Please use this identifier to cite or link to this item: https://doi.org/10.1016/j.ejrad.2021.109630
Title: Correct determination of the enhancement curve is critical to ensure accurate diagnosis using the Kaiser score as a clinical decision rule for breast MRI
Authors: Grippo, Cristina
Jagmohan, Pooja 
Helbich, Thomas H.
Kapetas, Panagiotis
Clauser, Paola
Baltzer, Pascal A. T.
Keywords: Breast cancer
DCE-MRI
False positive
Magnetic resonance imaging
Standardization
Issue Date: 1-May-2021
Publisher: Elsevier Ireland Ltd
Citation: Grippo, Cristina, Jagmohan, Pooja, Helbich, Thomas H., Kapetas, Panagiotis, Clauser, Paola, Baltzer, Pascal A. T. (2021-05-01). Correct determination of the enhancement curve is critical to ensure accurate diagnosis using the Kaiser score as a clinical decision rule for breast MRI. European Journal of Radiology 138 : 109630. ScholarBank@NUS Repository. https://doi.org/10.1016/j.ejrad.2021.109630
Rights: Attribution 4.0 International
Abstract: Objectives: the Kaiser score is increasingly recognized as a valuable tool to improve breast MRI interpretation. Contrast enhancement kinetics are the second most important diagnostic criterion, thus defining the curve type plays a crucial role in Kaiser score assessment. We investigate whether the timepoint used to determine the initial enhancement (earlyor peak) for the signal-intensity time curve analysis affects the diagnostic performance of the Kaiser score. Methods: This IRB-approved, retrospective, single-center study included 70 consecutives histologically verified breast MRI cases. Two off-site breast radiologists independently read all examinations using the Kaiser score, assessing the initial enhancement using three approaches: -first (1 st), second (2nd) and peak (maximum) of either 1 st or 2nd post-contrast timepoints. The initial enhancement was then compared to the last timepoint (delayed enhancement) to determine the curve type. Visual assessment of curve types was used for this study. Diagnostic performance was evaluated by receiver operating characteristics (ROC) analysis. Results: Kaiser score reading results using the peak enhancement of either the first or second timepoint performed significantly better than the other approaches (P < 0.05, respectively) and specifically achieved higher sensitivity. Diagnostic accuracy (AUC area under the curve) ranged between 85.4 % and 91.6 %, without significant differences between the two readers (P < 0.5). Conclusions: Diagnostic performance of the Kaiser score is significantly influenced by how the initial enhancement timepoint is determined. Peak enhancement should be used as initial timepoint to avoid pitfalls due to timing or physiological differences. © 2021 The Author(s)
Source Title: European Journal of Radiology
URI: https://scholarbank.nus.edu.sg/handle/10635/232612
ISSN: 0720-048X
DOI: 10.1016/j.ejrad.2021.109630
Rights: Attribution 4.0 International
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