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Contrast-Enhanced MR Mammography: Improved Lesion Detection and Differentiation with Gadobenate Dimeglumine

¹ Department of Radiological Sciences, University of Rome "La Sapienza," Viale le Regina Elena 324, 00161 Rome, Italy.
² Worldwide Medical & Regulatory Affairs, Bracco Imaging SpA, Milano, Italy.
³ Worldwide Medical & Regulatory Affairs, Bracco Diagnostics, Inc., Princeton, NJ.

OBJECTIVE. The objective of our study was to intraindividually compare 0.1 mmol/kg doses of gadobenate dimeglumine and gadopentetate dimeglumine for contrast-enhanced breast MRI.

SUBJECTS AND METHODS. Forty-seven women (mean age ± SD, 50.8 ± 12.9 years) with breast lesions classified as BI-RADS category 3, 4, or 5 for suspicion of malignancy underwent two identical MR examinations at 1.5 T separated by 48–72 hours. T1-weighted gradient-echo images were acquired before contrast administration and at 2-minute intervals after the randomized injection of gadopentetate dimeglumine or gadobenate dimeglumine at 2 mL/s. Two blinded readers evaluated randomized image sets for lesion detection and differentiation as benign or malignant compared with histology. The McNemar exact test and the generalized estimating equation (GEE) were used to compare lesion detection rates and diagnostic performance in terms of sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV).

RESULTS. Histopathology data were available for 78 lesions. Significantly more lesions overall (75/78 [96%] vs 62/78 [79%], respectively; p = 0.0002) and significantly more malignant lesions (49/50 [98%] vs 38/50 [76%]; p = 0.0009) were detected with gadobenate dimeglumine than gadopentetate dimeglumine. All detected malignant lesions were correctly diagnosed with both agents. More detected benign lesions were correctly diagnosed with gadobenate dimeglumine than with gadopentetate dimeglumine (20/26 [77%] vs 17/24 [71%], respectively). Differentiation of lesions was significantly (p = 0.0001) better with gadobenate dimeglumine. Significantly better diagnostic performance was noted with gadobenate dimeglumine than with gadopentetate dimeglumine, respectively, for sensitivity (98.0% vs 76.0%; p = 0.0064), accuracy (88.5% vs 69.2%; p = 0.0004), PPV (86.0% vs 76.0%; p = 0.0321), and NPV (95.2% vs 57.1%; p = 0.0003).

CONCLUSION. Lesion detection and malignant–benign differentiation is significantly better with 0.1 mmol/kg gadobenate dimeglumine than 0.1 mmol/kg gadopentetate dimeglumine.

Keywords: breast cancer • breast MRI • breast neoplasms • contrast media • gadobenate dimeglumine • MR mammography

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