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DOI:10.2214/AJR.09.2483
AJR 2009; 193:W295-W300
© American Roentgen Ray Society

Original Research

Dynamic Contrast-Enhanced MRI of the Breast: Quantitative Method for Kinetic Curve Type Assessment

Riham H. El Khouli1,2,3, Katarzyna J. Macura2, Michael A. Jacobs2,4, Tarek H. Khalil3, Ihab R. Kamel2, Andrew Dwyer1 and David A. Bluemke1

1 Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD.
2 Department of Radiology and Radiological Sciences, The Johns Hopkins University School of Medicine, 600 N Wolfe St., Baltimore, MD 21287.
3 Department of Diagnostic Radiology, Suez Canal University School of Medicine, Ismailia, Egypt.
4 Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD.

OBJECTIVE. The type of contrast enhancement kinetic curve (i.e., persistently enhancing, plateau, or washout) seen on dynamic contrast-enhanced MRI (DCE-MRI) of the breast is predictive of malignancy. Qualitative estimates of the type of curve are most commonly used for interpretation of DCE-MRI. The purpose of this study was to compare qualitative and quantitative methods for determining the type of contrast enhancement kinetic curve on DCE-MRI.

MATERIALS AND METHODS. Ninety-six patients underwent breast DCE-MRI. The type of DCE-MRI kinetic curve was assessed qualitatively by three radiologists on two occasions. For quantitative assessment, the slope of the washout curve was calculated. Kappa statistics were used to determine inter- and intraobserver agreement for the qualitative method. Matched sample tables, the McNemar test, and receiver operating characteristic (ROC) curve statistics were used to compare quantitative versus qualitative methods for establishing or excluding malignancy.

RESULTS. Seventy-eight lesions (77.2%) were malignant and 23 (22.8%) were benign. For the qualitative assessment, the intra- and interobserver agreement was good ({kappa} = 0.76–0.88), with an area under the ROC curve (AUC) of 0.73–0.77. For the quantitative method, the highest AUC was 0.87, reflecting significantly higher diagnostic accuracies compared with qualitative assessment (p < 0.01 for the difference between the two methods).

CONCLUSION. Quantitative assessment of the type of contrast enhancement kinetic curve on breast DCE-MRI resulted in significantly higher diagnostic performance for establishing or excluding malignancy compared with assessment based on the standard qualitative method.

Keywords: breast cancer • breast imaging • contrast-enhanced MRI • dynamic MRI • kinetic curve • washout


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