Ultrafast breast magnetic resonance imaging (MRI) may have a variety of limitations in comparison to conventional dynamic-contrast-enhanced MRI (DCE MRI), according to new research.
For the retrospective study, recently published in Radiology, researchers reviewed breast MRI data from 31 women who had a total of 59 enhancing lesions that were difficult to characterize and/or had moderate or marked background parenchymal enhancement (BPE). All patients had two-dimensional DCE MRI and subsequent ultrafast MRI, according to the study.
Rating BPE on a 1 (absent) to 4 (marked) scale, the study authors noted reduced BPE with ultrafast MRI in contrast to DCE MRI (mean BPE rating of 2.5 vs. 3.3).
However, employing a 1-5 scale, the researchers pointed out that ultrafast MRI offered significantly lower image quality (2.3 vs. 4.1) and lower lesion conspicuity (1.3 vs. 3.5).
“ … Compared with standard two-dimensional dynamic contrast-enhanced (DCE) MRI performed with a temporal resolution of 60 seconds, ultrafast MRI did not prove advantageous for the detection of cancers through reducing masking from background parenchymal enhancement, nor for improved lesion classification through ultrafast kinetics,” wrote lead study author Maike Bode, M.D., who is affiliated with the Department of Diagnostic and Interventional Radiology at University Hospital Aachen in Aachen, Germany, and colleagues.
For reader assessment of the modalities to categorize lesion morphology, the study authors noted that DEC and ultrafast MRI were deemed equivalent on lesion shape 61.4 percent of the time. However, the researchers pointed out that ultrafast MRI was deemed inferior to DCE MRI on lesion margins for 64.9 percent of lesions and inferior in assessing lesion architecture 98 percent of the time.
Three Key Takeaways
1. Lower diagnostic image quality: Ultrafast MRI showed significantly lower image quality and lesion conspicuity than standard DCE MRI, limiting its effectiveness in cancer detection and lesion classification.
2. Reduced BPE but limited benefit. While ultrafast MRI demonstrated reduced background parenchymal enhancement (BPE), this did not translate into improved detection of malignancies or better lesion assessment.
3. Higher rates of false diagnosis. Ultrafast MRI resulted in more false positive and false negative readings, and it was found inferior in evaluating lesion margins and architecture in the majority of cases.
Ultrafast MRI also yielded two more false positive assessments and three more false negative evaluations in comparison to DCE MRI, according to the study authors.
“Accelerating image acquisition to the degree required for ultrafast MRI comes at a price. Although the reconstructed voxel volume of ultrafast MRI and DCE MRI was similar, the true (acquired) spatial resolution of ultrafast MRI was substantially lower,” emphasized Bode and colleagues. “This difference, together with phase errors and blurring associated with ultrafast imaging, reduced overall image quality and readers’ ability to assess morphologic details.”
(Editor’s note: For related content, see “Can Abbreviated Breast MRI Have an Impact in Assessing Post-Neoadjuvant Chemotherapy Response?,” “Could Ultrafast MRI Enhance Detection of Malignant Foci for Breast Cancer?” and “How Does Hormonal Regulation Impact Background Parenchymal Enhancement on Contrast-Enhanced Mammography?”)
In regard to study limitations, the study authors acknowledged patient selection bias with a small cohort enriched with patients for whom ultrafast MRI was expected to be beneficial. The researchers also conceded that the reviewing radiologists had more experience interpreting DCE MRI scans in comparison to ultrafast MRI.
