Correct determination of the enhancement curve is critical to ensure accurate diagnosis using the Kaiser score as a clinical decision rule for breast MRI
Correct determination of the enhancement curve is critical to ensure accurate diagnosis using the Kaiser score as a clinical decision rule for breast MRI
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DOI：
10.1016/j.ejrad.2021.109630
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发表时间：
2021-03-18
影响因子：
3.3
通讯作者：
Baltzer, Pascal A. T.
中科院分区：
文献类型：
--
作者：
Grippo, Cristina;Jagmohan, Pooja;Baltzer, Pascal A. T.
目的：Kaiser评分越来越被认为是一个有价值的工具，以提高乳房MRI的解释。对比增强动力学是第二重要的诊断标准，因此定义曲线类型在Kaiser评分评估中起着至关重要的作用。我们研究用于确定信号强度时间曲线分析的初始增强（早期或峰值）的时间点是否会影响Kaiser评分的诊断性能。方法：这项经irb批准的回顾性单中心研究纳入了70例经组织学证实的连续乳腺MRI病例。两名非现场乳腺放射科医生使用Kaiser评分独立阅读所有检查结果，使用三种方法评估初始增强：对比后第1或第2个时间点的第一(1)，第二(2)和峰值（最大值）。然后将初始增强与最后一个时间点（延迟增强）进行比较，以确定曲线类型。本研究采用曲线类型目视评价。采用受试者工作特征（ROC）分析评价诊断效果。结果：使用第一或第二个时间点的峰值增强的Kaiser评分阅读结果明显优于其他方法（P分别< 0.05），并且具有更高的灵敏度。两种阅读器的诊断准确率（曲线下AUC面积）在85.4% ~ 91.6%之间，差异无统计学意义（P < 0.5）。结论：如何确定初始增强时间点对Kaiser评分的诊断性能有显著影响。应使用峰值增强作为初始时间点，以避免由于时间或生理差异而产生的陷阱。
Objectives: the Kaiser score is increasingly recognized as a valuable tool to improve breast MRI interpretation. Contrast enhancement kinetics are the second most important diagnostic criterion, thus defining the curve type plays a crucial role in Kaiser score assessment. We investigate whether the timepoint used to determine the initial enhancement (earlyor peak) for the signal-intensity time curve analysis affects the diagnostic performance of the Kaiser score.Methods: This IRB-approved, retrospective, single-center study included 70 consecutives histologically verified breast MRI cases. Two off-site breast radiologists independently read all examinations using the Kaiser score, assessing the initial enhancement using three approaches: -first (1 st), second (2nd) and peak (maximum) of either 1 st or 2nd post-contrast timepoints. The initial enhancement was then compared to the last timepoint (delayed enhancement) to determine the curve type. Visual assessment of curve types was used for this study. Diagnostic performance was evaluated by receiver operating characteristics (ROC) analysis.Results: Kaiser score reading results using the peak enhancement of either the first or second timepoint performed significantly better than the other approaches (P < 0.05, respectively) and specifically achieved higher sensitivity. Diagnostic accuracy (AUC area under the curve) ranged between 85.4 % and 91.6 %, without significant differences between the two readers (P < 0.5).Conclusions: Diagnostic performance of the Kaiser score is significantly influenced by how the initial enhancement timepoint is determined. Peak enhancement should be used as initial timepoint to avoid pitfalls due to timing or physiological differences.