Enhancement threshold: Designated threshold required to assign color to kinetics on CAD software
Can be manually set; usually 50% or 100% ↑ in SI
Depends on contrast agent concentration, precontrast tissue T1 signal, flip angle, RF pulse, local vasculature, cardiac output
Delayed phase: > 120 seconds after contrast injection, up to 5-10 minutes following contrast injection
3 patterns in delayed phase after exceeding initial enhancement threshold
Persistent (type 1 curve): Progressive, continued enhancement with > 10% ↑ over time
Plateau (type 2 curve): SI does not change (beyond ± 10%) over time, remains flat
Washout (type 3 curve): Subsequent ↓ in SI > 10% from peak over time
Signal enhancement ratio (SER): % increase in SI early vs. late [(SI early - SI pre)/(SI late - SI pre)] where "early" is typically 1st postcontrast acquisition (phase) and "late" is typically 2nd postcontrast acquisition (phase)
Only calculated on pixels/voxels above enhancement threshold
Subtraction images: Precontrast T1 images subtracted from postcontrast T1 images
Misregistration artifact: Motion between pre- and postcontrast images causes misregistration, alternating light and dark bands of signal usually best appreciated at edges of breast; can result in misinterpretation if not recognized
Most CAD software includes motion correction algorithms
Maximum-intensity projection (MIP): Thick-slab 3D reformat of postcontrast subtracted images showing highest pixel values through slab
IMAGING
MR Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
CLINICAL ISSUES
Risk of Malignancy Varies by Kinetics
Associations of Pathologic Findings and Kinetics
Associations of Treatment Response and Kinetics
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Fujiwara K et al: Grading system to categorize breast MRI in BI-RADS 5th edition: A multivariate study of breast mass descriptors in terms of probability of malignancy. AJR Am J Roentgenol. 210(3):W118-W127, 2018
Kim KW et al: Diagnostic Usefulness of Combination of Diffusion-weighted Imaging and T2WI, Including Apparent Diffusion Coefficient in Breast Lesions: Assessment of Histologic Grade. Acad Radiol. 25(5):643-652, 2018
Abe H et al: Kinetic analysis of benign and malignant breast lesions with ultrafast dynamic contrast-enhanced MRI: Comparison with standard kinetic assessment. AJR Am J Roentgenol. 207(5):1159-1166, 2016
Bae MS et al: Pretreatment MR Imaging Features of Triple-Negative Breast Cancer: Association with Response to Neoadjuvant Chemotherapy and Recurrence-Free Survival. Radiology. 281(2):392-400, 2016
Ferré R et al: Differentiation of fibroadenomas and pure mucinous carcinomas on dynamic contrast-enhanced MRI of the breast using volume segmentation for kinetic analysis: A Feasibility Study. AJR Am J Roentgenol. 206(2):253-8, 2016
Lewin AA et al: Assessment of background parenchymal enhancement and lesion kinetics in breast MRI of BRCA 1/2 mutation carriers compared to matched controls using quantitative kinetic analysis. Acad Radiol. 23(3):358-67, 2016
Blaschke E et al: MRI phenotype of breast cancer: Kinetic assessment for molecular subtypes. J Magn Reson Imaging. 42(4):920-4, 2015
Yamaguchi K et al: Intratumoral heterogeneity of the distribution of kinetic parameters in breast cancer: comparison based on the molecular subtypes of invasive breast cancer. Breast Cancer. 22(5):496-502, 2015
Giess CS et al: Background parenchymal enhancement at breast MR imaging: normal patterns, diagnostic challenges, and potential for false-positive and false-negative interpretation. Radiographics. 34(1):234-47, 2014
Partridge SC et al: Breast DCE-MRI: influence of postcontrast timing on automated lesion kinetics assessments and discrimination of benign and malignant lesions. Acad Radiol. 21(9):1195-203, 2014
Greenwood HI et al: Ductal carcinoma in situ of the breasts: review of MR imaging features. Radiographics. 33(6):1569-88, 2013
Hylton NM et al: Locally advanced breast cancer: MR imaging for prediction of response to neoadjuvant chemotherapy--results from ACRIN 6657/I-SPY TRIAL. Radiology. 263(3):663-72, 2012
Rahbar H et al: In vivo assessment of ductal carcinoma in situ grade: a model incorporating dynamic contrast-enhanced and diffusion-weighted breast MR imaging parameters. Radiology. 263(2):374-82, 2012
