Kinetic Curve Type Assessment for Classification of Breast Lesions Using Dynamic Contrast-Enhanced MR Imaging

<div><p>Objective</p><p>The aim of this study was to employ a kinetic model with dynamic contrast enhancement-magnetic resonance imaging to develop an approach that can efficiently distinguish malignant from benign lesions.</p><p>Materials and Methods</p><p>A total of 43 patients with 46 lesions who underwent breast dynamic contrast enhancement-magnetic resonance imaging were included in this retrospective study. The distribution of malignant to benign lesions was 31/15 based on histological results. This study integrated a single-compartment kinetic model and dynamic contrast enhancement-magnetic resonance imaging to generate a kinetic modeling curve for improving the accuracy of diagnosis of breast lesions. Kinetic modeling curves of all different lesions were analyzed by three experienced radiologists and classified into one of three given types. Receiver operating characteristic and Kappa statistics were used for the qualitative method. The findings of the three radiologists based on the time-signal intensity curve and the kinetic curve were compared.</p><p>Results</p><p>An average sensitivity of 82%, a specificity of 65%, an area under the receiver operating characteristic curve of 0.76, and a positive predictive value of 82% and negative predictive value of 63% was shown with the kinetic model (p = 0.017, 0.052, 0.068), as compared to an average sensitivity of 80%, a specificity of 55%, an area under the receiver operating characteristic of 0.69, and a positive predictive value of 79% and negative predictive value of 57% with the time-signal intensity curve method (p = 0.003, 0.004, 0.008). The diagnostic consistency of the three radiologists was shown by the κ-value, 0.857 (p<0.001) with the method based on the time-signal intensity curve and 0.826 (p<0.001) with the method of the kinetic model.</p><p>Conclusions</p><p>According to the statistic results based on the 46 lesions, the kinetic modeling curve method showed higher sensitivity, specificity, positive and negative predictive values as compared with the time-signal intensity curve method in lesion classification.</p></div

Percentages of benign and malignant Type 1 (persistent enhancing), Type 2 (plateau) and Type 3 (washout) lesions diagnosed by three radiologists based on the time-signal intensity curve and the kinetic curve.

<p>Percentages of benign and malignant Type 1 (persistent enhancing), Type 2 (plateau) and Type 3 (washout) lesions diagnosed by three radiologists based on the time-signal intensity curve and the kinetic curve.</p

The findings of the breast lesions from three radiologists based on the time-signal intensity curve and the kinetic curve.

<p>The sensitivity (SN), specificity (SP), area under the receiver operating characteristic curve (AUC), positive predictive value (PPV), negative predictive value (NPV), and kappa (κ) value are presented.</p

Comparison of the area under the ROC obtained by three radiologists using two different methods.

<p>Comparison of the area under the ROC obtained by three radiologists using two different methods.</p

Application of the time-signal intensity curve and the kinetic curve in breast MRI analysis.

<p>(a) MRI of a 58-year-old female showed an invasive ductal carcinoma on the upper outer quadrant of the left breast. The green circle indicates the region of interest (ROI) that was used for estimating the change in the C1 value, and the red circle represents the ROI for measuring the ΔM. (b) The blue line is the time-signal intensity curve, and the orange line was generated from a plot of the C2 values to form a kinetic modeling curve.</p

Illustration of the pre- and post- registration of breast MRI with annotation to fuse on mammography in a selected patient for the CC view.

<p>(a) the annotation (red) in MIP of MRI (b) (e) the annotation in mammography (green) (c) the fused annotations from MRI to the mammography (d) the registered MRI with annotation (red) (f) the fusion of registered annotation from MRI to mammography. The yellow area is the overlapping part between the annotations of the fused MRI and mammography.</p

A 54-year-old woman with invasive ductal carcinoma in the upper outer quadrant of the left breast.

<p>(a) MRI annotation (b) the kinetic curve for MRI annotations indicating the Type 3 for the lesion (c) the deformed MRI annotation to register the mammography (d) the microcalcification observed in mammography in corresponding contour.</p

The comparison of histological results with indication of MRI assessment with/without information of mammography.

<p>The comparison of histological results with indication of MRI assessment with/without information of mammography.</p

The proposed framework for MRI to mammography registration.

<p>The proposed framework for MRI to mammography registration.</p

The study flowchart of evaluation of lesion using integrated information from MRI and mammography.

<p>The study flowchart of evaluation of lesion using integrated information from MRI and mammography.</p