New subtraction algorithms for evaluation of lesions on dynamic contrast-enhanced MR mammography

We report new subtraction algorithms for the detection of lesions in dynamic contrast-enhanced MR mammography(CE MRM). Twenty-five patients with suspicious breast lesions underwent dynamic CE MRM using 3D fast low-angle shot. After the acquisition of the T1-weighted scout images, dynamic images were acquired six times after the bolus injection of contrast media. Serial subtractions, step-by-step subtractions, and reverse subtractions, were performed. Two radiologists attempted to differentiate benign from malignant lesion in consensus. The sensitivity, specificity, and accuracy of the method leading to the differentiation of malignant tumor from benign lesions were 85.7, 100, and 96%, respectively. Subtraction images allowed for better visualization of the enhancement as well as its temporal pattern than visual inspection of dynamic images alone. Our findings suggest that the new subtraction algorithm is adequate for screening malignant breast lesions and can potentially replace the time-intensity profile analysis on user-selected regions of interest.