Kim JA et al: MRI findings of pure ductal carcinoma in situ: kinetic characteristics compared according to lesion type and histopathologic factors. AJR Am J Roentgenol. 196(6):1450-6, 2011
Morris EA, et al: ACR BI-RADS® Magnetic Resonance Imaging. In: ACR BI-RADS® Atlas, Breast Imaging Reporting and Data System. Reston, VA, American College of Radiology; 2013
Fernández-Guinea O et al: Relationship between morphological features and kinetic patterns of enhancement of the dynamic breast magnetic resonance imaging and clinico-pathological and biological factors in invasive breast cancer. BMC Cancer. 10:8, 2010
Loiselle CR et al: Dynamic contrast-enhanced MRI kinetics of invasive breast cancer: a potential prognostic marker for radiation therapy. Int J Radiat Oncol Biol Phys. 76(5):1314-9, 2010
Yamada T et al: Radiologic-pathologic correlation of ductal carcinoma in situ. Radiographics. 30(5):1183-98, 2010
Jansen SA et al: Kinetic curves of malignant lesions are not consistent across MRI systems: need for improved standardization of breast dynamic contrast-enhanced MRI acquisition. AJR Am J Roentgenol. 193(3):832-9, 2009
Wang LC et al: MRI-detected suspicious breast lesions: predictive values of kinetic features measured by computer-aided evaluation. AJR Am J Roentgenol. 193(3):826-31, 2009
Chen JH et al: Magnetic resonance imaging features of fibrocystic change of the breast. Magn Reson Imaging.
Jansen SA et al: DCEMRI of breast lesions: is kinetic analysis equally effective for both mass and nonmass-like enhancement? Med Phys. 35(7):3102-9, 2008
Li KL et al: Invasive breast cancer: predicting disease recurrence by using high-spatial-resolution signal enhancement ratio imaging. Radiology. 248(1):79-87, 2008
Mann RM et al: MRI compared to conventional diagnostic work-up in the detection and evaluation of invasive lobular carcinoma of the breast: a review of existing literature. Breast Cancer Res Treat. 107(1):1-14, 2008
Jansen SA et al: Pure ductal carcinoma in situ: kinetic and morphologic MR characteristics compared with mammographic appearance and nuclear grade. Radiology. 245(3):684-91, 2007
Kuhl C: The current status of breast MR imaging. Part I. Choice of technique, image interpretation, diagnostic accuracy, and transfer to clinical practice. Radiology. 244(2):356-78, 2007
Williams TC et al: Breast MR imaging: computer-aided evaluation program for discriminating benign from malignant lesions. Radiology. 244(1):94-103, 2007
Macura KJ et al: Patterns of enhancement on breast MR images: interpretation and imaging pitfalls. Radiographics. 26(6):1719-34; quiz 1719, 2006
Schnall MD et al: Diagnostic architectural and dynamic features at breast MR imaging: multicenter study. Radiology. 238(1):42-53, 2006
van den Bosch MA et al: Magnetic resonance imaging characteristics of fibrocystic change of the breast. Invest Radiol. 40(7):436-41, 2005
Liberman L et al: Breast lesions detected on MR imaging: features and positive predictive value. AJR Am J Roentgenol. 179(1):171-8, 2002
Nunes LW et al: Update of breast MR imaging architectural interpretation model. Radiology. 219(2):484-94, 2001
Kuhl CK et al: Dynamic breast MR imaging: are signal intensity time course data useful for differential diagnosis of enhancing lesions? Radiology. 211(1):101-10, 1999
Gallardo X et al: Enhancement of intramammary lymph nodes with lymphoid hyperplasia: a potential pitfall in breast MRI. Eur Radiol. 8(9):1662-5, 1998
Brinck U et al: The variability of fibroadenoma in contrast-enhanced dynamic MR mammography. AJR Am J Roentgenol. 168(5):1331-4, 1997
Related Anatomy
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Related Differential Diagnoses
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References
Tables
Tables
KEY FACTS
Terminology
Top Differential Diagnoses
Clinical Issues
Diagnostic Checklist
TERMINOLOGY
Definitions
Time-intensity curve (TIC): Plot of % increase in signal intensity (SI) (y-axis) as a function of time (x-axis) after contrast injection
Most common technique for kinetic assessment
Pixel: In-plane resolution of image = field of view (FOV)/matrix size
