Motion artifacts,lesion type,and parenchymal enhancement in breast MRI: what does really influence diagnostic accuracy?

Abstract

Background

Motion artifacts can reduce image quality of breast magnetic resonance imaging (MRI). There is a lack of data regarding their effect on diagnostic estimates.

Purpose

To evaluate factors that potentially influence readers’ diagnostic estimates in breast MRI: motion artifacts; amount of fibroglandular tissue; background parenchymal enhancement; lesion size; and lesion type.

Material and Methods

This Institutional Review Board-approved, retrospective, cross-sectional, single-center study included 320 patients (mean age = 55.1 years) with 334 histologically verified breast lesions (139 benign, 195 malignant) who underwent breast MRI. Two expert breast radiologists evaluated the images considering: motion artifacts (1 = minimal to 4 = marked); fibroglandular tissue (BI-RADS FGT); background parenchymal enhancement (BI-RADS BPE); lesion size; lesion type; and BI-RADS score. Univariate (Chi-square) and multivariate (Generalized Estimation Equations [GEE]) statistics were used to identify factors influencing sensitivity, specificity, and accuracy.

Results

Lesions were: 230 mass (68.9%) and 59 non-mass (17.7%), no foci. Forty-five lesions (13.5%) did not enhance in MRI but were suspicious or unclear in conventional imaging. Sensitivity, specificity, and accuracy were 93.8%, 83.4%, and 89.8% for Reader 1 and 95.4%, 87.8%, and 91.9% for Reader 2. Lower sensitivity was observed in case of increased motion artifacts (P = 0.007), non-mass lesions (P < 0.001), and small lesions ≤ 10 mm (P < 0.021). No further factors (e.g. BPE, FGT) significantly influenced diagnostic estimates. At multivariate analysis, lesion type and size were retained as independent factors influencing the diagnostic performance (P < 0.033).

Conclusion

Motion artifacts can impair lesion characterization with breast MRI, but lesion type and small size have the strongest influence on diagnostic estimates.

Keywords

Breast magnetic resonance imaging artifacts sensitivity specificity cross-sectional studies

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