Accurately Differentiating Benign from Malignant Contrast-Enhancing Breast Lesions Using an Automated Method of Quantitative Washout Kinetics and Fractional Lesion Volume Analysis

Jie Huang¹, Tobias Hahn^1,2, Lori Hoisington¹, Kevin Berger¹

Dynamic contrast-enhancing breast MRI has been shown to be very sensitive in cancer detection. Most malignant tumors demonstrate a rapid initial enhancement followed by a wash-out (WO) or plateau curve in the post-contrast signal intensity time courses, whereas most benign lesions exhibit a slow persistent enhancement. The WO curve mainly reflects the hypervascularity associated with tumor angiogenesis, and the total volume of the WO voxels may account for the degree of the hypervascularity. Benign proliferative breast diseases can also produce the WO curve, yielding an overlap between benign and malignant lesions and making them hardly distinguishable. Nevertheless, the WO volume fraction for benign proliferation might be relatively small in comparison to that for tumor angiogenesis, considering that an aggressive cancer cell growth is most likely accompanied by relatively larger angiogenesis. Thus, measuring the WO volume fraction may help in differentiating benign from malignant contrast-enhancing lesions.