HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Warren, R. M. L. Search for Related Content PubMed PubMed Citation Articles by Warren, R. M. L.

Reading Protocol for Dynamic Contrast-enhanced MR Images of the Breast: Sensitivity and Specificity Analysis¹

¹ From the Department of Radiology, Addenbrooke's Hospital, Cambridge, England (R.M.L.W.); Study Coordinating Office, Section of Magnetic Resonance, Institute of Cancer Research, Royal Marsden Hospital, Downs Rd, Sutton, Surrey SM2 5PT, England (L.P., R.H., M.O.L.); Department of Radiology, University of Aberdeen, Scotland (F.J.G.); CR-UK Genetic Epidemiology Unit, Cambridge, England (D.T., D.E.); Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, Royal Marsden Hospital, London, England (S.R.L.); and Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, Middlesex, England (A.P.). Received April 23, 2004; revision requested July 1; revision received October 19; accepted December 10. Supported by a project grant from the UK Medical Research Council. Address correspondence to M.O.L. (e-mail: martin.leach{at}icr.ac.uk).

PURPOSE: To prospectively determine sensitivity and specificity of breast magnetic resonance (MR) imaging in a screening and symptomatic population by using independent double reading, with histologic or cytologic results or a minimum 18-month follow-up as the standard.

MATERIALS AND METHODS: Informed consent and ethical approval were obtained. Reader performance was analyzed in 44 radiologists at 18 centers from 1541 examinations, including 1441 screening examinations in 638 high-risk women aged 24–51 years (mean, 40.5 years) and 100 examinations in symptomatic women aged 23–81 years (mean, 49.2 years). A screening protocol of dynamic T1-weighted three-dimensional imaging and 0.2 mmol/kg gadolinium-based intravenous contrast agent was used. Logistic and Poisson regressions were used to analyze reader performance in relation to experience. Correlation between readers was determined with statistics. Sensitivity and specificity were analyzed according to reader, field strength, machine type, and histologic results.

RESULTS: The proportion of studies with lesions analyzed reduced significantly with reader experience (odds ratio, 0.84 per 6 months; P < .001), and number of regions per lesion analyzed also diminished (incidence rate ratio, 0.98 per 6 months; P = .047). The two readers for each study agreed 87% of the time, with a moderately good statistic of 0.52 (95% confidence interval [CI]: 0.45, 0.58). By taking the reading with the highest score (most likely to be malignant) from each double-read study, sensitivity was 91% (95% CI: 83%, 96%) and specificity was 81% (95% CI: 79%, 83%). Single readings had 7% lower sensitivity (95% CI: 4%, 11%) and 7% higher specificity (95% CI: 6%, 7%). Sensitivity did not differ between MR imager manufacturers or between 1.0- and 1.5-T field strength, but there were significant differences in specificity for machine type (P = .001) and for field strength adjusted for manufacturer (P = .001). Specificity, but not sensitivity, was higher in women younger than 50 years (P = .02).

CONCLUSION: Independent double reading by 44 radiologists blinded to mammography results showed sensitivity and specificity acceptable for screening; sensitivity was higher when two readings were used, at the cost of specificity. Interreader correlation was moderately good, and evidence of learning was seen. Equipment manufacturer, field strength, and age affected specificity but not sensitivity.

© RSNA, 2005

This article has been cited by other articles:

				D. Saslow, C. Boetes, W. Burke, S. Harms, M. O. Leach, C. D. Lehman, E. Morris, E. Pisano, M. Schnall, S. Sener, et al. American Cancer Society Guidelines for Breast Screening with MRI as an Adjunct to Mammography CA Cancer J Clin, March 1, 2007; 57(2): 75 - 89. [Abstract] [Full Text] [PDF]

				W. A. Berg, J. D. Blume, J. B. Cormack, and E. B. Mendelson Operator Dependence of Physician-performed Whole-Breast US: Lesion Detection and Characterization. Radiology, November 1, 2006; 241(2): 355 - 365. [Abstract] [Full Text] [PDF]

				R. M. L. Warren, D. Thompson, L. J. Pointon, R. Hoff, F. J. Gilbert, A. R. Padhani, D. F. Easton, S. R. Lakhani, M. O. Leach, and Collaborators in the United Kingdom Medical Resear Evaluation of a Prospective Scoring System Designed for a Multicenter Breast MR Imaging Screening Study. Radiology, June 1, 2006; 239(3): 677 - 685. [Abstract] [Full Text] [PDF]