Enhanced Masses on Contrast-Enhanced Breast: Differentiation Using a Combination of Dynamic Contrast-EnhancedMRIand Quantitative Evaluation with SyntheticMRI

Background The addition of synthetic MRI might improve the diagnostic performance of dynamic contrast-enhanced MRI (DCE-MRI) in patients with breast cancer. Purpose To evaluate the diagnostic value of a combination of DCE-MRI and quantitative evaluation using synthetic MRI for differentiation between benign and malignant breast masses. Study Type Retrospective, observational. Population In all, 121 patients with 131 breast masses who underwent DCE-MRI with additional synthetic MRI were enrolled. Field Strength/Sequence 3.0 Tesla,T-1-weightedDCE-MRIand syntheticMRIacquired by a multiple-dynamic, multiple-echo sequence. Assessment All lesions were differentiated as benign or malignant using the following three diagnostic methods: DCE-MRI type based on the Breast Imaging-Reporting and Data System; synthetic MRI type using quantitative evaluation values calculated by synthetic MRI; and a combination of the DCE-MRI + Synthetic MRI types. The diagnostic performance of the three methods were compared. Statistical Tests Univariate (Mann-WhitneyU-test) and multivariate (binomial logistic regression) analyses were performed, followed by receiver-operating characteristic curve (AUC) analysis. Results Univariate and multivariate analyses showed that the mean T(1)relaxation time in a breast mass obtained by synthetic MRI prior to injection of contrast agent (pre-T-1) was the only significant quantitative value acquired by synthetic MRI that could independently differentiate between malignant and benign breast masses. The AUC for all enrolled breast masses assessed by DCE-MRI + Synthetic MRI type (0.83) was significantly greater than that for the DCE-MRI type (0.70,P < 0.05) or synthetic MRI type (0.73,P < 0.05). The AUC for category 4 masses assessed by the DCE-MRI + Synthetic MRI type was significantly greater than that for those assessed by the DCE-MRI type (0.74 vs. 0.50,P < 0.05). Data Conclusion A combination of synthetic MRI and DCE-MRI improves the accuracy of diagnosis of benign and malignant breast masses, especially category 4 masses. Level of Evidence 4 Technical Efficacy Stage 2

Automated summary

The study evaluated the diagnostic value of combining DCE-MRI and synthetic MRI in differentiating between benign and malignant breast masses, with the findings showing that the T(1) relaxation time acquired by synthetic MRI was a significant quantitative value for differentiation. The AUC for the combination of DCE-MRI + Synthetic MRI was significantly higher than that of DCE-MRI or synthetic MRI alone, especially for category 4 masses.