Ultrafast MRI in BI-RADS 4 Masses: The Fast Lane to Clarity

This study aims to evaluate the diagnostic accuracy of ultrafast magnetic resonance imaging (UF-MRI)-derived kinetic parameters in differentiating benign from malignant BI-RADS (Breast Imaging-Reporting and Data System) 4 breast masses. It also compares the performance of UF-MRI with standard dynamic contrast-enhanced MRI (DCE-MRI) to determine its impact on clinical decision-making and overall diagnostic accuracy.

This cross-sectional observational study included patients with BI-RADS 4 breast masses who underwent UF-MRI from January to December 2024. UF-MRI was acquired continuously over a brief period, capturing kinetic parameters including time to enhancement (TTE), arterial-venous interval (AVI), and maximum slope (MS), in addition to standard DCE-MRI. Two radiologists with more than 10 years of experience in breast radiology independently evaluated the results from standard DCE-MRI and UF-MRI. Statistical analysis assessed the correlation between UF-MRI parameters, standard DCE-MRI, and final histopathology.

A total of 31 breast masses from 29 patients (mean age: 45.3 ± 10.9 years) were evaluated, with 16 malignant and 15 benign masses confirmed on histopathology. UF-MRI parameters TTE and AVI demonstrated a strong correlation with malignancy (Cramer's V: 0.81 and 0.87, p  < 0.001) while MS (Cramer's V: 0.50) showed moderate association. AVI had the highest specificity (86.7%), followed by TTE (80%) and MS (66.7%) when compared with standard DCE-MRI kinetic curves that showed significantly lower specificity (40%). The combined accuracy of TTE + AVI + MS was 93.5%, with an area under curve of 0.969. UF-MRI showed a high sensitivity and specificity of 100 and 87%, respectively.

UF-MRI offers a fast and accurate approach for distinguishing benign from malignant BI-RADS 4 lesions, with TTE and AVI emerging as highly reliable diagnostic markers. It addresses the limitations of standard DCE-MRI by providing early contrast wash-in dynamic data with shorter acquisition times and higher specificity. Integrating UF-MRI kinetic parameters with morphological characteristics such as shape and margins can significantly enhance diagnostic precision, especially in patients with dense breasts and multiple masses, thereby minimizing the need for unnecessary biopsies.