Voxel: Resolution of image in 3 dimensions = pixel size x slice thickness
Parametric analysis software calculates kinetic information
Each pixel/voxel is color-coded; color maps created based on thresholding and kinetic features
Lack of color mapping standard across software platforms; annotations explain color map
Signal intensity (pixel basis) plot of lesion enhancement over time
Use ≥ 3 pixel-size region of interest (ROI) to manually calculate
Initial phase: 1st 120 seconds after contrast injection or when peak enhancement is reached
Enhancement threshold: Designated threshold required to assign color to kinetics on CAD software
Can be manually set; usually 50% or 100% ↑ in SI
Depends on contrast agent concentration, precontrast tissue T1 signal, flip angle, RF pulse, local vasculature, cardiac output
Delayed phase: > 120 seconds after contrast injection, up to 5-10 minutes following contrast injection
3 patterns in delayed phase after exceeding initial enhancement threshold
Persistent (type 1 curve): Progressive, continued enhancement with > 10% ↑ over time
Plateau (type 2 curve): SI does not change (beyond ± 10%) over time, remains flat
Washout (type 3 curve): Subsequent ↓ in SI > 10% from peak over time
Signal enhancement ratio (SER): % increase in SI early vs. late [(SI early - SI pre)/(SI late - SI pre)] where "early" is typically 1st postcontrast acquisition (phase) and "late" is typically 2nd postcontrast acquisition (phase)
Only calculated on pixels/voxels above enhancement threshold
Subtraction images: Precontrast T1 images subtracted from postcontrast T1 images
Misregistration artifact: Motion between pre- and postcontrast images causes misregistration, alternating light and dark bands of signal usually best appreciated at edges of breast; can result in misinterpretation if not recognized
Most CAD software includes motion correction algorithms
Maximum-intensity projection (MIP): Thick-slab 3D reformat of postcontrast subtracted images showing highest pixel values through slab
IMAGING
MR Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
CLINICAL ISSUES
Risk of Malignancy Varies by Kinetics
Associations of Pathologic Findings and Kinetics
Associations of Treatment Response and Kinetics
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Fujiwara K et al: Grading system to categorize breast MRI in BI-RADS 5th edition: A multivariate study of breast mass descriptors in terms of probability of malignancy. AJR Am J Roentgenol. 210(3):W118-W127, 2018
Kim KW et al: Diagnostic Usefulness of Combination of Diffusion-weighted Imaging and T2WI, Including Apparent Diffusion Coefficient in Breast Lesions: Assessment of Histologic Grade. Acad Radiol. 25(5):643-652, 2018
Abe H et al: Kinetic analysis of benign and malignant breast lesions with ultrafast dynamic contrast-enhanced MRI: Comparison with standard kinetic assessment. AJR Am J Roentgenol. 207(5):1159-1166, 2016
Bae MS et al: Pretreatment MR Imaging Features of Triple-Negative Breast Cancer: Association with Response to Neoadjuvant Chemotherapy and Recurrence-Free Survival. Radiology. 281(2):392-400, 2016
Ferré R et al: Differentiation of fibroadenomas and pure mucinous carcinomas on dynamic contrast-enhanced MRI of the breast using volume segmentation for kinetic analysis: A Feasibility Study. AJR Am J Roentgenol. 206(2):253-8, 2016
Lewin AA et al: Assessment of background parenchymal enhancement and lesion kinetics in breast MRI of BRCA 1/2 mutation carriers compared to matched controls using quantitative kinetic analysis. Acad Radiol. 23(3):358-67, 2016
Blaschke E et al: MRI phenotype of breast cancer: Kinetic assessment for molecular subtypes. J Magn Reson Imaging. 42(4):920-4, 2015
Yamaguchi K et al: Intratumoral heterogeneity of the distribution of kinetic parameters in breast cancer: comparison based on the molecular subtypes of invasive breast cancer. Breast Cancer. 22(5):496-502, 2015
Giess CS et al: Background parenchymal enhancement at breast MR imaging: normal patterns, diagnostic challenges, and potential for false-positive and false-negative interpretation. Radiographics. 34(1):234-47, 2014
Partridge SC et al: Breast DCE-MRI: influence of postcontrast timing on automated lesion kinetics assessments and discrimination of benign and malignant lesions. Acad Radiol. 21(9):1195-203, 2014
