Breast cancer is the second most common cancer overall and the most common cancer in woman worldwide. MRI is the most sensitive imaging technique for cancer detection. Women with very high risk for cancer are currently recommended for cancer screening with magnetic resonance imaging (MRI). MRI also plays a critical role in lesion characterization and monitoring the treatment response in clinical trials.
Breast evaluation using MRI is time-consuming because of the number of images, image processing and interpretation. To solve several limitations of DCE-MRI, DYNAMIKA was enhanced to allows for faster identification of tissue of interest, increasing workflow and more accurate measurements.
Qualitative estimates of the type of curve are most commonly used for interpretation of DCE-MRI and this dynamic enhancement pattern of a lesion can be analysed using computer aided detection software. Changes in the tumor microvasculature, visualised by DCE-MRI, can be important in tumor assessment and response evaluation. The type of contrast enhancement kinetic curve (i.e., persistently enhancing, plateau, or washout) seen on dynamic contrast-enhanced MRI (DCE-MRI) of the breast is used to predict the chance of malignancy.
We conducted this study with researchers from Heerlen, Netherlands and Zuyderland MC, Radiology-MRI, London, UK to compare quantitative enhancement parameters of 1.0 molar Gadobutrol with and without the utilisation of a Computer Aided Detection (CAD) software DYNAMIKA in 30 patients with histologically proven breast cancers initially classified as BIRADS-5, undergoing dynamic contrast-enhanced MRI of the breasts.
We concluded that
- Presenting parametric maps on demand can guide an observer in reading DCE-MRI. A computer aided detection (CAD)-system provides additional pharmokinetic information and guides the reader in DCE-MRI series of the breast.
- The Intra-class Correlation Coefficient (ICC) showed an excellent (0.9) agreement in MEmean and IREmean
- The maximum diameter measurement (MDM) using parametric maps correlate excellent (0.9) with the MDM on early subtraction images. Measuring the MDM on parametric maps (ME,IRE,AUC) can reliably be done when using a CAD-system.
Measurements of contrast kinetics do not significantly differ when ROI is placed inside a breast tumor with usage of a CAD-system or when the ROI is placed inside a breast tumor without the use of a CAD-system. CAD systems in reading breast series can be a valuable tool as more pharmacokinetic information about the dynamic series is presented.
CLINICAL TRIAL REFERENCE: http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4956
Read full article: Contrast kinetics of Gadobutrol in dynamic contrast-enhanced MRI of the breast in patients with histologically proven breast cancers initially classified as BIRADS 5 with and without a computer aided detection system, M. Junghans, D. Roettger, S.D. Meens-Koreman, ESMRMB 2017, The European Forum for MR research and clinical practice, www.esmrmb.org
Maximum Enhancement (ME) parametric map, bright yellow pixels show the height of the contrast enhancement curve.
Initial Rate of Washout (IRW) parametric map, red pixels show the fastest washout of the contrast agent.
Area Under the Curve (AUC) parametric map, white pixels in the map highlight maximum contrast agent accumulation.