Abstract：
OBJECTIVE: To determine the usefulness of BI-RADS® MRI for the morphological description and categorization of images obtained with contrast-enhanced digital mammography in comparison with the final diagnosis.
METHODS: We included patients who had palpable breast lesions, those who needed clarification regarding abnormalities identified with another imaging technique, and those which needed a complementary evaluation of heterogeneously dense breast parenchyma. Three radiologists working independently used a template with the BI-RADS® MRI qualitative descriptors to evaluate the breast lesions studied with contrast-enhanced digital mammography. In a second phase, two other experienced radiologists reached a consensus about discrepant interpretations. Readers also classified each lesion (both benign and malignant lesions) on the BI-RADS® scale (1 - 5). All the results were compared with the real state of disease (determined by the appropriate gold standard for each type of lesion), and the statistical significance was assessed with the chi-square test.
RESULTS: A total of 218 benign lesions and 426 malignant lesions were included. The interobserver agreement among the three radiologists was high (Fleiss-Cohen kappa=0.805; 95% CI: 0.728-0.837). Similarly to what has been reported about breast MRI, on contrast-enhanced digital mammography, malignant lesions with mass effect tended to have an irregular shape with spiculated or ill-defined margins and a pattern of intense and heterogeneous enhancement (p <0.001). Nevertheless, unlike on breast MRI, ring enhancement was not an independent criterion of malignancy on contrast-enhanced digital mammography. For lesions without a mass effect, the only significant descriptor was the intensity of contrast material uptake (p <0.05). Applying the BI-RADS® MRI material to contrast-enhanced digital mammography images enabled the correct classification of 85% of lesions in the benign categories (BI-RADS 1 and BI-RADS 2 and 3 lesions) and of 93% of the lesions in the malignant categories (BI-RADS 4-5); these values are similar to those reported for breast MRI.
CONCLUSIONS: The morphological descriptors used in BI-RADS® MRI can be applied to the morphological analysis of breast lesions studied with contrast-enhanced digital mammography. The partial discrepancies in the interpretation did not influence the final BI-RADS® score, and the score enabled good differentiation between benign and malignant lesions.
METHODS: We included patients who had palpable breast lesions, those who needed clarification regarding abnormalities identified with another imaging technique, and those which needed a complementary evaluation of heterogeneously dense breast parenchyma. Three radiologists working independently used a template with the BI-RADS® MRI qualitative descriptors to evaluate the breast lesions studied with contrast-enhanced digital mammography. In a second phase, two other experienced radiologists reached a consensus about discrepant interpretations. Readers also classified each lesion (both benign and malignant lesions) on the BI-RADS® scale (1 - 5). All the results were compared with the real state of disease (determined by the appropriate gold standard for each type of lesion), and the statistical significance was assessed with the chi-square test.
RESULTS: A total of 218 benign lesions and 426 malignant lesions were included. The interobserver agreement among the three radiologists was high (Fleiss-Cohen kappa=0.805; 95% CI: 0.728-0.837). Similarly to what has been reported about breast MRI, on contrast-enhanced digital mammography, malignant lesions with mass effect tended to have an irregular shape with spiculated or ill-defined margins and a pattern of intense and heterogeneous enhancement (p <0.001). Nevertheless, unlike on breast MRI, ring enhancement was not an independent criterion of malignancy on contrast-enhanced digital mammography. For lesions without a mass effect, the only significant descriptor was the intensity of contrast material uptake (p <0.05). Applying the BI-RADS® MRI material to contrast-enhanced digital mammography images enabled the correct classification of 85% of lesions in the benign categories (BI-RADS 1 and BI-RADS 2 and 3 lesions) and of 93% of the lesions in the malignant categories (BI-RADS 4-5); these values are similar to those reported for breast MRI.
CONCLUSIONS: The morphological descriptors used in BI-RADS® MRI can be applied to the morphological analysis of breast lesions studied with contrast-enhanced digital mammography. The partial discrepancies in the interpretation did not influence the final BI-RADS® score, and the score enabled good differentiation between benign and malignant lesions.
