Breast MRI in the era of diffusion weighted imaging: do we still need signal-intensity time curves? (original) (raw)
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Diffusion-weighted MRI: role in the differential diagnosis of breast lesions
Journal of the Belgian Society of Radiology, 2014
Background: Precise diagnosis of suspicious breast lesions helps in better assessment and management. The aim of this study is to explore the role of DCE-MRI and DWI in evaluation of suspicious breast lesions (BI-RADS 3 and 4). Subjects and Methods: A total of 50 patients with suspicious breast lesions (BI-RADS 3 and 4) participated in the study. After giving informed consent, all patients were subjected to DWI and DCE-MRI, and their findings were compared to histopathology results. DCE-MRI curves, borders, and enhancement were described, and DWI findings were also extracted. Factors predicting distinction of cancerous tissue from benign tissue by DCE-MRI and DWI according to histopathology reference have been analyzed. Results: Using DCE-MRI, out of 19 patients proven by histopathology to have benign lesions, 12 (63.2%) showed mass lesions and out of 29 patients with malignant lesions 21 (72.4%) had mass lesions (p<0.001).Curves of benign lesions were mostly persistent (83.3%) whenever malignant curves were either plateau or wash out;(47.6%) each (p<0.001).ADC brightness was more frequent in benign lesions (p<0.05). The best cutoff of ADC that can differentiate between malignant and benign lesions was 1.19 (sensitivity 94.7% and specificity 67.7%).DCE-MRI had a sensitivity of 75.8% and specificity of 73.7%, while DWI had a sensitivity of 82.8% and specificity of 73.7%. No statistically significant differences have been noticed between benign and malignant breast non-mass lesions regarding any of the studied measures (p>0.05). Conclusion: DCE-MRI and DWI are crucial in distinction of suspicious breast mass lesions. The sensitivity and specificity of DCE-MRI and DWI as diagnostics have been determined.
Objective: To evaluate the role of diffusion-weighted magnetic resonance imaging (DW-MRI) with calculation of the apparent diffusion coefficient (ADC) value in characterizing benign and malignant breast lesions. Patients and methods: The imaging data of thirty-nine female patients (mean age 48 years) who underwent breast MRI using conventional pulse sequences. DW-MRI and dynamic contrast enhanced (DCE) study were all analyzed and correlated with the results of histopathological evaluation. Results: Forty-six breast lesions were detected in the thirty-nine patients of the study. According to the histo-pathological analysis, there were 27 malignant lesions (58.69%) and 19 benign lesions (41.31%). The malignant lesions showed a mean ADC value of 0.93 ± 0.42 × 10 −3 mm 2 /s. and the benign lesions showed a mean ADC value of 1.54 ± 0.43 × 10 −3 mm 2 /s. The receiver operating characteristic (ROC) curve could identify an ADC 1.26 × 10 −3 mm 2 /s as a cutoff value to differentiate between benign and malignant lesions with sensitivity and specificity of 89% and 94.7% respectively. Conclusion: DW-MRI is useful for differentiating malignant and benign breast lesions, increasing the specificity of breast MRI. DW-MRI doesn't cause significant increase in the total examination time and is recommended to be incorporated in the standard breast MRI protocol.
Background: Breast neoplasms are common in women of all ages, especially during their reproductive age from the menarche to menopause.Breast cancer is the most common of all cancers in women and the leading cause of death due to cancer among women worldwide and the rates are higher in countries with majority of the population having a low-income.A recent study on the risk of breast cancer in India found that 1 in 28 women had breast cancer in their lives. This rate is higher in urban areas with a rate of 1 in 22 females compared to rural areas where the risk is relatively much lower with 1 in 60 women. The age range of the high-risk group in India is 43-46 years; and this is unlike in the west, where women aged 53-57 years are more prone to breast cancer. 1 Early detection of lesions is the mainstay of treatment in today's world and mammography is widely used as a screening tool for the same. In addition, sonography has become a standard screening modality also. Sonography also plays an important role in image guided procedures such as needle aspiration cytology and core biopsy. MRI of the breast is also an important and advanced imaging modality, used for assessment of lesions both before and after administration of intravenous contrast agent. In this study we have used an extra sequence in MRI known as diffusion weighted imaging which requires no contrast administration to differentiate malignant from benign lesions. Materials and Methods: This study was carried out on 26 patients with clinically or ultrasonographically detected breast lesion.All patients were subjected to MRI of breast and the suspected lesion was sent for histopathology All the patients underwent MRI examination on a 3 T scanner (GE Signa HDxt scanner). An HD 8 channel VIBRANT dedicated breast array coil from GE was used in all patients. Before administration of contrast Axial T1 and T2, axial fat saturation T2, STIR T2, sagittal fat saturation T2, DWI and corresponding ADC of each breast was obtained.Using these raw data, post-processing was done with the help of a built-in software. In the post-processing subtracted images obtained Results: 26 lesions were detected , 13 were benign and 13 malignant. The sensitivity of DWI was 100% while specificity was 92.8% the ADC values for benign lesions were 1.1-2.2 x 10-3 mm 2 /sec, while malignant lesions showed ADC values of 0.46-0.99 x 10-3 mm 2 /sec. The ADC value of 1.1 x 10-3 mm 2 / sec can be used as cut off value for differentiating benign from malignant lesions. Conclusion: DWI and ADC calculation are short unenhanced sequence that can be inserted into MRI protocols to accurately differentiate between the benign and malignant breast lesions.
