Clinical MR Mammography: Impact of Hormonal Status on Background Enhancement and Diagnostic Accuracy

Zusammenfassung

Ziel: Hormonelle Stimulation kann Hintergrundanreicherungen (HA) in der MR-Mammografie (MRM) hervorrufen, welche als potenzielle diagnostische Beeinträchtigung aufgefasst werden. Diese Studie untersuchte 1. die Frequenz von HA in post- sowie prämenopausalen Patientinnen zu verschiedenen Zyklusphasen (ZP), 2. den Einfluss von hormonellem Status (HS) und HA auf die diagnostische Genauigkeit. Material und Methoden: Eingeschlossen in diese prospektive Studie wurden konsekutive (22 Monate) Patientinnen mit vollständigen Informationen über den HS (prä- vs. postmenopausal, ZP). Ausschlusskriterium waren hormonelle Substitution, Hysterektomie sowie bioptisch vor MRM gesicherte Karzinome. Referenzstandard war die Histopathologie. MRM wurden unter Verwendung eines einheitlichen Messprotokolls (1,5 T, T 1w GRE-Dynamik nach i. v. Gabe von 0,1 mmol/kg KG Gd-DTPA) gemessen. 2 Radiologen bewerteten die MRM im Konsensus gemäß BI-RADS. HA wurden eingeteilt in: 0 = fehlend, 1 = gering, 2 = ausgeprägt. Ergebnisse: 224 Patientinnen (150 postmenopausal und 74 prämenopausal, 45 in der zweiten Zykluswoche) wurden in die Studie eingeschlossen (83 benigne und 141 maligne Befunde). HA traten häufiger in prämenopausalen Patientinnen auf (p = 0,006), hier ohne Präferenz einer ZP (p = 0,460). Weder HS, noch HA hatten einen signifikanten Einfluss auf die diagnostischen Parameter der MRM (p ≥ 0.375). Die höchste Frequenz falsch positiver Befunde wurde in Fällen mit ausgeprägter HA beobachtet (5 / 10; 50 %), bei prämenopausalen Patientinnen fanden sich 17 % mehr falsch positive Befunde außerhalb der 2. Zykluswoche. Schlussfolgerung: Der HS prämenopausaler Patientinnen führt unabhängig von der ZP zu vermehrten HA des Drüsenparenchyms. Ausgeprägte Hintergrundanreicherungen und, weniger ausgeprägt, inoptimale ZP können dabei eine erhöhte Anzahl falsch positiver Befunde verursachen.

Abstract

Purpose: Hormonal stimulation can induce background enhancement (BE) in MR mammography (MRM). This fact has been assumed to decrease the accuracy of MRM. Consequently, this report investigates: 1. The prevalence of BE in postmenopausal vs. premenopausal women in correlation to hormonal cycle phase (CP). 2. The impact of hormonal status (HS) and BE on diagnostic accuracy. Materials and Methods: Consecutive patients over 22 months with complete HS information (week of CP or postmenopausal) were included in this prospective investigation. Exclusion criteria were any hormonal therapy, hysterectomy as well as cancer proven by biopsy. The standard of reference was histopathology. All MRM scans were acquired using the same protocol (1.5 T, dynamic T 1w GRE after 0.1 mmol/kg bw Gd-DTPA i. v.). Two radiologists rated all examinations in consensus according to BI-RADS. BE was defined as: 0 = missing, 1 = moderate, 2 = distinct. Results: 224 patients (150 postmenopausal, 74 premenopausal, 45 in the second week of CP) were included in this study (83 benign and 141 malignant findings). BE was more frequent in premenopausal women (p = 0.006), but did not differ between CP (p = 0.460). Neither HS nor BE had a significant impact on the diagnostic parameters of MRM (p ≥ 0.375). However, regarding BE, the relative number of false positive (FP) findings was highest (5 / 10; 50 %) in the distinct BE group. Regarding HS, 17 % more FP findings were observed in premenopausal women examined outside the second week of CP. Conclusion: In premenopausal women, HS leads to increased BE of breast tissue, independent of CP. Distinct BE and less pronounced, non-optimal CP may lead to an increased number of false positive findings.

Key words

breast - MR imaging - backgroundenhancement - hormones - sensitivity and specificity - DCE-MRI

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