Harmonization of Quantitative Parenchymal Enhancement in T1-Weighted Breast MRI

Background Differences in imaging parameters influence computer-extracted parenchymal enhancement measures from breast MRI. Purpose To investigate the effect of differences in dynamic contrast-enhanced MRI acquisition parameter settings on quantitative parenchymal enhancement of the breast, and to evaluate harmonization of contrast-enhancement values with respect to flip angle and repetition time. Study Type Retrospective. Phantom/Populations We modeled parenchymal enhancement using simulations, a phantom, and two cohorts (N = 398 and N = 302) from independent cancer centers. Sequence Field/Strength 1.5T dynamic contrast-enhanced T-1-weighted spoiled gradient echo MRI. Vendors: Philips, Siemens, General Electric Medical Systems. Assessment We assessed harmonization of parenchymal enhancement in simulations and phantom by varying the MR parameters that influence the amount of T-1-weighting: flip angle (8 degrees-25 degrees) and repetition time (4-12 msec). We calculated the median and interquartile range (IQR) of the enhancement values before and after harmonization. In vivo, we assessed overlap of quantitative parenchymal enhancement in the cohorts before and after harmonization using kernel density estimations. Cohort 1 was scanned with flip angle 20 degrees and repetition time 8 msec; cohort 2 with flip angle 10 degrees and repetition time 6 msec. Statistical Tests Paired Wilcoxon signed-rank-test of bootstrapped kernel density estimations. Results Before harmonization, simulated enhancement values had a median (IQR) of 0.46 (0.34-0.49). After harmonization, the IQR was reduced: median (IQR): 0.44 (0.44-0.45). In the phantom, the IQR also decreased, median (IQR): 0.96 (0.59-1.22) before harmonization, 0.96 (0.91-1.02) after harmonization. Harmonization yielded significantly (P < 0.001) better overlap in parenchymal enhancement between the cohorts: median (IQR) was 0.46 (0.37-0.58) for cohort 1 vs. 0.37 (0.30-0.44) for cohort 2 before harmonization (57% overlap); and 0.35 (0.28-0.43) vs. .0.37 (0.30-0.44) after harmonization (85% overlap). Data Conclusion The proposed practical harmonization method enables an accurate comparison between patients scanned with differences in imaging parameters. Level of Evidence 3 Technical Efficacy Stage 4