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. 2025 Sep 2;7(4):453-462.
doi: 10.1093/jbi/wbae089.

Time to Enhancement Measured From Ultrafast Dynamic Contrast-Enhanced MRI for Improved Breast Lesion Diagnosis

Yun An Chen  1 , Anum S Kazerouni  1 , Matthew D Phelps  1 , Daniel S Hippe  2 , Inyoung Youn  3 , Janie M Lee  1 , Savannah C Partridge  1 , Habib Rahbar  1
Affiliations

Time to Enhancement Measured From Ultrafast Dynamic Contrast-Enhanced MRI for Improved Breast Lesion Diagnosis

Yun An Chen et al. J Breast Imaging. .

Abstract

Objective: Breast MRI affords high sensitivity with intermediate specificity for cancer detection. Ultrafast dynamic contrast-enhanced (DCE) MRI assesses early contrast inflow with potential to supplement or replace conventional DCE-MRI kinetic features. We sought to determine whether radiologist's evaluation of ultrafast DCE-MRI can increase specificity of a clinical MRI protocol.

Methods: In this IRB-approved, HIPAA-compliant study, breast MRIs from March 2019 to August 2020 with a BI-RADS category 3, 4, or 5 lesion were identified. Ultrafast DCE-MRI was acquired during the first 40 seconds after contrast injection and before conventional DCE-MRI postcontrast acquisitions in the clinical breast MRI protocol. Three radiologists masked to outcomes retrospectively determined lesion time to enhancement (TTE) on ultrafast DCE-MRI. Interreader agreement, differences between benign and malignant lesion TTE, and TTE diagnostic performance were evaluated.

Results: Ninety-five lesions (20 malignant, 75 benign) were included. Interreader agreement in TTE was moderate to substantial for both ultrafast source images and subtraction maximum intensity projections (overall κ = 0.63). Time to enhancement was greater across benign lesions compared with malignancies (P <.05), and all lesions demonstrating no enhancement during the ultrafast series were benign. With a threshold TTE ≥40 seconds, ultrafast DCE-MRI yielded an average 40% specificity (95% CI, 30%-48%) and 92% sensitivity (95% CI, 81%-100%), yielding a potential reduction in 31% (95% CI, 23%-39%) of benign follow-ups based on conventional DCE-MRI.

Conclusion: Ultrafast imaging can be added to conventional DCE-MRI to increase diagnostic accuracy while adding minimal scan time. Future work to standardize evaluation criteria may improve interreader agreement and allow for more robust ultrafast DCE-MRI assessment.

Keywords: breast MRI; breast cancer; screening; ultrafast imaging.

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Conflict of interest statement

Y.A.C., A.S.K, M.D.P., and I.Y. declare no financial conflicts of interest related to this work. D.S.H., S.C.P, J.L., and H.R. receive or have received grant funding and services from GE Healthcare. D.S.H., S.C.P, and H.R. receive grant funding from Guerbet, LLC. S.C.P. receives grant funding from Microsoft AI for Good and other services from Philips Healthcare.

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