Volume 47, Issue 6 pp. 1685-1691

Original Research

Comparison between qualitative and quantitative assessment of background parenchymal enhancement on breast MRI

Akshat C. Pujara MD,

Akshat C. Pujara MD

Department of Radiology, New York University School of Medicine, New York, New York, USA

Search for more papers by this author

Artem Mikheev BS,

Artem Mikheev BS

Department of Radiology, New York University School of Medicine, New York, New York, USA

Center for Biomedical Imaging, New York University School of Medicine, New York, New York, USA

Search for more papers by this author

Henry Rusinek PhD,

Henry Rusinek PhD

Department of Radiology, New York University School of Medicine, New York, New York, USA

Center for Biomedical Imaging, New York University School of Medicine, New York, New York, USA

Search for more papers by this author

Yiming Gao MD,

Yiming Gao MD

Department of Radiology, New York University School of Medicine, New York, New York, USA

Breast Imaging Section, New York University School of Medicine, New York, New York, USA

Search for more papers by this author

Chloe Chhor MD,

Chloe Chhor MD

Department of Radiology, New York University School of Medicine, New York, New York, USA

Breast Imaging Section, New York University School of Medicine, New York, New York, USA

Search for more papers by this author

Kristine Pysarenko MD,

Kristine Pysarenko MD

Department of Radiology, New York University School of Medicine, New York, New York, USA

Breast Imaging Section, New York University School of Medicine, New York, New York, USA

Search for more papers by this author

Harikrishna Rallapalli BS,

Harikrishna Rallapalli BS

Center for Biomedical Imaging, New York University School of Medicine, New York, New York, USA

Search for more papers by this author

Jerzy Walczyk AMET,

Jerzy Walczyk AMET

Department of Radiology, New York University School of Medicine, New York, New York, USA

Center for Biomedical Imaging, New York University School of Medicine, New York, New York, USA

Search for more papers by this author

Melanie Moccaldi BS,

Melanie Moccaldi BS

Department of Radiology, New York University School of Medicine, New York, New York, USA

Perlmutter Cancer Center, New York University School of Medicine, New York, New York, USA

Search for more papers by this author

James S. Babb PhD,

James S. Babb PhD

Department of Radiology, New York University School of Medicine, New York, New York, USA

Search for more papers by this author

Amy N. Melsaether MD,

Corresponding Author

Amy N. Melsaether MD

[email protected]

Department of Radiology, New York University School of Medicine, New York, New York, USA

Breast Imaging Section, New York University School of Medicine, New York, New York, USA

Address reprint requests to: A.M., 160 East 34th Street, 3rd Floor, New York, NY 10016. E-mail: [email protected]Search for more papers by this author

Akshat C. Pujara MD,

Akshat C. Pujara MD

Department of Radiology, New York University School of Medicine, New York, New York, USA

Search for more papers by this author

Artem Mikheev BS,

Artem Mikheev BS

Department of Radiology, New York University School of Medicine, New York, New York, USA

Center for Biomedical Imaging, New York University School of Medicine, New York, New York, USA

Search for more papers by this author

Henry Rusinek PhD,

Henry Rusinek PhD

Department of Radiology, New York University School of Medicine, New York, New York, USA

Center for Biomedical Imaging, New York University School of Medicine, New York, New York, USA

Search for more papers by this author

Yiming Gao MD,

Yiming Gao MD

Department of Radiology, New York University School of Medicine, New York, New York, USA

Breast Imaging Section, New York University School of Medicine, New York, New York, USA

Search for more papers by this author

Chloe Chhor MD,

Chloe Chhor MD

Department of Radiology, New York University School of Medicine, New York, New York, USA

Breast Imaging Section, New York University School of Medicine, New York, New York, USA

Search for more papers by this author

Kristine Pysarenko MD,

Kristine Pysarenko MD

Department of Radiology, New York University School of Medicine, New York, New York, USA

Breast Imaging Section, New York University School of Medicine, New York, New York, USA

