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. 2012 May;263(2):374-82.
doi: 10.1148/radiol.12111368.

In vivo assessment of ductal carcinoma in situ grade: a model incorporating dynamic contrast-enhanced and diffusion-weighted breast MR imaging parameters

Habib Rahbar  1 , Savannah C Partridge, Wendy B Demartini, Robert L Gutierrez, Kimberly H Allison, Sue Peacock, Constance D Lehman
Affiliations

In vivo assessment of ductal carcinoma in situ grade: a model incorporating dynamic contrast-enhanced and diffusion-weighted breast MR imaging parameters

Habib Rahbar et al. Radiology. 2012 May.

Abstract

Purpose: To develop a model incorporating dynamic contrast material-enhanced (DCE) and diffusion-weighted (DW) magnetic resonance (MR) imaging features to differentiate high-nuclear-grade (HNG) from non-HNG ductal carcinoma in situ (DCIS) in vivo.

Materials and methods: This HIPAA-compliant study was approved by the institutional review board and requirement for informed consent was waived. A total of 55 pure DCIS lesions (19 HNG, 36 non-HNG) in 52 women who underwent breast MR imaging at 1.5 T with both DCE and DW imaging (b = 0 and 600 sec/mm(2)) were retrospectively reviewed. The following lesion characteristics were recorded or measured: DCE morphology, DCE maximum lesion size, peak initial enhancement at 90 seconds, worst-curve delayed enhancement kinetics, apparent diffusion coefficient (ADC), contrast-to-noise ratio (CNR) at DW imaging with b values of 0 and 600 sec/mm(2), and T2 signal effects (measured with CNR at b = 0 sec/mm(2)). Univariate and stepwise multivariate logistic regression modeling was performed to identify MR imaging features that optimally discriminated HNG from non-HNG DCIS. Discriminative abilities of models were compared by using the area under the receiver operating characteristic curve (AUC).

Results: HNG lesions exhibited larger mean maximum lesion size (P = .02) and lower mean CNR for images with b value of 600 sec/mm(2) (P = .004), allowing discrimination of HNG from non-HNG DCIS (AUC = 0.71 for maximum lesion size, AUC = 0.70 for CNR at b = 600 sec/mm(2)). Differences in CNR for images with b value of 0 sec/mm(2) (P = .025) without corresponding differences in ADC values were observed between HNG and non-HNG lesions. Peak initial enhancement was the only kinetic variable to approach significance (P = .05). No differences in lesion morphology (P = .11) or worst-curve delayed enhancement kinetics (P = .97) were observed. A multivariate model combining CNR for images with b value of 600 sec/mm(2) and maximum lesion size most significantly discriminated HNG from non-HNG (AUC = 0.81).

Conclusion: The preliminary findings suggest that DCE and DW MR imaging features may aid in identifying patients with high-risk DCIS. Further study may yield a model combining MR characteristics with histopathologic data to facilitate lesion-specific targeted therapies. © RSNA, 2012.

