Evidenzbasierte und strukturierte Diagnostik in der MR-Mammografie anhand des Kaiser-Score

Zusammenfassung

Hintergrund Die MR-Mammografie (MRM) ist als sensitivstes Verfahren zur Detektion von Brustkrebs integraler Bestandteil der modernen Mammadiagnostik. Aufgrund umfangreicher multiparametrischer Bildinformationen gilt die Befundung der MRM jedoch als schwierig. Klinische Entscheidungsregeln kombinieren diagnostische Kriterien in einem Algorithmus. Damit unterstützen sie Radiologen dabei, objektive und exakte sowie weitgehend von der Untersuchererfahrung unabhängige MRM-Diagnosen zu stellen.

Methodik Narrativer review. Der Kaiser-Score (KS) als klinische Entscheidungsregel für die MRM wird eingeführt. Befundkriterien werden erläutert, Strategien zur klinischen Entscheidungsfindung diskutiert und illustriert.

Ergebnisse Entwickelt mit Methoden des maschinellen Lernens wurde der Kaiser-Score in internationalen Studien unabhängig validiert. Dabei ist der KS unabhängig von der Untersuchungstechnik. Anhand von auf T2w- und kontrastangehobenen T1w-Aufnahmen fassbaren diagnostischen BI-RADS-Kriterien ermöglicht der KS die objektive und genaue Differenzialdiagnose von benignen und malignen Befunden in der MRM. Ein Flowchart leitet den Leser über maximal 3 Zwischenschritte zu einem Punktwert, entsprechend einer Malignomwahrscheinlichkeit. Damit lässt sich der KS direkt einer konkreten BI-RADS-Kategorie zuordnen. Individuelle Managemententscheidungen sollten dabei auch den klinischen Kontext berücksichtigen, was anhand von typischen Beispielen dargestellt wird.

Kernaussagen: 

• Der evidenzbasierte KS zur objektiven Differenzierung von gutartigen und bösartigen Brustläsionen basiert auf T2w- und dynamisch kontrastangehobenen T1w-Informationen und ist weitgehend unabhängig von der verwendeten Untersuchungstechnik.

• Der KS basiert auf den etablierten diagnostischen Kriterien des MRT BI-RADS-Lexikons. Wir setzen einen Fokus auf die Definition einer Basiskategorie, welche bei Unklarheiten greift.

• Der KS reflektiert steigende Malignomwahrscheinlichkeiten und kann in Zusammenschau mit dem klinischen Kontext als Entscheidungshilfe das Patientenmanagement unterstützen.

Zitierweise

• Baltzer PA, Krug KB, Dietzel M. Evidence-Based and Structured Diagnosis in Breast MRI using the Kaiser Score. Fortschr Röntgenstr 2022; 194: 1216 – 1228

Key words

breast - decision analysis - biopsy - MR imaging

Publikationsverlauf

Eingereicht: 28. Oktober 2021

Angenommen: 05. März 2022

Artikel online veröffentlicht:
25. Mai 2022

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