Multiparametric breast MRI to problem-solve mammographically detected suspicious calcifications.

Area of Science:

• Radiology and Imaging Science
• Breast Cancer Diagnostics
• Medical Imaging Analysis

Background:

• Mammography is crucial for detecting suspicious calcifications, but differentiating benign from malignant cases can be challenging.
• Multiparametric breast MRI offers advanced imaging capabilities to assess these calcifications.
• Accurate characterization of calcifications is vital to guide biopsy decisions and improve patient outcomes.

Purpose of the Study:

• To assess the diagnostic performance of multiparametric breast MRI in evaluating mammographically detected suspicious calcifications.
• To determine the added value of dynamic contrast-enhanced MRI (DCE-MRI) and diffusion-weighted imaging (DWI) in this context.
• To compare MRI performance against mammographic findings for BI-RADS category 4a and 4b calcifications.

Main Methods:

• Prospective enrollment of 81 women with suspicious calcifications from August 2017 to May 2023.
• Pre-biopsy multiparametric MRI including standard/high-temporal resolution DCE-MRI and DWI.
• Univariable and multivariable logistic regression analyses were used to associate MRI features with malignancy outcomes, with AUCs calculated via cross-validation.

Main Results:

• Of 86 calcifications, 29% were malignant. Malignancy rates for mammographic BI-RADS 4a and 4b were low (3.8% and 8.7%, respectively).
• Mammographic BI-RADS category, MRI BI-RADS category, DWI visibility, peak enhancement, functional tumor volume, and Ktrans were associated with malignancy.
• Multivariable models incorporating qualitative DCE-MRI showed higher AUCs (malignancy: 0.71-0.76; invasive cancer/high-grade DCIS: 0.78-0.91) than mammographic features alone (0.57 and 0.61).

Conclusions:

• Breast DCE-MRI is valuable for evaluating mammographic BI-RADS category 4a/4b calcifications, potentially reducing the need for biopsy.
• Inclusion of DWI or quantitative MRI features did not significantly enhance diagnostic performance beyond qualitative DCE-MRI.
• Multiparametric MRI, particularly DCE-MRI, improves the characterization of suspicious calcifications detected on mammography.