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. 2007 Jun;25(5):593-603.
doi: 10.1016/j.mri.2006.10.011. Epub 2006 Nov 30.

Diagnosis of suspicious breast lesions using an empirical mathematical model for dynamic contrast-enhanced MRI

Xiaobing Fan  1 , Milica Medved, Gregory S Karczmar, Cheng Yang, Sean Foxley, Sanaz Arkani, Wendy Recant, Marta A Zamora, Hiroyuki Abe, Gillian M Newstead
Affiliations

Diagnosis of suspicious breast lesions using an empirical mathematical model for dynamic contrast-enhanced MRI

Xiaobing Fan et al. Magn Reson Imaging. 2007 Jun.

Abstract

The purpose of this study was to test whether an empirical mathematical model (EMM) of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) can distinguish between benign and malignant breast lesions. A modified clinical protocol was used to improve the sampling of contrast medium uptake and washout. T(1)-weighted DCE magnetic resonance images were acquired at 1.5 T for 22 patients before and after injection of Gd-DTPA. Contrast medium concentration as a function of time was calculated over a small region of interest containing the most rapidly enhancing pixels. Then the curves were fitted with the EMM, which accurately described contrast agent uptake and washout. Results demonstrate that benign lesions had uptake (P<2.0 x 10(-5)) and washout (P<.01) rates of contrast agent significantly slower than those of malignant lesions. In addition, secondary diagnostic parameters, such as time to peak of enhancement, enhancement slope at the peak and curvature at the peak of enhancement, were derived mathematically from the EMM and expressed in terms of primary parameters. These diagnostic parameters also effectively differentiated benign from malignant lesions (P<.03). Conventional analysis of contrast medium dynamics, using a subjective classification of contrast medium kinetics in lesions as "washout," "plateau" or "persistent" (sensitivity=83%, specificity=50% and diagnostic accuracy=72%), was less effective than the EMM (sensitivity=100%, specificity=83% and diagnostic accuracy=94%) for the separation of benign and malignant lesions. In summary, the present research suggests that the EMM is a promising alternative method for evaluating DCE-MRI data with improved diagnostic accuracy.

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Figures

Fig. 1
Fig. 1
The contrast concentration curves (open circle) calculated from the average signal over the ROI using Eq. (1) are plotted as a function of time for (A) benign, (B) DCIS and (C) IDC lesions. The fitted curves (solid lines) obtained from the EMM demonstrate goodness of fit. The ROI are shown in images next to the plots.
Fig. 2
Fig. 2
The contrast medium concentrations (open circle) calculated from the average signal over the ROI using Eq. (1) are plotted as a function of time for the (A) liver, (B) heart and (C) vessels. The fitted curves (solid lines) obtained from the EMM demonstrate goodness of fit. The ROI are shown in images next to the plots. The location of the liver, heart and vessels is indicated by arrows.
Fig. 3
Fig. 3
Plot of uptake rate (α) versus washout rate (β) obtained by fitting the contrast concentration curves with the EMM for 6 benign lesions and 12 malignant lesions. Triangles inside squares indicate IDC. There is clear separation between benign and malignant lesions, although one of the benign lesions is an outlier.
Fig. 4
Fig. 4
Plots of calculated secondary parameters (A) enhancement slope at the peak versus time to peak of enhancement and (B) curvature at the peak of enhancement versus time to peak of enhancement for 6 benign lesions and 12 malignant lesions. The plots show that most benign lesions have longer times to peak of enhancement, more gentle enhancement slopes and smaller curvatures at the peak of enhancement compared to malignant lesions.
Fig. 5
Fig. 5
The number of lesions classified by radiologists as ‘washout,’ ‘plateau’ and ‘persistent’ based on the system proposed by Kuhl et al. for 6 benign lesions and 12 malignant lesions. There is a clear overlap between benign and malignant lesions in the ‘plateau’ and ‘persistent’ groups.
Fig. 6
Fig. 6
(A–D) Plot of sensitivities of four parameters of the EMM based on Eqs. (12)-(15). The vertical axis is unitless and corresponds to changes in C(t) due to variations in each parameter. The a value used in simulations does not cover the range seen in the data because decay was too rapid at larger α values.
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