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Gadobenate dimeglumine as a contrast agent for dynamic breast magnetic resonance imaging: effect of higher initial enhancement thresholds on diagnostic performance


, : Gadobenate dimeglumine as a contrast agent for dynamic breast magnetic resonance imaging: effect of higher initial enhancement thresholds on diagnostic performance. Investigative Radiology 43(4): 236-242

Rationale and Objective: Gadobenate dimeglumine (Gd-BOPTA), a high-relaxivity contrast agent, has been recently proposed for dynamic MR imaging of the breast. The objective of this study was to optimize the diagnostic performance of Gd-BOPTA-enhanced dynamic breast MR imaging by using adjusted initial enhancement thresholds.Methods: Thirty-four patients with 36 breast lesions (malignant/benign = 28/8) underwent dynamic breast MRI with 0.1 mmol/kg Gd-BOPTA and 120-second time resolution. A score system based on shape (round/oval/lobular = 0; linear/dendritic/stellate = 1), margins (defined = 0; undefined = 1), pattern (homogeneous = 0; inhomogeneous = 1; rim = 2), kinetics (continuous = 0; plateau = 1; washout = 2), and initial enhancement was used. Initial enhancement was determined with standard (< 50% = 0; 50%-100% = 1; > 100% 2) and adjusted (< 100% = 0; 100%-240% = 1; > 240% 2) thresholds. Scores of 0 to 3 indicated benign lesions and scores of 4 to 8 malignant lesions. Diagnostic performance was assessed in terms of sensitivity, specificity, positive and negative predictive values, and overall accuracy.Results: The initial enhancement was > 100% for 26 malignant and 7 benign lesions and >240% for 16 and I lesions, respectively. The overall score was 5.89 +/- 1.34 with standard thresholds and 5.50 +/- 1.53 with adjusted thresholds (P = 0.003) for cancers, 4.00 +/- 1.93 and 3.25 +/- 1.75 (P = 0.028) for benign lesions, respectively. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy was 96%, 13%, 79%, 50%, and 78%, respectively, with standard thresholds and 96%, 75%, 93%, 86%, and 92%, respectively, with adjusted thresholds. A ductal carcinoma in situ was false negative whereas a fat necrosis and a papilloma were positive with both thresholds. Three fibroadenomas, 1 adenosis, and 1 fibrosis were false positive with standard thresholds but true negatives with adjusted thresholds.Conclusions: Lesion characterization with Gd-BOPTA requires higher thresholds for initial enhancement than those used with conventional Gd-chelates, leading to improved specificity, predictive values, and accuracy.

US$19.90

PMID: 18340247

DOI: 10.1097/RLI.0b013e318160678d


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