Role of Dynamic Contrast Enhanced MRI in the Evaluation and Characterisation of Breast Lesions with Pathological Correlation

Introduction: Magnetic Resonance Imaging (MRI) has an excellent soft tissue resolution and can detect and accurately characterise lesions which are not seen on other imaging modalities like mammography or ultrasonography. Dynamic Contrast Enhanced (DCE) MRI is better for characterisation of fibroglandular tissue and breast lesions as it further improves specificity of MRI. Kinetic Curves (KC) derived from DCE MRI according to the wash in and wash out patterns of intravenous contrast are analysed and correlated with morphology of a lesion. Aim: To evaluate the efficacy of DCE MRI in detection and characterisation of breast lesions according to KC analysis and to correlate MRI findings with pathological findings. Materials and Methods: A prospective observational study was conducted at Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India. DCE MRI was performed after informed consent in 50 females (Age ranging from 17 years to 80 years). MRI was conducted on Siemens " MAGNETOM Avanto" 1.5 Tesla machine using standard dedicated breast matrix coils. The standard MRI protocol included the T1 and T2 weighted fat-sat sequences along with DCE MRI after intravenous administration of Meglumine-Gadoterate (0.1 mmol/kg body weight) followed by a 20-mL saline flush. Post processing manipulation included standard subtraction, reverse subtraction, Maximum-Intensity Projection ( MIP) images and KC analysis. Findings of DCE MRI were graded according to Breast Imaging-Reporting And Data System (BI-RADS) category after morphological and KC analysis and were correlated with pathological findings. Results: MRI is a highly sensitive modality to detect breast lesions especially bilateral and multifocal/multicentric lesions with sensitivity of 98.18%. However, specificity was relatively low (55.56%). The Positive and Negative Predictive Values (PPV, NPV) of MRI in characterisation of breast lesions in present study were 93.10% and 83.33%, respectively. Conclusion: Although MRI is extremely sensitive for detecting breast lesions it has a relatively low specificity. Both morphological characteristics and KC analysis should be used in combination for interpretation as it improves the specificity of MRI.