Association of Breast Cancer Odds with Background Parenchymal Enhancement Quantified Using a Fully Automated Method at MRI: The IMAGINE Study.

Background Background parenchymal enhancement (BPE) at breast MRI has been associated with increased breast cancer risk in several independent studies. However, variability of subjective BPE assessments have precluded its use in clinical practice. Purpose To examine the association between fully objective measures of BPE at MRI and odds of breast cancer. Materials and Methods This prospective case-control study included patients who underwent a bilateral breast MRI examination and were receiving care at one of three centers in the United States from November 2010 to July 2017. Breast volume, fibroglandular tissue (FGT) volume, and BPE were quantified using fully automated software. Fat volume was defined as breast volume minus FGT volume. BPE extent was defined as the proportion of FGT voxels with enhancement of 20% or more. Spearman rank correlation between quantitative BPE extent and Breast Imaging Reporting and Data System (BI-RADS) BPE categories assigned by an experienced board-certified breast radiologist was estimated. With use of multivariable logistic regression, breast cancer case-control status was regressed on tertiles (low, moderate, and high) of BPE, FGT volume, and fat volume, with adjustment for covariates. Results In total, 536 case participants with breast cancer (median age, 48 years [IQR, 43-55 years]) and 940 cancer-free controls (median age, 46 years [IQR, 38-55 years]) were included. BPE extent was positively associated with BI-RADS BPE (rs = 0.54; P < .001). Compared with low BPE extent (range, 2.9%-34.2%), high BPE extent (range, 50.7%-97.3%) was associated with increased odds of breast cancer (odds ratio [OR], 1.74 [95% CI: 1.23, 2.46]; P for trend = .002) in a multivariable model also including FGT volume (OR, 1.39 [95% CI: 0.97, 1.98]) and fat volume (OR, 1.46 [95% CI: 1.04, 2.06]). The association of high BPE extent with increased odds of breast cancer was similar for premenopausal and postmenopausal women (ORs, 1.75 and 1.83, respectively; interaction P = .73). Conclusion Objectively measured BPE at breast MRI is associated with increased breast cancer odds for both premenopausal and postmenopausal women. Clinical trial registration no. NCT02301767 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Bokacheva in this issue

Untitled Item

Data contains Breast MRI Data images of 2 patients, for each patient, DCE-MRI,T₂-W,T₁-W and PD-W with and without fat saturation are included

Breast_MRI_datasets.rar

Data contains Breast MRI Data images of 2 patients, for each patient, DCE-MRI,T₂-W,T₁-W and PD-W with and without fat saturation are included

Breast MRI data for image registration application

This is one set of MRI data (T1, T2, PD and DCE-MRI ) . It contains visible motions. Image registration techniques can be applied on these images for testing or validation purposes.<br

Breast_MRI_datasets.rar

Data contains Breast MRI Data images of 2 patients(one slice for each patient), for each patient, DCE-MRI,T₂-W,T₁-W and PD-W with and without fat saturation are included

Manual segmentation.

<p>(A and B) show Extreme Slices (C) ROI was drawn on T₂-W without fat saturation images for separating out the breast tissue. (D) ROI was drawn on tumor tissue. Dark green color shows the ROI contour on both images.</p

Bar graph of breast density vs age.

<p>The figure shows bar graph plot of breast density in different age groups. Error bars represent SD of breast density within each group.</p

General overview of the process for outer and inner segmentation in breast MR images.

<p>(A) Original T₂-W MRI Image. (B) Image shows points P1, P2 and P3. (C) Image after fractional Otsu thresholding. (D) Image after the morphological operation. (E) Image shows points P3 and P3’(new P3 point). (F) Image shows points P1, P2, P3, P3’, P4, P5 and fat thickness t, indicated by red arrow. (G) Image shows an overlay of the fitted B-spline curve (yellow) through P4, P3’ and P5. (H) Outer segmented mask image. (I) Outer segmented breast tissue overlaid on the original T₂-W image using the proposed method. (I) and (J) show Non-Fat-Sat T₂-W and Fat-Sat T₂-W images after outer segmentation respectively. (K) Difference image. (L) Inner segmentation image in which FG indicated by green color, fatty tissue by orange and tumor by red color.</p