Abstract P2-02-03: Multiparametric MR imaging of the breast with dynamic contrast-enhanced MR imaging, diffusion-weighted imaging and proton MR spectroscopy: Are all three parameters necessary for accurate breast cancer diagnosis?
Authors: Pinker-Domenig K , Bogner W , Gruber S , Dubsky PC , Bago-Horvath Z , Bartsch R , Helbich T 
Published: August 2014

Abstract
Purpose
To compare the diagnostic accuracy of dynamic contrast-enhanced magnetic resonance (MR) imaging (DCE) to multiparametric (MP) MR imaging with two [DCE, diffusion weighted imaging (DWI) or three dimensional proton MR spectroscopy (3D1H-MRSI)] or three MR imaging parameters (DCE, DWI,3D 1H-MRSI) in breast cancer diagnosis.
Materials and Methods
This prospective HIPAA-compliant study was approved by the Institutional review board. Written informed consent was obtained in all patients. One hundred thirteen patients with an imaging abnormality (BIRADS 0, 4-5) were included in this study. MP MR imaging of the breast at 3Tesla with DCE, DWI and 3D-1H-MRSI was performed. The likelihood of malignancy was assessed for DCE and MP MR imaging with two and three parameters separately. Histopathology was used as the standard of reference. Appropriate statistical tests were used to assess sensitivity, specificity and diagnostic accuracy for each assessment combination.
Results
There were 74 malignant and 39 benign breast lesions. Sensitivities, specificities, PPV, NPV, diagnostic accuracies and the AUCs for dynamic contrast-enhanced MR imaging of the breast and MP MR imaging with two or three MR imaging parameters are summarized in Table 1.
Sensitivities, specificities, PPV, NPV, diagnostic accuracy, AUC and 95% CIs for DCE and MP MR imaging SensitivitySpecificityPPVNPVDiagnostic AccuracyAUCDynamic contrast enhanced MR imaging (one parameter)98.6% (92.7%-99.8%)64.1% (48.4%-77.3%)83.9% (74.8%-90.2%)96.2% (81.1%-99.3%)86.7% (79.2%-91.8%)0.814 (0.72-0.91)MP MR imaging with dynamic contrast-enhanced MR imaging and DWI (two parameters)100% (93.6%-100%)61.5% (44.7%-76.2%)83.1% (74%-89.5%)100% (86.2%-100%)86.7% (79.2%-91.8%)0.808 (0.71-0.91)MP MR imaging with dynamic contrast-enhanced MR imaging and 3D 1H-MRSI (two parameters)100% (93.6%-100%)61.5% (45.9%-75.1%)83.1% (74%-89.5%)100% (86.2%-100%)86.7% (79.2%-91.8%)0.808 (0.71-0.91)MP MR imaging with dynamic contrast-enhanced MR imaging, DWI and 3D 1H-MRSI (three parameters)100% (95.1%-100%)87.2% (73.3%-94.4%)†*93.7% (86.0%-97.3%)†*100% (89.8%-100%)95.6% (90.1%-98.1%)†*0.936 (0.87-0.99)†*†* significantly different from DCE and MP MRI with 2 parameters (p&lt;0.001)
MP MR with three MR imaging parameters yielded significantly higher AUCs (0.936) than dynamic contrast-enhanced MR imaging alone (0.814) (p&lt;0.001). MP MR with just two MR imaging parameters at 3T did not yield higher AUCs (0.808) than dynamic contrast-enhanced MR imaging alone (0.814). MP MR imaging with three MR imaging parameters allowed an elimination of all false-negative findings and a significant reduction of false-positives (p = 0.002).
Conclusion
MP MR imaging with three MR imaging parameters has greater diagnostic accuracy in breast cancer diagnosis than DCE alone or MP MR imaging with two MR imaging parameters.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-02-03.