Volumetric kinetic assessment in dynamic contrast enhanced-MRI (DCE-MRI) of breast cancer: A new method for evaluation of whole tumor enhancing pattern
Keywords:
Breast MRI, breast cancer, volumetric kinetic assessment, color coded breast MRIAbstract
Background: At present, dynamic contrast enhancement-MRI (DCE-MRI) has an immense role in the diagnosis and evaluation of the extent of breast cancer. As for diagnosis, evaluation of patterns of kinetic enhancement in dynamic contrast studies is performed after gadolinium injection. Since each breast cancer has internal pathophysiological variety, the kinetic enhancement patterns are supposed to be varied within each mass as well.
Objective: This study aimed to investigate the characteristics and additional value of volumetric analysis of kinetic enhancement patterns on DCE-MRI in evaluating breast cancer in Thai patients.
Methods: We retrospectively studied 52 women, and 67 lesions which were histologically proven breast cancers, using software of breast MRI and generating 3D volumetric voxels covering the total tumor volume in DCE-MRI performed between January 2014 and December 2017. Measurement of enhancement patterns was categorized by software into the percentage of part of the tumor which enhanced in each pattern. Consequently, percentages of enhancement in different type were collected and allocated into type I (persistent), type II (plateau), and type III (washout) enhancements. Analysis of the kinetic pattern was done together with subgroup analysis of each type of tumor (IDC, DCIS, and other subtypes of breast cancer), as well as tumor grades.
Results: The mean percentages of enhancement pattern in kinetic assessment by 3D voxels of tumor volume showed the most common type I enhancement (72%), followed by type III enhancement (14.3%) and type II enhancement (13.7%). Subgroup analysis showed similar higher type I enhancement in both IDC (68.3%) and DCIS (81.3%). However, there were slightly higher suspicious malignant patterns of enhancement (31.7% type II and 18.7% type III enhancements) in IDC than DCIS, as well as in high tumor grade (grade 3) than low tumor grade (grade 1) (37% type II and 30.7% type III enhancements), but there were no significant differences.
Conclusion: Volumetric analysis showed heterogeneity of kinetic curve enhancement patterns inside each tumor. That means each tumor has a variety of enhancement patterns in itself and dissimilarity with others. The majority of patterns were found as type I enhancement which was not particular for malignant, whereas there was only 28% with suspicious kinetic enhancement patterns (type II and type III enhancements). The slightly higher suspicious malignant patterns of enhancement (type II and III enhancements) in IDC more than DCIS along with high tumor grade was observed, deprived of statistical significance.
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