Keywords:
Breast, MR, Diagnostic procedure
Authors:
P. Jagmohan1, C. Grippo2, C. Sodano3, P. Clauser4, P. Kapetas3, T. H. Helbich3, P. A. T. Baltzer3; 1Singapore/SG, 2Rome/IT, 3Vienna/AT, 4Vienna, Vienna/AT
DOI:
10.26044/ecr2019/C-2750
Aims and objectives
Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is becoming an increasingly popular breast imaging tool especially for screening high-risk women,
staging local disease in newly diagnosed breast cancer,
and tumour evaluation during neoadjuvant treatment.[1]
While it has an excellent sensitivity,
breast MRI interpretation can be challenging.
The American College of Radiology (ACR) Breast Imaging Reporting and Data System.
(BI-RADS) lexicon is a widely accepted standard that provides a common language with MRI descriptors based on lesion morphology and functional contrast enhancement kinetics.[2]
While this is a valuable tool to improve breast MRI interpretation,
specificity and inter-reader agreement using BIRADS remains moderate.
The Kaiser score (formerly known as Tree) is a scoring system based on a diagnostic flow chart that assesses five criteria (margins,
signal-intensity time curve,
internal enhancement pattern,
ipsilateral oedema,
root sign/spiculations) that aids in characterising lesions on MRI,
assessing likelihood of malignancy and provides a clinical decision rule that converts imaging features into a diagnostic category (Fig.
1).
This score has been shown to reduce inter-observer variability,
improve the performance of less experienced readers and reduce unnecessary biopsies.[3][4]
One of the diagnostic criteria evaluated in the Kaiser score is the signal time intensity curve type.
The type of curve is determined by initial and delayed enhancement and by comparing early or peak and delayed enhancement time points.
The aim of this study was to investigate whether the timepoint used to determine the initial enhancement (early or peak) for the signal-intensity time curve analysis influences the diagnostic performance of the Kaiser score.