Search for more papers by this author

Harikrishna Rallapalli BS,

Harikrishna Rallapalli BS

Center for Biomedical Imaging, New York University School of Medicine, New York, New York, USA

Search for more papers by this author

Jerzy Walczyk AMET,

Jerzy Walczyk AMET

Department of Radiology, New York University School of Medicine, New York, New York, USA

Center for Biomedical Imaging, New York University School of Medicine, New York, New York, USA

Search for more papers by this author

Melanie Moccaldi BS,

Melanie Moccaldi BS

Department of Radiology, New York University School of Medicine, New York, New York, USA

Perlmutter Cancer Center, New York University School of Medicine, New York, New York, USA

Search for more papers by this author

James S. Babb PhD,

James S. Babb PhD

Department of Radiology, New York University School of Medicine, New York, New York, USA

Search for more papers by this author

Amy N. Melsaether MD,

Corresponding Author

Amy N. Melsaether MD

[email protected]

Department of Radiology, New York University School of Medicine, New York, New York, USA

Breast Imaging Section, New York University School of Medicine, New York, New York, USA

Address reprint requests to: A.M., 160 East 34th Street, 3rd Floor, New York, NY 10016. E-mail: [email protected]Search for more papers by this author

First published: 15 November 2017

https://doi.org/10.1002/jmri.25895

Citations: 14

Share a link

Email
Wechat
Bluesky

Abstract

Background

Potential clinical implications of the level of background parenchymal enhancement (BPE) on breast MRI are increasing. Currently, BPE is typically evaluated subjectively. Tests of concordance between subjective BPE assessment and computer-assisted quantified BPE have not been reported.

Purpose or Hypothesis

To compare subjective radiologist assessment of BPE with objective quantified parenchymal enhancement (QPE).

Study Type

Cross-sectional observational study.

Population

Between 7/24/2015 and 11/27/2015, 104 sequential patients (ages 23 – 81 years, mean 49 years) without breast cancer underwent breast MRI and were included in this study.

Field Strength/Sequence

3T; fat suppressed axial T2, axial T1, and axial fat suppressed T1 before and after intravenous contrast.

Assessment

Four breast imagers graded BPE at 90 and 180 s after contrast injection on a 4-point scale (a–d). Fibroglandular tissue masks were generated using a phantom-validated segmentation algorithm, and were co-registered to pre- and postcontrast fat suppressed images to define the region of interest. QPE was calculated.

Statistical Tests

Receiver operating characteristic (ROC) analyses and kappa coefficients (k) were used to compare subjective BPE with QPE.

Results

ROC analyses indicated that subjective BPE at 90 s was best predicted by quantified QPE ≤20.2 = a, 20.3–25.2 = b, 25.3–50.0 = c, >50.0 = d, and at 180 s by quantified QPE ≤ 32.2 = a, 32.3–38.3 = b, 38.4–74.5 = c, >74.5 = d. Agreement between subjective BPE and QPE was slight to fair at 90 s (k = 0.20–0.36) and 180 s (k = 0.19–0.28). At higher levels of QPE, agreement between subjective BPE and QPE significantly decreased for all four radiologists at 90 s (P ≤ 0.004) and for three of four radiologists at 180 s (P ≤ 0.004).

Data Conclusion

Radiologists were less consistent with QPE as QPE increased.

