What question did this study set out to answer?

Investigate the influence of background parenchymal enhancement on the detection of breast lesions via dynamic contrast-enhanced MRI.

April 6, 2026European Radiology0 citationsOpen Access

Impact of background parenchymal enhancement on the diagnosis of enhancing lesions in breast MRI: a systematic approach

ASAmbra SantonocitoDepartment of Medical Sciences SBSonja BechynaMedical University of Vienna PCPaola ClauserMedical University of Vienna

Key Points

Investigate the influence of background parenchymal enhancement on the detection of breast lesions via dynamic contrast-enhanced MRI.
Analyzed MRI images of patients with indeterminate or suspicious findings on breast imaging.
Divided breasts into 10 regions of interest (ROIs) to assess BPE and lesion type using MRI BI-RADS.
Conducted ROC analysis for MRI performance assessment and evaluated inter-reader agreement with k statistics.
Included 316 patients with 282 histopathologically analyzed lesions, comprising 129 malignant and 153 benign.
78% of patients exhibited minimum/mild background parenchymal enhancement (BPE1) and 22% showed moderate/marked (BPE2).
Diagnostic accuracy was comparable with AUC of 0.989 for BPE1 and 0.988 for BPE2.
Sensitivity was 98.1% for BPE1 and 100% for BPE2, with specificities of 95.5% (BPE1) and 92.6% (BPE2).

Abstract

Abstract Objective Dynamic contrast-enhanced MRI (DCE-MRI) enhances both suspicious lesions and normal tissue, known as background parenchymal enhancement (BPE). There is controversial evidence regarding whether BPE compromises the accuracy of breast MRI. Our aim was to investigate the influence of BPE in the detection of breast lesions by DCE-MRI using an ROI-based approach. Materials and methods MRI Images of consecutive patients with indeterminate or suspicious findings on mammography or ultrasound (BI-RADS 0, 3, 4, 5). tested between May 2020 and September 2023 were retrospectively analyzed. Both breasts were divided into 10 regions of interest (ROIs), and BPE, BI-RADS and lesion type were assessed according to the MRI BI-RADS lexicon for each ROI by two blinded readers. BPE was dichotomized into minimum/mild (BPE1) and moderate/marked (BPE2). Patients without a standard reference were excluded. The standard reference was defined as histology or 1 year follow-up. The MRI performance was assessed using ROC analysis in an ROI-based analysis. Inter-reader agreement was assessed using k statistics. Results A total of 316 patients (mean of 54 years, SD 10.6; range 31–84) were included. Among the 282 lesions histopathologically analyzed, 129 were malignant and 153 were benign. BPE1 was observed in 78% of patients and BPE2 in 22%. AUC did not differ between BPE1 (0.989) and BPE2 (0.988), p > 0.05. Sensitivity was 98.1% for BPE1 and 100% for BPE2, with comparable specificity: 95.5% (BPE1) vs. 92.6% (BPE2), p > 0.05. Conclusion Our study demonstrated that BPE does not have a negative impact on the detection and identification of suspicious lesions on breast MRI. Key Points Question What is the role of background parenchymal enhancement on DCE-MRI in terms of potential masking or mimicking remains a challenging issue? Findings The diagnostic accuracy of DCE-MRI for detecting breast lesions is not affected by elevated BPE levels. Clinical relevance Systematic evaluation of DCE-MRI using ROI-based analysis improves breast cancer detection and ensures diagnostic accuracy across different levels of background parenchymal enhancement. Graphical Abstract

问 AI

Bookmark

View Full Paper