Clinical evaluation of cylindrical regional suppression in dynamic contrast-enhanced breast MRI: An intra-individual comparison study on image quality and lesion conspicuity

Purpose: To evaluate the effect of a cylindrical regional-suppression technique (CREST) on image quality and lesion conspicuity in dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) of the breast.Method: This was a comparative study of 67 women with 44 lesions who underwent breast DCE-MRI with CREST (CREST-DCE) and had a previous DCE-MRI without CREST (conv-DCE) available. Two radiologists assessed image quality parameters and lesion conspicuity using five-point Likert scales. In an intra-individual comparison, the effects of CREST on image quality (strong degradation to strong improvement) were assessed. Moreover, both radiologists identified the post-contrast phase, which benefited the most from using CREST in direct comparison. The statistical analysis included the Wilcoxon signed-rank test.Results: Cardiac motion-rated artefacts were significantly reduced in CREST-DCE compared to conv-DCE (3.6 +/- 1.2 [CREST-DCE] vs 2.1 +/- 0.8 [conv-DCE], p < 0.001). At the axilla, the visualisation of anatomical structures (3.9 +/- 1.0 vs 2.3 +/- 1.2, p < 0.001) and the skin contour (4.3 +/- 0.8 vs 3.0 +/- 1.1, p < 0.001) were significantly improved in CREST-DCE, whereas ghosting artefacts were significantly less pronounced (3.8 +/- 1.1 vs 2.4 +/- 1.0, p < 0.001). The parasternal region was similarly assessable using both techniques (4.3 +/- 1.1 vs 4.2 +/- 1.2, p = 0.47). In direct comparison, CREST-DCE images were classified as improved in 54/67 and equivalent in 13/ 67 exams. The effects of CREST were found to be most pronounced in the very early post-contrast phase (32/67). The lesion conspicuity was rated similar for CREST and conv-DCE (4.7 +/- 0.7 vs 4.8 +/- 0.2, p = 0.18).Conclusions: CREST appears to be an effective tool to reduce cardiac motion-related artefacts and, therefore, may improve image quality in breast DCE-MRI without impairing lesion conspicuity.

Automated summary

This study aimed to evaluate the effect of a cylindrical regional-suppression technique (CREST) on image quality and lesion conspicuity in dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) of the breast. The results showed that CREST can effectively reduce cardiac motion-related artifacts and improve image quality in breast DCE-MRI without impairing lesion conspicuity.