Level of Evidence: 3

Technical Efficacy: Stage 3

J. Magn. Reson. Imaging 2018;47:1685–1691.

References

1 Kuhl CK, Bieling HB, Gieseke J, et al. Healthy premenopausal breast parenchyma in dynamic contrast-enhanced MR imaging of the breast: normal contrast medium enhancement and cyclical-phase dependency. Radiology 1997; 203: 137–144.
10.1148/radiology.203.1.9122382
CAS PubMed Web of Science® Google Scholar
2 Morris EA, Comstock CE, Lee CH, 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.
Google Scholar
3 DeMartini WB, Liu F, Peacock S, Eby PR, Gutierrez RL, Lehman CD. Background parenchymal enhancement on breast MRI: impact on diagnostic performance. AJR Am J Roentgenol 2012; 198: W373–W380.
10.2214/AJR.10.6272
PubMed Web of Science® Google Scholar
4 Giess CS, Yeh ED, Raza S, Birdwell RL. Background parenchymal enhancement at breast MR imaging: normal patterns, diagnostic challenges, and potential for false-positive and false-negative interpretation. Radiographics 2014; 34: 234–247.
10.1148/rg.341135034
PubMed Web of Science® Google Scholar
5 Hambly NM, Liberman L, Dershaw DD, Brennan S, Morris EA. Background parenchymal enhancement on baseline screening breast MRI: impact on biopsy rate and short-interval follow-up. AJR Am J Roentgenol 2011; 196: 218–224.
10.2214/AJR.10.4550
PubMed Web of Science® Google Scholar
6 Uematsu T, Kasami M, Watanabe J. Does the degree of background enhancement in breast MRI affect the detection and staging of breast cancer? Eur Radiol 2011; 21: 2261–2267.
10.1007/s00330-011-2175-6
PubMed Web of Science® Google Scholar
7 Telegrafo M, Rella L, Stabile Ianora AA, Angelelli G, Moschetta M. Effect of background parenchymal enhancement on breast cancer detection with magnetic resonance imaging. Diagn Interv Imaging 2016; 97: 315–320.
10.1016/j.diii.2015.12.006
CAS PubMed Web of Science® Google Scholar
8 King V, Gu Y, Kaplan JB, Brooks JD, Pike MC, Morris EA. Impact of menopausal status on background parenchymal enhancement and fibroglandular tissue on breast MRI. Eur Radiol 2012; 22: 2641–2647.
10.1007/s00330-012-2553-8
PubMed Web of Science® Google Scholar
9 Amarosa AR, McKellop J, Klautau Leite AP, at al. Evaluation of the kinetic properties of background parenchymal enhancement throughout the phases of the menstrual cycle. Radiology 2013; 268: 356–365.
10.1148/radiol.13121101
PubMed Web of Science® Google Scholar
10 Macura KJ, Ouwerkerk R, Jacobs MA, Bluemke DA. Patterns of enhancement on breast MR images: interpretation and imaging pitfalls. Radiographics 2006; 26: 1719–1734.
10.1148/rg.266065025
PubMed Web of Science® Google Scholar
11 Müller-Schimpfle M, Ohmenhaüser K, Stoll P, Dietz K, Claussen CD. Menstrual cycle and age: influence on parenchymal contrast medium enhancement in MR imaging of the breast. Radiology 1997; 203: 145–149.
10.1148/radiology.203.1.9122383
PubMed Web of Science® Google Scholar
12 King V, Brooks JD, Bernstein JL, Reiner AS, Pike MC, Morris EA. Background parenchymal enhancement at breast MR imaging and breast cancer risk. Radiology 2011; 260: 50–60.
10.1148/radiol.11102156
PubMed Web of Science® Google Scholar
13 Dontchos BN, Rahbar H, Partridge SC, et al. Are qualitative assessments of background parenchymal enhancement, amount of fibroglandular tissue on MR Images, and mammographic density associated with breast cancer risk? Radiology 2015; 276: 371–380.
10.1148/radiol.2015142304
PubMed Web of Science® Google Scholar
14 Melsaether A, McDermott M, Gupta D, Pysarenko K, Shaylor SD, Moy L. Inter- and intrareader agreement for categorization of background parenchymal enhancement at baseline and after training. AJR Am J Roentgenol 2014; 203: 209–215.