摘要：
目的：确定BI-RADS®MRI对对比增强数字乳腺X线摄影获得的图像的形态学描述和分类的有用性，并与最终诊断进行比较。
方法：我们纳入了有明显乳腺病变的患者，那些需要澄清使用另一种成像技术识别的异常的人，以及需要对异质致密乳腺实质进行补充评估的那些。三位独立工作的放射科医生使用具有BI-RADS®MRI定性描述符的模板来评估通过对比增强数字乳房X线照相术研究的乳腺病变。在第二阶段,另外两名经验丰富的放射科医师就不同的解释达成了共识.读者还在BI-RADS®量表(1-5)上对每个病变(良性和恶性病变)进行分类。将所有结果与疾病的真实状态（由每种类型的病变的适当金标准确定）进行比较，用卡方检验评估统计学意义。
结果：共纳入218个良性病变和426个恶性病变。三位放射科医师的观察者之间的共识很高（Fleiss-Cohenkappa=0.805；95％CI：0.728-0.837）。类似于乳腺MRI的报道，在对比增强数字乳房X线照相术上，具有肿块效应的恶性病变往往具有不规则的形状,边缘呈针状或界限不清,并且呈强烈且不均匀的增强模式(p<0.001).然而，与乳腺MRI不同,在对比增强数字乳腺X线照相术中,环增强不是恶性肿瘤的独立标准.对于没有质量效应的病变，唯一显著的描述符是造影剂摄取强度(p<0.05).将BI-RADS®MRI材料应用于对比增强的数字乳腺X线摄影图像，可以正确分类85％的良性类别（BI-RADS1和BI-RADS2和3个病变）和93％的病变恶性类别（BI-RADS4-5）；这些值与乳腺MRI报告的值相似。
结论：BI-RADS®MRI中使用的形态学描述符可用于对比增强数字乳腺X线摄影研究的乳腺病变的形态学分析。解释中的部分差异并不影响最终的BI-RADS®评分，评分能够很好地区分良性和恶性病变。
方法：我们纳入了有明显乳腺病变的患者，那些需要澄清使用另一种成像技术识别的异常的人，以及需要对异质致密乳腺实质进行补充评估的那些。三位独立工作的放射科医生使用具有BI-RADS®MRI定性描述符的模板来评估通过对比增强数字乳房X线照相术研究的乳腺病变。在第二阶段,另外两名经验丰富的放射科医师就不同的解释达成了共识.读者还在BI-RADS®量表(1-5)上对每个病变(良性和恶性病变)进行分类。将所有结果与疾病的真实状态（由每种类型的病变的适当金标准确定）进行比较，用卡方检验评估统计学意义。
结果：共纳入218个良性病变和426个恶性病变。三位放射科医师的观察者之间的共识很高（Fleiss-Cohenkappa=0.805；95％CI：0.728-0.837）。类似于乳腺MRI的报道，在对比增强数字乳房X线照相术上，具有肿块效应的恶性病变往往具有不规则的形状,边缘呈针状或界限不清,并且呈强烈且不均匀的增强模式(p<0.001).然而，与乳腺MRI不同,在对比增强数字乳腺X线照相术中,环增强不是恶性肿瘤的独立标准.对于没有质量效应的病变，唯一显著的描述符是造影剂摄取强度(p<0.05).将BI-RADS®MRI材料应用于对比增强的数字乳腺X线摄影图像，可以正确分类85％的良性类别（BI-RADS1和BI-RADS2和3个病变）和93％的病变恶性类别（BI-RADS4-5）；这些值与乳腺MRI报告的值相似。
结论：BI-RADS®MRI中使用的形态学描述符可用于对比增强数字乳腺X线摄影研究的乳腺病变的形态学分析。解释中的部分差异并不影响最终的BI-RADS®评分，评分能够很好地区分良性和恶性病变。
