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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
- Weight-based, bolus technique, contrast agent administration
- % SI increase = [(SI post - SI pre)/SI pre] x 100
- Initial phase slow, medium, or fast
- Slow: SI increase < 50%
- Medium: SI increase 50-100%
- Fast (rapid): SI increase > 100%
- 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
- 3 patterns in delayed phase after exceeding initial 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
- Time-intensity curve (TIC): Plot of % increase in signal intensity (SI) (y-axis) as a function of time (x-axis) after contrast injection
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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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
- Weight-based, bolus technique, contrast agent administration
- % SI increase = [(SI post - SI pre)/SI pre] x 100
- Initial phase slow, medium, or fast
- Slow: SI increase < 50%
- Medium: SI increase 50-100%
- Fast (rapid): SI increase > 100%
- 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
- 3 patterns in delayed phase after exceeding initial 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
- Time-intensity curve (TIC): Plot of % increase in signal intensity (SI) (y-axis) as a function of time (x-axis) after contrast injection
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
