Rationale and objectives: The aims of this study were to evaluate high spectral and spatial resolution (HiSS) magnetic resonance imaging (MRI) for the diagnosis of breast cancer without the injection of contrast media by comparing the performance of precontrast HiSS images to that of conventional contrast-enhanced, fat-suppressed, T1-weighted images on the basis of image quality and in the task of classifying benign and malignant breast lesions.
Materials and methods: Ten benign and 44 malignant lesions were imaged at 1.5 T with HiSS (precontrast administration) and conventional fat-suppressed imaging (3-10 minutes after contrast administration). This set of 108 images, after randomization, was evaluated by three experienced radiologists blinded to the imaging technique. Breast Imaging Reporting and Data System morphologic criteria (lesion shape, lesion margin, and internal signal intensity pattern) and final assessment were used to measure reader performance. Image quality was evaluated on the basis of boundary delineation and quality of fat suppression. An overall probability of malignancy was assigned to each lesion for HiSS and conventional images separately.
Results: On boundary delineation and quality of fat suppression, precontrast HiSS scored similarly to conventional postcontrast MRI. On benign versus malignant lesion separation, there was no statistically significant difference in receiver-operating characteristic performance between HiSS and conventional MRI, and HiSS met a reasonable noninferiority condition.
Conclusions: Precontrast HiSS imaging is a promising approach for showing lesion morphology without blooming and other artifacts caused by contrast agents. HiSS images could be used to guide subsequent dynamic contrast-enhanced MRI scans to maximize spatial and temporal resolution in suspicious regions. HiSS MRI without contrast agent injection may be particularly important for patients at risk for contrast-induced nephrogenic systemic fibrosis or allergic reactions.
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