10.2214/AJR.13.10952
PubMed Web of Science® Google Scholar
15 Tagliafico A, Bignotti B, Tagliafico G, Tosto S, Signori A, Calabrese M. Quantitative evaluation of background parenchymal enhancement (BPE) on breast MRI. A feasibility study with a semi-automatic and automatic software compared to observer-based scores. Br J Radiol 2015; 88: 20150417.
10.1259/bjr.20150417
PubMed Web of Science® Google Scholar
16 Klifa C, Suzuki S, Aliu S, et al. Quantification of background enhancement in breast magnetic resonance imaging. J Magn Reson Imaging 2011; 33: 1229–1234.
10.1002/jmri.22545
CAS PubMed Web of Science® Google Scholar
17 Kim EJ, Kang BJ, Kim SH, Youn IK, Baek JE, Lee HS. Diagnostic performance of and breast tissue changes at early breast MR imaging surveillance in women after breast conservation therapy. Radiology 2017; 284: 656–666
10.1148/radiol.2017162123
PubMed Web of Science® Google Scholar
18 Wu S, Berg WA, Zuley ML, et al. Breast MRI contrast enhancement kinetics of normal parenchyma correlate with presence of breast cancer. Breast Cancer Res 2016; 18: 76.
10.1186/s13058-016-0734-0
PubMed Web of Science® Google Scholar
19 Melsaether A, Pujara AC, Elias K, et al. Background parenchymal enhancement over exam time in patients with and without breast cancer. J Magn Reson Imaging 2017; 45: 74–83.
10.1002/jmri.25338
PubMed Web of Science® Google Scholar
20 Giannini V, Vignoti A, Morra L, et al. A fully automatic algorithm for segmentation of the breasts in DCE-MR images. Conf Proc IEEE Eng Med Biol Soc 2010; 2010: 3146–3149.
PubMed Google Scholar
21 Milenkovic J, Chambers O, Marolt Music M, Tasic JF. Automated breast-region segmentation in the axial breast MR images. Comput Biol Med 2015; 62: 55–64.
10.1016/j.compbiomed.2015.04.001
PubMed Web of Science® Google Scholar
22 Wu S, Weinstein SP, Conant EF, Schnall MD, Kontos D. Automated chest wall line detection for whole-breast segmentation in sagittal breast MR images. Med Phys 2013; 40: 042301.
10.1118/1.4793255
PubMed Web of Science® Google Scholar
23 Pujara AC, Mikheev A, Rusinek H, et al. Clinical applicability and relevance of fibroglandular tissue segmentation on routine T1 weighted breast MRI. Clin Imaging 2017; 42: 119–125.
10.1016/j.clinimag.2016.12.002
PubMed Web of Science® Google Scholar
24 Mikheev AV, Rusinek H, Wiggins G. Non-uniformity utilization using 3D canny edges and Legendre polynomial approximation of the bias field: validation on 7T T1W brain images. In: Proceedings of the 21st Annual Meeting of ISMRM, Salt Lake City, 2013. (abstract 2695).
Google Scholar
25 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159–174.
10.2307/2529310
CAS PubMed Web of Science® Google Scholar
26 DeLeo MJ III, Domchek SM, Kontos D, Conant E, Chen J, Weinstein S. Breast MRI fibroglandular volume and parenchymal enhancement in BRCA1 and BRCA2 mutation carriers before and immediately after risk-reducing salpingo-oophorectomy. AJR Am J Roentgenol 2015; 204: 669–673.
10.2214/AJR.13.12146
PubMed Web of Science® Google Scholar
27 King V, Goldfarb SB, Brooks JD, et al. Effect of aromatase inhibitors on background parenchymal enhancement and amount of fibroglandular tissue at breast MR imaging. Radiology 2012; 264: 670–678.
10.1148/radiol.12112669
PubMed Web of Science® Google Scholar
28 King V, Kaplan J, Pike MC, et al. Impact of tamoxifen on amount of fibroglandular tissue, background parenchymal enhancement, and cysts on breast magnetic resonance imaging. Breast J 2012; 18: 527–534.
