Background parenchymal enhancement and its effect on lesion detectability in ultrafast dynamic contrast-enhanced MRI

Purpose Background parenchymal enhancement (BPE) often affects interpretation of dynamic contrast-enhanced (DCE) MRI. There is limited evidence that reduced BPE is a feature of ultrafast DCE (UF-DCE) MRI. We aimed to evaluate the effect of BPE levels on lesion detectability on UF-DCE MRI in comparison with conventional DCE MRI. Method MRIs of 70 patients with histologically proven breast lesions were retrospectively evaluated. The total number of analyzed lesions was 84 (56 malignant and 28 benign). Using 3 T MRI, 20 phases of UF-DCE MRI based on the three-dimensional gradient-echo VIBE sequence combined with a compressed sensing reconstruction were acquired followed by conventional DCE MRI. Three maximum intensity projection (MIP) images were generated from the 12th phase, the 20th phase of UF-DCE MRI and the initial phase of conventional DCE MRI. Two radiologists independently evaluated the degree of BPE and lesion detectability of the three MIP images for each breast with histologically confirmed lesions. The degree of BPE was scored on a four-point scale and lesion detectability (conspicuity and confidence levels) was scored on a three-point scale. Data were analyzed using the Wilcoxon signed-rank test with Bonferroni correction. Results BPE was lower on UF-DCE MRI than on conventional DCE MRI. Lesion detectability was higher on UF-DCE MRI among patients with higher BPE on conventional DCE MRI or premenopausal women. Conclusions Images with lower BPE can be achieved using UF-DCE MRI and may be advantageous when assessing breast lesions among patients with higher BPE or premenopausal women.