ABSTRACT
RATIONALE AND OBJECTIVES: Enhancement characteristics after administration of a contrast agent are regarded as a major criterion for differential diagnosis in magnetic resonance mammography (MRM). However, no consensus exists about the best measurement method to assess contrast enhancement kinetics. This systematic investigation was performed to compare visual estimation with manual region of interest (ROI) and computer-aided diagnosis (CAD) analysis for time curve measurements in MRM. MATERIALS AND METHODS: A total of 329 patients undergoing surgery after MRM (1.5 T) were analyzed prospectively. Dynamic data were measured using visual estimation, including ROI as well as CAD methods, and classified depending on initial signal increase and delayed enhancement. RESULTS: Pathology revealed 469 lesions (279 malignant, 190 benign). Kappa agreement between the methods ranged from 0.78 to 0.81. Diagnostic accuracies of 74.4% (visual), 75.7% (ROI), and 76.6% (CAD) were found without statistical significant differences. CONCLUSIONS: According to our results, curve type measurements are useful as a diagnostic criterion in breast lesions irrespective of the method used.
Subject(s)
Algorithms , Artificial Intelligence , Breast Neoplasms/diagnosis , Gadolinium DTPA , Image Interpretation, Computer-Assisted/methods , Magnetic Resonance Imaging/methods , Pattern Recognition, Automated/methods , Adolescent , Adult , Aged , Aged, 80 and over , Contrast Media/administration & dosage , Female , Gadolinium DTPA/administration & dosage , Humans , Image Enhancement/methods , Mammography/methods , Middle Aged , Observer Variation , Reproducibility of Results , Sensitivity and Specificity , Young AdultABSTRACT
OBJECTIVE: The purpose of our study was to evaluate the MRI appearance of phyllodes breast tumors and to differentiate them from fibroadenomas. MATERIALS AND METHODS: MR images were obtained on a 1.5-T imager. T1- and T2-weighted sequences and dynamic 2D fast-field echo T1-weighted sequences were performed. MR images of 23 patients with 24 phyllodes breast tumors (one malignant, 23 benign) were analyzed with respect to morphology and contrast enhancement. The tumors were compared with the MRI appearance of 81 fibroadenomas of 75 patients. RESULTS: Well-defined margins were seen in 87.5% of the phyllodes tumors and 70.4% of the fibroadenomas, and a round or lobulated shape in 100% and 90.1%, respectively. A heterogeneous internal structure was observed in 70.8% of phyllodes tumors and in 49.4% of fibroadenomas. Nonenhancing internal septations were found in 45.8% of phyllodes tumors and 27.2% of fibroadenomas. A significantly greater increase in signal was seen on T2-weighted images in the tissue surrounding phyllodes tumors (21%) compared with fibroadenomas (1.2%). Most of both lesions appeared with low signal intensity on T1- and T2-weighted images. After the administration of contrast material, 33.3% of phyllodes tumors and 22.2% of fibroadenomas showed a suspicious signal intensity-time course. CONCLUSION: Phyllodes breast tumors and other fibroadenomas cannot be precisely differentiated on breast MRI. Phyllodes tumors have benign morphologic features and contrast enhancement characteristics suggestive of malignancy in 33% of cases.