10.1111/tbj.12002
CAS PubMed Web of Science® Google Scholar
29 Mousa NA, Eiada R, Crystal P, Nayot D, Casper RF. The effect of acute aromatase inhibition on breast parenchymal enhancement in magnetic resonance imaging: a prospective pilot clinical trial. Menopause 2012; 19: 420–425.
10.1097/gme.0b013e31823772a8
PubMed Web of Science® Google Scholar
30 Price ER, Brooks JD, Watson EJ, Brennan SB, Comen EA, Morris EA. The impact of bilateral salpingo-oophorectomy on breast MRI background parenchymal enhancement and fibroglandular tissue. Eur Radiol 2014; 24: 162–168.
10.1007/s00330-013-2993-9
CAS PubMed Web of Science® Google Scholar
31 Schrading S, Schild H, Kühr M, Kuhl C. Effects of tamoxifen and aromatase inhibitors on breast tissue enhancement in dynamic contrast-enhanced breast MR imaging: a longitudinal intraindividual cohort study. Radiology 2014; 271: 45–55.
10.1148/radiol.13131198
PubMed Web of Science® Google Scholar
32 Brown JC, Kontos D, Schnall M, Wu S, Schmitz KH. The dose-response effects of aerobic exercise on body composition and breast tissue among women at high risk for breast cancer: a randomized trial. Cancer Prev Res (Phila) 2016; 9: 581–588.
10.1158/1940-6207.CAPR-15-0408
PubMed Web of Science® Google Scholar
33 Zeng L, Lo G, Moshonov H, Liang J, Hodgson D, Crystal P. Breast background parenchymal enhancement on screening magnetic resonance imaging in women who received chest radiotherapy for childhood Hodgkin's lymphoma. Acad Radiol 2016; 23: 168–175.
10.1016/j.acra.2015.09.010
PubMed Web of Science® Google Scholar
34 Mema E, Mango VL, Guo X, et al. Does breast MRI background parenchymal enhancement indicate metabolic activity? Qualitative and 3D quantitative computer imaging analysis. 2017. (In press). doi: 10.1002/jmri.25798.
Google Scholar
35 Chen JH, Yu HJ, Hsu C, Mehta RS, Carpenter PM, Su MY. Background parenchymal enhancement of the contralateral normal breast: association with tumor response in breast cancer patients receiving neoadjuvant chemotherapy. Transl Oncol 2015; 8: 204–209.
10.1016/j.tranon.2015.04.001
PubMed Web of Science® Google Scholar
36 van der Velden BH, Dmitriev I, Loo CE, Pijnappel RM, Gilhuijs KG. Association between parenchymal enhancement of the contralateral breast in dynamic contrast-enhanced MR imaging and outcome of patients with unilateral invasive breast cancer. Radiology 2015; 276: 675–685.
10.1148/radiol.15142192
PubMed Web of Science® Google Scholar
37 Wu S, Weinstein SP, DeLeo MJ III, et al. Quantitative assessment of background parenchymal enhancement in breast MRI predicts response to risk-reducing salpingo-oophorectomy: preliminary evaluation in a cohort of BRCA1/2 mutation carriers. Breast Cancer Res 2015; 17: 67.
10.1186/s13058-015-0577-0
PubMed Web of Science® Google Scholar

Citing Literature

Volume47, Issue6

June 2018

Pages 1685-1691

Comparison between qualitative and quantitative assessment of background parenchymal enhancement on breast MRI

Abstract

Background

Purpose or Hypothesis

Study Type

Population

Field Strength/Sequence

Assessment

Statistical Tests

Results

Data Conclusion

References

Citing Literature

References

Information

About Wiley Online Library

Help & Support

Opportunities

Connect with Wiley

Comparison between qualitative and quantitative assessment of background parenchymal enhancement on breast MRI

Abstract

Background

Purpose or Hypothesis

Study Type

Population

Field Strength/Sequence

Assessment

Statistical Tests

Results

Data Conclusion

References

Citing Literature

References

Related

Information