Dynamic analysis of breast lesions : Can we use the wash-in phase instead of the washout phase ?

Introduction: It was shown that using TWIST acquisitions it is feasible to obtain whole breast MRI data with a diagnostic spatial resolution of 1*0.9*2.5 mm in less than 7 seconds. Consequently imaging resolution is sufficiently high to assess morphology while it is fast enough to document the inflow of contrast in eventual lesions (fig 1). Since in conventional breast MRI the highest specificity is achieved by evaluating both morphologic and dynamic features of breast lesions we sought a simple way to use the inflow information for the differentiation of benign and malignant breast disease. Since pharmacokinetic modeling is not readily available everywhere, we propose the use of the upslope angle in a fixed grid of relative enhancement versus time as a novel heuristic discriminating parameter and compare this approach to the classic curve types derived from conventional 3 timepoint analysis.