Greenwood HI et al: Ductal carcinoma in situ of the breasts: review of MR imaging features. Radiographics. 33(6):1569-88, 2013
Hylton NM et al: Locally advanced breast cancer: MR imaging for prediction of response to neoadjuvant chemotherapy--results from ACRIN 6657/I-SPY TRIAL. Radiology. 263(3):663-72, 2012
Rahbar H et al: In vivo assessment of ductal carcinoma in situ grade: a model incorporating dynamic contrast-enhanced and diffusion-weighted breast MR imaging parameters. Radiology. 263(2):374-82, 2012
Kim JA et al: MRI findings of pure ductal carcinoma in situ: kinetic characteristics compared according to lesion type and histopathologic factors. AJR Am J Roentgenol. 196(6):1450-6, 2011
Morris EA, et al: ACR BI-RADS® Magnetic Resonance Imaging. In: ACR BI-RADS® Atlas, Breast Imaging Reporting and Data System. Reston, VA, American College of Radiology; 2013
Fernández-Guinea O et al: Relationship between morphological features and kinetic patterns of enhancement of the dynamic breast magnetic resonance imaging and clinico-pathological and biological factors in invasive breast cancer. BMC Cancer. 10:8, 2010
Loiselle CR et al: Dynamic contrast-enhanced MRI kinetics of invasive breast cancer: a potential prognostic marker for radiation therapy. Int J Radiat Oncol Biol Phys. 76(5):1314-9, 2010
Yamada T et al: Radiologic-pathologic correlation of ductal carcinoma in situ. Radiographics. 30(5):1183-98, 2010
Jansen SA et al: Kinetic curves of malignant lesions are not consistent across MRI systems: need for improved standardization of breast dynamic contrast-enhanced MRI acquisition. AJR Am J Roentgenol. 193(3):832-9, 2009
Wang LC et al: MRI-detected suspicious breast lesions: predictive values of kinetic features measured by computer-aided evaluation. AJR Am J Roentgenol. 193(3):826-31, 2009
Chen JH et al: Magnetic resonance imaging features of fibrocystic change of the breast. Magn Reson Imaging.
Jansen SA et al: DCEMRI of breast lesions: is kinetic analysis equally effective for both mass and nonmass-like enhancement? Med Phys. 35(7):3102-9, 2008
Li KL et al: Invasive breast cancer: predicting disease recurrence by using high-spatial-resolution signal enhancement ratio imaging. Radiology. 248(1):79-87, 2008
Mann RM et al: MRI compared to conventional diagnostic work-up in the detection and evaluation of invasive lobular carcinoma of the breast: a review of existing literature. Breast Cancer Res Treat. 107(1):1-14, 2008
Jansen SA et al: Pure ductal carcinoma in situ: kinetic and morphologic MR characteristics compared with mammographic appearance and nuclear grade. Radiology. 245(3):684-91, 2007
Kuhl C: The current status of breast MR imaging. Part I. Choice of technique, image interpretation, diagnostic accuracy, and transfer to clinical practice. Radiology. 244(2):356-78, 2007
Williams TC et al: Breast MR imaging: computer-aided evaluation program for discriminating benign from malignant lesions. Radiology. 244(1):94-103, 2007
Macura KJ et al: Patterns of enhancement on breast MR images: interpretation and imaging pitfalls. Radiographics. 26(6):1719-34; quiz 1719, 2006
Schnall MD et al: Diagnostic architectural and dynamic features at breast MR imaging: multicenter study. Radiology. 238(1):42-53, 2006
van den Bosch MA et al: Magnetic resonance imaging characteristics of fibrocystic change of the breast. Invest Radiol. 40(7):436-41, 2005
Liberman L et al: Breast lesions detected on MR imaging: features and positive predictive value. AJR Am J Roentgenol. 179(1):171-8, 2002
Nunes LW et al: Update of breast MR imaging architectural interpretation model. Radiology. 219(2):484-94, 2001
Kuhl CK et al: Dynamic breast MR imaging: are signal intensity time course data useful for differential diagnosis of enhancing lesions? Radiology. 211(1):101-10, 1999
Gallardo X et al: Enhancement of intramammary lymph nodes with lymphoid hyperplasia: a potential pitfall in breast MRI. Eur Radiol. 8(9):1662-5, 1998
Brinck U et al: The variability of fibroadenoma in contrast-enhanced dynamic MR mammography. AJR Am J Roentgenol. 168(5):1331-4, 1997
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