Beyond the Trade-Off: Achieving High Spatial and Temporal Resolution in Breast DCE-MRI Using a Novel 4D Stack-of-Stars Sequence

Academic Radiology, vol. 33, pp. 2486–2496

Abstract

RATIONALE AND OBJECTIVES: To clinically implement and evaluate a 4D diamond-shaped pseudo-golden angle stack-of-stars acquisition with k-space weighted image contrast reconstruction for breast dynamic contrast-enhanced MRI (4D-DCE), assessing image quality, diagnostic confidence, and Breast Imaging Reporting and Data System (BI-RADS) agreement across conventional and ultrafast protocols. MATERIAL AND METHODS: This retrospective study included female patients who underwent breast MRI at 3 T using the 4D-DCE sequence. Three protocol types were generated: (1) conventional (4 × 60 s), (2) ultrafast (20 × 3 s), and (3) combined (ultrafast followed by 3 × 60 s). Two readers independently or in consensus rated image quality (overall quality, artifacts, sharpness, lesion conspicuity, and morphology) and diagnostic confidence using a 5-point Likert scale. BI-RADS scores were compared to the final reference standard (histology or ≥2-year imaging follow-up). Agreement was assessed using Cohen's kappa. RESULTS: A total of 167 patients (mean age: 59 ± 11 years) were included. Despite high temporal resolution of the ultrafast 4D-DCE, image quality was good to excellent and was comparable to the standard-resolution post-contrast T1 mDixon sequence (e.g., overall quality: 4.8 ± 0.4 vs. 4.8 ± 0.3, P =0.99). The combined 4D-DCE protocol yielded the highest diagnostic confidence by BI-RADS assignment in both readers, with the most pronounced improvement observed in patients with high background parenchymal enhancement (e.g., reader 1: 3.2 ± 0.6 [conventional] vs. 4.2 ± 0.4 [ultrafast] vs. 4.9 ± 0.3 [combined], P <0.001). BI-RADS agreement with the final reference standard was good to excellent across all DCE protocols, with the highest agreement achieved using the combined 4D-DCE (e.g., reader 1: κ = 0.89, 95% CI: 0.84-0.95). CONCLUSION: The proposed 4D-DCE technique enables robust breast DCE-MRI with high spatial and temporal resolution. Combining ultrafast and conventional acquisitions within a single protocol improves diagnostic confidence and BI-RADS agreement.

Authors 13

1. Narine Mesropyan corresponding

   University Hospital Bonn

   Affiliation as printed

   Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (N.M., A.L., C.L., C.K., A.I., T.D., C.C.P., A.S., J.A.L.). Electronic address: narine.mesropyan@ukbonn.de

2. Christoph Katemann

   Philips (Germany)

   Affiliation as printed

   Philips Healthcare, Hamburg, Germany (C.K., O.M.W.)

3. Asadeh Lakghomi

   University Hospital Bonn

   Affiliation as printed

   Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (N.M., A.L., C.L., C.K., A.I., T.D., C.C.P., A.S., J.A.L.)

4. C Leutner

   University Hospital Bonn

   Affiliation as printed

   Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (N.M., A.L., C.L., C.K., A.I., T.D., C.C.P., A.S., J.A.L.)

5. Johannes Peeters

   Philips (Netherlands)

   Affiliation as printed

   Philips Healthcare, Best, the Netherlands (J.M.P.)

6. Christopher Kämpfer

   University Hospital Bonn

   Affiliation as printed

   Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (N.M., A.L., C.L., C.K., A.I., T.D., C.C.P., A.S., J.A.L.)

7. Oliver M. Weber

   Philips (Germany)

   Affiliation as printed

   Philips Healthcare, Hamburg, Germany (C.K., O.M.W.)

8. Can Yüksel Aachen Department of Diagnostic and Interventional Radiology

   Universitätsklinikum Aachen

   Affiliation as printed

   Department of Diagnostic and Interventional Radiology, University Hospital Aachen, Aachen, Germany (C.Y.)

9. Alexander Isaak

   University Hospital Bonn

   Affiliation as printed

   Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (N.M., A.L., C.L., C.K., A.I., T.D., C.C.P., A.S., J.A.L.)

10. Tatjana Dell

    University Hospital Bonn

    Affiliation as printed

    Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (N.M., A.L., C.L., C.K., A.I., T.D., C.C.P., A.S., J.A.L.)

11. Claus Christian Pieper

    University Hospital Bonn

    Affiliation as printed

    Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (N.M., A.L., C.L., C.K., A.I., T.D., C.C.P., A.S., J.A.L.)

12. Alexandra Sommer

    University Hospital Bonn

    Affiliation as printed

    Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (N.M., A.L., C.L., C.K., A.I., T.D., C.C.P., A.S., J.A.L.)

13. Julian Alexander Luetkens

    University Hospital Bonn

    Affiliation as printed

    Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (N.M., A.L., C.L., C.K., A.I., T.D., C.C.P., A.S., J.A.L.)