology 2007;245:684-691.
• Sanaz A. Jansen, Akiko Shimauchi, Lindsay Zak, et al. The diverse pathology and kinetics of mass, nonmass and focus enhancement on MR imaging of the breast. J Magn Reson Imaging 2011 ;33:1382–1389.
• A Karahaliou, K Vassiou, Arikidis NS, et al. Assessing het- erogeneity of lesion enhancement kinetics in dynamic con- trast-enhanced MRI for breast cancer diagnosis. Br J Radiol 2010;83:296-306.
• Szabó BK, Aspelin P, Wiberg MK. Neural network ap- proach to the segmentation and classification of dynamic magnetic resonance images of the breast: comparison with empiric and quantitative kinetic parameters. Acad Radiol 2004;11:1344-1354.
• Warren RML, Pointon L, Thompson D, et al. Reading protocol for dynamic contrast-enhanced MR images of the breast: Sensitivity and specificity analysis. Radiology 2005;236:779-788.
• U Sivarjan, KJ Jayapragasam, YF Abdul Aziz, et al. Dy- namic contrast enhancement magnetic resonance imaging evaluation of breast lesions: A morphological and quantita- tive analysis. JHK Coll Radiol 2009;12:43-52.
• M.D.Schnall, J. Blume, D. A. Bluemke, et al. Diagnostic architectural and dynamic features at breast MR imaging: Multicenter study. Radiology 2006; 238:42-53.
• Greenstein Orel, MD. Differentiating benign from malig- nant enhancing lesions identified at MR imaging of the breast: Are time-signal intensity curves an accurate predic- tor? Radiology 1999;211:25-27.
• Brinck U, Fischer U, Korabiowska M, et al. The variability of fibroadenoma in contrast enhanced dynamic MR mam- mography. AJR Am J Roentgenol 1997;168:1331–1334.
• Stelling CB, Powell DE, Mattingly SS. Fibroadenomas: histopathologic and MR imaging features. Radiology 1987;162:399–407.
• Kuhl CK, Schild HH. Dynamic image interpretation of MRI of the breast. J Magn Reson Imaging 2000;12:965–974.
• Ikeda DM, Hylton NM, Kinkel K, et al. Development, stan- dardization, and testing of a lexicon for reporting contrast- enhanced breast magnetic resonance imaging studies. J Magn Reson Imaging 2001;13:889-895.
• Liberman L, Morris EA, Dershaw DD, et al. Ductal en- hancement on MR imaging of the breast. AJR Am J Roent- genol 2003;181:519–525.
• Sanaz A. Jansen, Xiaobing Fan, Gregory S, et al. DCEMRI of breast lesions: Is kinetic analysis equally effective for both mass and nonmass-like enhancemente? Am Assoc Phys Med 2008;35:3102-3109.
• Jansen SA, Fan X, Karczmar GS, et al. Differentiation be- tween benign and malignant breast lesions. Magn Reson Med 2008;59:747–754.
• Orel SG, Schnall MD, Powell CM, et al. Staging of sus- pected breast cancer: effect of MR imaging and MR-guided biopsy. Radiology 1995;196:115-122.