Clinical application of gadoterate meglumine in abbreviated dynamic contrast-enhanced magnetic resonance imaging of the breast with ultrafast imaging: a single-center retrospective study
Year: 2025
Type: article
Study design: Observational Study
Abstract: Background: There is increasing interest in high temporal resolution imaging techniques in breast magnetic resonance imaging (MRI) for breast cancer detection. The purpose of this study was to evaluate the clinical application of gadoterate meglumine (Dotarem) in abbreviated dynamic contrast-enhanced MRI (DCE-MRI) of the breast for cancer detection, focusing on quantitative kinetic analysis with ultrafast DCE-MRI. Methods: Ultrafast acquisition is a high temporal resolution (3.5–4.6 seconds) imaging technique used during the first minute following contrast injection to obtain three-dimensional (3D) whole breast images. All ultrafast DCE-MRIs were motion-corrected by a non-rigid registration method. A retrospective study was performed for 49 patients with 60 malignant lesions and 2 benign lesions. Background parenchymal enhancement (BPE) was evaluated in 47 of the patients because two patients had breast implants. Semi-automatic volumetric segmentation of the lesions was performed with 3D Slicer. Signal enhancement ratio (SER) over time was fitted with an empirical mathematical model (EMM) by using each voxel within the lesion and selected normal parenchymal regions of interest (ROIs). Quantitative pharmacokinetic parameters, including transfer constant (Ktrans) and fractional volume of the extravascular extracellular space (ve), are calculated with the Tofts model. The individual arterial input function (AIF) was traced over an ROI within the descending thoracic aorta that was utilized to calibrate the time course of average signal intensity. Mean values of kinetic parameters for malignant lesions and BPE were compared with Welch’s t-test for normally distributed variables and the Mann-Whitney U test for non-normally distributed variables. The average ratio of malignant lesions to BPE was computed. Area under the receiver operating characteristic curve (AUC), sensitivity, and specificity at the optimal cutoff point as determined by Youden’s index and 95% confidence interval (CI) were calculated for each parameter to separate the malignant lesions from the BPE. Results: Higher signal enhancement in malignant lesions than signal in BPE was observed in the time course of ultrafast DCE-MRI. The ratio of Ktrans for malignant lesions to BPE is 15.58±14.35 [standard deviation (SD)]. The maximum enhancement slope (A*α), area under the enhancement-time curve over 30 seconds (AUC30), upper limit of initial contrast agent uptake (A), and Ktrans demonstrated excellent discriminating performance for cancer detection, with corresponding AUCs of 0.963, 0.963, 0.955, and 0.938, respectively, listed in descending order of discriminative power. Ktrans had the highest diagnostic sensitivity [98.3% (95% CI: 91.1–100%), P<0.05]. Conclusions: Based on quantitative pharmacokinetic analysis of ultrafast DCE-MRI, the study demonstrated the viability of utilizing Dotarem as an intravenous gadolinium-based contrast agent for DCE-MRI of the breast with preserved clinical success for breast cancer detection.
Authors: Saengsiri Chumsaengsri, Hiroyuki Abe, Gregory S. Karczmar, Zhen Ren, Kirti Kulkarni
Language: English
Topic: MRI in cancer diagnosis
Subfield: Radiology, Nuclear Medicine and Imaging
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
Funder: National Institutes of Health
OpenAlex ID: W4414450245