Optimizing ultrafast dynamic contrast-enhanced MRI scan duration in the differentiation of benign and malignant breast lesions

Abstract

Objective: To determine the optimal scan duration for ultrafast DCE-MRI in effectively differentiating benign from malignant breast lesions.

Methods: The study prospectively recruited participants who underwent breast ultrafast DCE-MRI from September 2021 to March 2023. A 30-phase breast ultrafast DCE-MRI on a 3.0-T MRI system was conducted with a 4.5-s temporal resolution. Scan durations ranged from 40.5 s to 135.0 s, during which the analysis is performed at three-phase intervals, forming eight dynamic sets (scan duration [SD]_40.5s: 40.5 s, SD_54s: 54.0 s, SD_67.5s: 67.5 s, SD_81s: 81.0 s, SD_94.5s: 94.5 s, SD_108s: 108.0 s, SD_121.5s: 121.5 s, and SD_135s: 135.0 s). Two ultrafast DCE-MRI parameters, maximum slope (MS) and initial area under the curve in 60 s (iAUC), were calculated for each dynamic set and compared between benign and malignant lesions. Areas under the receiver operating characteristic curve (AUCs) were used to assess their diagnostic performance.

Results: A total of 140 women (mean age, 47 ± 11 years) with 151 lesions were included. MS and iAUC from eight dynamic sets exhibited significant differences between benign and malignant lesions (all p < 0.05), except iAUC at SD_40.5s. The AUC of MS (AUC = 0.804) and iAUC (AUC = 0.659) at SD_67.5s were significantly higher than their values at SD_40.5s (AUC = 0.606 and 0.516; corrected p < 0.05). No significant differences in AUCs for MS and iAUC were observed from SD_67.5s to SD_135s (all corrected p > 0.05).

Conclusions: Ultrafast DCE-MRI with a 67.5-s scan duration appears optimal for effectively differentiating malignant from benign breast lesions.

Critical relevance statement: By evaluating scan durations (40.5-135 s) and analyzing two ultrafast DCE-MRI parameters, we found a scan duration of 67.5 s optimal for discriminating between these lesions and offering a balance between acquisition time and diagnostic efficacy.

Key points: Ultrafast DCE-MRI can effectively differentiate malignant from benign breast lesions. A minimum of 67.5-sec ultrafast DCE-MRI scan duration is required to differentiate benign and malignant lesions. Extending the scan duration beyond 67.5 s did not significantly improve diagnostic accuracy.

Keywords: Breast neoplasms; Differential diagnosis; Kinetics; Magnetic resonance imaging.

Fig. 1

Flow diagram of participant selection. n Represents the number of participants, and n^* represents the number of lesions

Fig. 2

Flow chart of ultrafast DCE-MRI data processing. The image set that showed the pre-contrast CS-VIBE was marked as the first phase. The pre-contrast sequences and different phases of post-contrast sequences (1–9, 1–12, 1–15, 1–21, 1–24, 1–27, and 1–30) were used to form eight sets of dynamic series with scan duration ranging from 40.5 s t0 135.0 s. CS-VIBE T1-weighted compressed-sensing volume interpolated breath-hold examination

Fig. 3

Line plots of ultrafast DCE-MRI parameter values in relation to scan duration for all benign lesions (blue) and malignant lesions (red). MS maximum slope, iAUC initial area under the curve in 60 s

Fig. 4

A Ultrafast breast DCE-MRI scans in a 49-year-old woman with pathologically confirmed benign fibroadenoma in the right breast. The first two rows (a–h) show color maps of the MS from SD_40.5s to SD_135s. The last two rows (i–p) show color maps of iAUC from SD_40.5s to SD_135s. B Ultrafast breast DCE-MRI scans in a 53-year-old woman with pathologically confirmed invasive ductal carcinoma in the left breast. The first two rows (a–h) show color maps of the MS from SD_40.5s to SD_135s. The last two rows (i–p) show color maps of the iAUC in 60 s from SD_40.5s to SD_135s. MS maximum slope, iAUC initial area under the curve in 60 s, SD scan duration

Fig. 5

Graphs show the receiver operating characteristic (ROC) curve of ultrafast DCE-MRI parameters with different scan durations. MS_40.5s = MS with a scan duration of 40.5 s, MS_54s = MS with a scan duration of 54 s, MS_67.5s = MS with a scan duration of 67.5 s, MS_81s = MS with a scan duration of 81 s, MS_94.5s = MS with a scan duration of 94.5 s, MS_108s = MS with a scan duration of 108 s, MS_121.5s = MS with a scan duration of 121.5 s, MS_135s = MS with a scan duration of 135 s. iAUC definitions for different scan durations are the same as MS above. MS maximum slope, iAUC initial area under the curve in 60 s