Editorial for “Enhanced Mass on Contrast‐Enhanced Breast MRI: Differentiation Using a Combination of Dynamic Contrast‐Enhanced MRI and Quantitative Evaluation With Synthetic MRI”

Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is a highly sensitive tool for the detection of breast cancer. However, it has not developed into a standalone diagnostic tool due to variable specificity. A multiparametric approach, using apparent diffusion coefficient and choline concentrations along with DCE-MRI, improves the specificity of this technique. The development of synthetic MRI (SyMRI) using a multidelay and multiecho acquisition method is another step in this direction. It provides for quick quantification of three MR parameters: T1 and T2 relaxation times, and proton density (PD) of tissues. These parametric maps obtained from a single acquisition scan can also be used to generate conventional contrast-weighted images for diagnostic purposes. Recent studies on the feasibility of SyMRI in neuroimaging and imaging of cartilage lesions have shown its comparability with conventional images and sufficient accuracy for clinical practice. In breast imaging, comparable T2 relaxation times in SyMRI and conventional MRI techniques have been reported, highlighting its potential in clinical settings. Further, its utility in predicting Ki-67 status in certain breast cancer patients has been assessed. In this issue of the Journal of Magnetic Resonance Imaging, Matsuda et al evaluated the diagnostic value of a combination of DCE-MRI and SyMRI to differentiate between malignant and benign breast lesions. This retrospective study included 121 patients with 131 enhancing breast masses. The authors compared three diagnostic methods: DCE-MRI, with BI-RADS categorization (3: benign, 4 and 5: malignant); SyMRI, with categorization (0: benign, 1: malignant) based on a quantitative evaluation value decided by univariate and multivariate analysis; and DCE-MRI + SyMRI, with categorization based on the sum of category scores obtained using individual techniques (4 or less: benign, 5 or 6: malignant). Their analysis of quantitative values suggested that there is a significant difference in mean pre-T1 relaxation time between malignant and benign masses. However, T2 and PD values did not exhibit a significant difference. Significantly higher area under the curve (AUC) was obtained by DCE-MRI + SyMRI than the two techniques alone. While noting the limitations posed by a small sample size, potential patient selection bias, noncomparison of SyMRI acquired values (of T1, T2, and PD) with those obtained from traditional methods, and systematic errors; the authors concluded that the use of SyMRI in combination with DCE-MRI improves differentiation of malignant breast masses from benign, especially those in BI-RADS category 4. The study by Matsuda et al is the first of its kind and presents an interesting case for incorporating SyMRI in clinical MRI protocols. The quantification of high throughput data in a shorter acquisition period will reduce the scan time for patients. Further, a significant increase in the specificity of DCE-MRI will reduce the need for biopsy. This would require the development of robust and large datasets acquired through uniform MR protocols encompassing various subtypes of breast cancer. The apprehensions regarding the time, cost, and complexity of processing algorithms involved in such protocols may be addressed with advancements in computational capabilities.