Unenhanced breast magnetic resonance imaging: detection of breast cancer

P. Belli, E. Bufi, A. Bonatesta, F. Patrolecco, F. Padovano, M. Giuliani, P. Rinaldi, L. Bonomo

Department of Radiology, Catholic University of Sacred Heart, Policlinico A. Gemelli, Rome, Italy. fedepadov@gmail.com

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• Radiology

OBJECTIVE: To evaluate the diagnostic performance of unenhanced MRI (UE-MRI) for malignant breast lesions and its reproducibility.

PATIENTS AND METHODS: We retrospectively included 118 patients who had breast MRI. DWI and STIR images were read in combination and referred to as UE-MRI; the presence or absence of the malignant lesion was noted by two observers. Their results were compared with those of final histopathology or with a two-year negative follow-up for diagnostic performance assessment; ROC curves were built. Diagnostic performance was stratified according to lesion site and size. Interobserver agreement was evaluated through the Cohen’s k statistic.

RESULTS: Specificity of STIR and DWI was 99.3% and 95.7% for Reader 1; 99.3% and 96.4% for Reader 2. Sensitivity was 76.5% and 76.5% for Reader 1; 77.5% and 77.6% for Reader 2. The ROC AUC (Reader 1) was 0.869 and 0.844 for STIR and DWI, respectively (p<0.001 both); for Reader 2, values were 0.874 and 0.853 respectively (p<0.001 both). Lesion dimension ≤10 mm was associated with lower AUC values. Lesion site didn’t influence the diagnostic performance. Interobserver agreement was very good for STIR and DWI (k=0.887, p <0.001, and k=0.867, p <0.001).

DISCUSSION: UE-MRI has a good overall diagnostic performance in the detection of breast cancer and a very good specificity for both STIR and DWI sequences. We observed reduced diagnostic performance for lesions ≤10 mm in size. Lesion’s site isn’t associated with a significantly decreased diagnostic performance of UE-MRI. There’s a good interobserver agreement for both sequences (STIR and DWI).

CONCLUSIONS: UE-MRI may be employed in patients with contraindication to gadolinium. It has considerable specificity and positive predictive value and good reproducibility.

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