Time-to-enhancement at ultrafast breast DCE-MRI: potential imaging biomarker of tumour aggressiveness



This study was conducted in order to investigate whether there is a correlation between the time-to-enhancement (TTE) in ultrafast MRI and histopathological characteristics of breast cancers.


Between January and August 2017, 274 consecutive breast cancer patients (mean age, 53.5 years; range, 25–80 years) who underwent ultrafast MRI and subsequent surgery were included for analysis. Ultrafast MRI scans were acquired using TWIST-VIBE or 4D TRAK-3D TFE sequences. TTE and maximum slope (MS) were derived from the ultrafast MRI. The repeated measures ANOVA, Mann–Whitney U test and Kruskal–Wallis H test were performed to compare the median TTE, MS and SER according to histologic type, histologic grade, ER/PR/HER2 positivity, level of Ki-67 and tumour subtype. For TTE calculation, intraclass correlation coefficient (ICC) was used to evaluate interobserver variability.


The median TTE of invasive cancers was shorter than that of in situ cancers (p < 0.001). In invasive cancers, large tumours showed shorter TTE than small tumours (p = 0.001). High histologic/nuclear grade cancers had shorter TTE than low to intermediate grade cancers (p < 0.001 and p < 0.001). HER2-positive cancers showed shorter TTE than HER2-negative cancers (p = 0.001). The median TTE of cancers with high Ki-67 was shorter than that of cancers with low Ki-67 (p < 0.001). ICC between two readers showed moderate agreement (0.516). No difference was found in the median MS or SER values according to the clinicopathologic features.


The median TTE of breast cancer in ultrafast MRI was shorter in invasive or aggressive tumours than in in situ cancer or less aggressive tumours, respectively.

Key Points

• Invasive breast tumours show a shorter TTE in ultrafast DCE-MRI than in situ cancers.

• A shorter TTE in ultrafast DCE-MRI is associated with breast tumours of a large size, high histologic or nuclear grade, PR negativity, HER2 positivity and high Ki-67 level.

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Dynamic contrast-enhanced


Oestrogen receptor


Enhanced T1-weighted high-resolution isotropic volume examination


Human epidermal growth factor receptor (HER)-2




Magnetic resonance imaging


Maximum slope


Progesterone receptor


Region of interest


Signal enhancement ratio


Turbo field echo


Time-resolved MR angiography with keyhole




Time-resolved angiography with interleaved stochastic trajectories


Volume-interpolated breath-hold examination


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This study has received funding by a grant (no. 04-2017-0470) from the Seoul National University Hospital Research Fund.

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Correspondence to Nariya Cho.

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The scientific guarantor of this publication is Nariya Cho MD, PhD, Professor of the Department of Radiology, Seoul National University Hospital.

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The authors declare that they have no conflict of interest.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.


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Shin, S.U., Cho, N., Kim, S. et al. Time-to-enhancement at ultrafast breast DCE-MRI: potential imaging biomarker of tumour aggressiveness. Eur Radiol 30, 4058–4068 (2020). https://doi.org/10.1007/s00330-020-06693-0

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  • Breast
  • Neoplasms
  • Magnetic resonance imaging