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Figures

Figure 1a:
Figure 1a:
Non-HNG DCIS lesion on (a, b) DCE and (c, d) DW (b = 600 sec/mm2) MR images in 42-year-old woman. (a) T1-weighted fat-suppressed image shows 9-mm focal area (arrow) of non–mass-like enhancement. (b) The lesion demonstrates 178% peak initial enhancement with areas of delayed washout (red), persistent (blue), and plateau (green) kinetic features. (c) The lesion demonstrates high signal intensity (arrow), with a calculated CNR of 2.655. (d) On ADC map the lesion demonstrates low signal intensity (arrow), with a mean ADC value of 1.28 × 10−3 mm2/sec.
Figure 1b:
Figure 1b:
Non-HNG DCIS lesion on (a, b) DCE and (c, d) DW (b = 600 sec/mm2) MR images in 42-year-old woman. (a) T1-weighted fat-suppressed image shows 9-mm focal area (arrow) of non–mass-like enhancement. (b) The lesion demonstrates 178% peak initial enhancement with areas of delayed washout (red), persistent (blue), and plateau (green) kinetic features. (c) The lesion demonstrates high signal intensity (arrow), with a calculated CNR of 2.655. (d) On ADC map the lesion demonstrates low signal intensity (arrow), with a mean ADC value of 1.28 × 10−3 mm2/sec.
Figure 1c:
Figure 1c:
Non-HNG DCIS lesion on (a, b) DCE and (c, d) DW (b = 600 sec/mm2) MR images in 42-year-old woman. (a) T1-weighted fat-suppressed image shows 9-mm focal area (arrow) of non–mass-like enhancement. (b) The lesion demonstrates 178% peak initial enhancement with areas of delayed washout (red), persistent (blue), and plateau (green) kinetic features. (c) The lesion demonstrates high signal intensity (arrow), with a calculated CNR of 2.655. (d) On ADC map the lesion demonstrates low signal intensity (arrow), with a mean ADC value of 1.28 × 10−3 mm2/sec.
Figure 1d:
Figure 1d:
Non-HNG DCIS lesion on (a, b) DCE and (c, d) DW (b = 600 sec/mm2) MR images in 42-year-old woman. (a) T1-weighted fat-suppressed image shows 9-mm focal area (arrow) of non–mass-like enhancement. (b) The lesion demonstrates 178% peak initial enhancement with areas of delayed washout (red), persistent (blue), and plateau (green) kinetic features. (c) The lesion demonstrates high signal intensity (arrow), with a calculated CNR of 2.655. (d) On ADC map the lesion demonstrates low signal intensity (arrow), with a mean ADC value of 1.28 × 10−3 mm2/sec.
Figure 2a:
Figure 2a:
HNG DCIS lesion on (a, b) DCE and (c, d) DW (b = 600 sec/mm2) MR images in 37-year-old woman. (a) T1-weighted fat-suppressed image shows 51-mm mass. (b) The mass demonstrates 146% peak initial enhancement with areas of delayed washout (red), persistent (blue), and plateau (green) kinetic features. (c) The lesion demonstrated high signal intensity, with a calculated CNR of 2.35. (d) On ADC map the lesion demonstrates low signal intensity, with a mean ADC value of 1.45 × 10−3 mm2/sec.
Figure 2b:
Figure 2b:
HNG DCIS lesion on (a, b) DCE and (c, d) DW (b = 600 sec/mm2) MR images in 37-year-old woman. (a) T1-weighted fat-suppressed image shows 51-mm mass. (b) The mass demonstrates 146% peak initial enhancement with areas of delayed washout (red), persistent (blue), and plateau (green) kinetic features. (c) The lesion demonstrated high signal intensity, with a calculated CNR of 2.35. (d) On ADC map the lesion demonstrates low signal intensity, with a mean ADC value of 1.45 × 10−3 mm2/sec.
Figure 2c:
Figure 2c:
HNG DCIS lesion on (a, b) DCE and (c, d) DW (b = 600 sec/mm2) MR images in 37-year-old woman. (a) T1-weighted fat-suppressed image shows 51-mm mass. (b) The mass demonstrates 146% peak initial enhancement with areas of delayed washout (red), persistent (blue), and plateau (green) kinetic features. (c) The lesion demonstrated high signal intensity, with a calculated CNR of 2.35. (d) On ADC map the lesion demonstrates low signal intensity, with a mean ADC value of 1.45 × 10−3 mm2/sec.
Figure 2d:
Figure 2d:
HNG DCIS lesion on (a, b) DCE and (c, d) DW (b = 600 sec/mm2) MR images in 37-year-old woman. (a) T1-weighted fat-suppressed image shows 51-mm mass. (b) The mass demonstrates 146% peak initial enhancement with areas of delayed washout (red), persistent (blue), and plateau (green) kinetic features. (c) The lesion demonstrated high signal intensity, with a calculated CNR of 2.35. (d) On ADC map the lesion demonstrates low signal intensity, with a mean ADC value of 1.45 × 10−3 mm2/sec.
Figure 3:
Figure 3:
Univariate ROC curves. Relative abilities of DCE maximum lesion size, CNR at DW imaging with b values of 600 sec/mm2 (CNRb600) and 0 sec/mm2 (CNRb0), and peak initial enhancement at imaging 90 seconds after contrast material administration for discrimination of HNG from non-HNG DCIS, as measured by their respective AUCs.
Figure 4:
Figure 4:
Comparison of optimal multivariate model with individual univariate models with ROC curve analysis. Graph shows that a model incorporating both CNR for DW images with b of 600 sec/mm2 (CNRb600) and maximal (Max) lesion size provided the best discriminative ability (AUC = 0.81) than did individual parameters (AUC = 0.71 for maximum size, AUC = 0.70 for CNR).
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