Optimization of Time-to-peak Analysis for Differentiating Malignant and Benign Breast Lesions with Dynamic Contrast-Enhanced MRI

Rationale and Objectives The aim of this study was to investigate the feasibility of applying measures sensitive to time-to-peak ( T peak ) heterogeneity as indicators for malignancy on breast dynamic contrast-enhanced magnetic resonance imaging. Materials and Methods The study included 39 benign and 97 malignant breast lesions from 103 patients. Lesions were automatically segmented by k-means clustering. Voxel-by-voxel T peak values were extracted using an empirical model. The p th percentile values ( p = 10, 20…) of the T peak distribution within each lesion and the fractional and absolute hot spot volumes were determined, where the hot spot volume is the volume of tissue with T peak less than a threshold value. Using the area under the receiver-operating characteristic curve (AUC), these measures were tested as indicators for differentiating fibroadenomas from invasive lesions and from ductal carcinoma in situ, as well as for differentiating nonfibroadenoma benign lesions from these malignant lesions. Region of interest–based T peak measurements were also tested. Finally, the relationship between hot spot volume and lesion volume was investigated. Results For differentiating fibroadenomas from malignant lesions, AUC values increased with decreasing values of p . At the optimal threshold (3 minutes), the hot spot volume provided high diagnostic performance (AUC ≥0.96 ± 0.02 for absolute hot spot volume). However, for differentiating nonfibroadenoma benign lesions from malignant lesions, AUC values were low. A significant correlation between absolute hot spot volume and lesion volume was found for malignant lesions and nonfibroadenoma benign lesions. Conclusion Quantitative analysis of the T peak distribution can be optimized for diagnostic performance, providing indicators sensitive to intralesion T peak heterogeneity.