European Journal of Radiology, 2013
To evaluate the diagnostic efficiency of the diffusion parameters measured by conventional diffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI) for discrimination of malignant breast lesions from benign lesions and the normal breast. Materials and methods: The study included 52 women with 55 breast lesions (30 malignant, 25 benign). DTI and DWI were performed complementary to dynamic contrast MRI at 3T. Apparent diffusion coefficient (ADC) of DWI, mean diffusivity (MD) and fractional anisotropy (FA) values of DTI were measured for lesions and contralateral breast parenchyma in each patient. We used b factors of 0, 50, 850, 1000 and 1500 s/mm 2 for DWI and b 0 and 1000 s/mm 2 for DTI. ADC, MD and FA values were compared between malignant and benign lesions, and the normal parenchyma by univariate and multivariate analyses. Results: Diffusion parameters showed no difference according to menopausal status in the normal breast. ADC and MD values of the malignant lesions were significantly lower than benign lesions and normal parenchyma (p = 0.001). The FA showed no statistical significance. With the cutoff values of ≤1.23 × 10 −3 mm 2 /s (b 0-1000 s/mm 2) and ≤1.12 × 10 −3 mm 2 /s (b 0-1500 s/mm 2), ADC showed 92.85% and 96.15% sensitivity; 72.22% and 73.52% PPV, respectively. With a cutoff value of ≤1.27 × 10 −3 mm 2 /s (b 1000 s/mm 2), MD was 100% sensitive with a PPV of 65.90%. Comparing the diagnostic performance of the parameters in DTI with DWI, we obtained similar efficiency of ADC with b values of 0,1000 and 0,1500 s/mm 2 and MD with a b value of 0, 1000 s/mm 2 (AUC = 0.82 ± 0.07). Conclusion: ADC of DWI and MD of DTI values provide significant discriminative factors for benign and malignant breast lesions. FA measurement was not discriminative. Supported with clinical and dynamic contrast MRI findings, DWI and DTI findings provide significant contribution to the final radiologic decision.
European Radiology, 2014
Objective To assess if the application of diffusion-weighted imaging (DWI) obviates unnecessary MR-guided biopsies in suspicious breast lesions visible only on contrast-enhanced MRI (CE-MRI). Methods This institutional review board (IRB)-approved, retrospective, single-centre study included 101 patients (mean age, 49.5; SD 13.9 years) who underwent additional DWI at 1.5 T prior to MRI-guided biopsy of 104 lesions classified as suspicious for malignancy and visible on CE-MRI only. An experienced radiologist, blinded to histopathologic and follow-up results, measured apparent diffusion coefficient (ADC) values obtained from DWI. Diagnostic accuracy was investigated using receiver operating characteristics (ROC) analysis. Results Histopathology revealed 20 malignant and 84 benign lesions. Lesions were masses in 61 (15 malignant, 24.6 %) and non-masses in 43 cases (five malignant, 11.6 %). Mean ADC values were 1.53±0.38×10 −3 mm 2 /s in benign lesions and 1.06±0.27×10 −3 mm 2 /s in malignant lesions. ROC analysis revealed exclusively benign lesions if ADC values were greater than 1.58×10 −3 mm 2 /s. As a consequence, 29 false-positive biopsies (34.5 %) could have been avoided without any falsenegative findings. Both in mass and in non-mass lesions, rulein and rule-out criteria were identified using flexible ADC thresholds based on ROC analysis. Conclusion Additional application of DWI in breast lesions visible only on MRI can avoid false-positive, MR-guided biopsies. Thus, DWI should be an integral part of breast MRI protocols. Key Points • DWI measurements are a fast and helpful technique for improved breast lesion diagnosis • DWI application in breast lesions visible only on MRI obviates false-positive, MR-guided biopsies • Flexible ADC thresholds provide rule-in and rule-out criteria for breast lesion malignancy
Quantitative diffusion imaging in breast cancer: A clinical prospective study
Journal of Magnetic Resonance Imaging, 2006
Purpose: To study the correlation between apparent diffusion coefficient (ADC) and pathology in patients with undefined breast lesion, to validate how accurately ADC is related to histology, and to define a threshold value of ADC to distinguish malignant from benign lesions. Materials and Methods: Seventy-eight patients (110 lesions) were referred for positive or dubious findings. Threedimensional fast low-angle shot (3D-FLASH) with contrast injection was applied. EPI diffusion-weighted imaging (DWI) with fat saturation was performed, and ROIs were selected on subtraction 3D-FLASH images before and after contrast injection, and copied on an ADC map. Inter-and intraobserver analyses were performed. Results: At pathology 22 lesions were benign, 65 were malignant, and 23 were excluded. The ADCs of malignant and benign lesions were statistically different. In malignant tumors the ADC was (mean Ϯ SEM) 0.95 Ϯ 0.027 ϫ 10-3mm 2 /second, and in benign tumors it was 1.51 Ϯ 0.068 ϫ 10-3 mm 2 /second. According to receiver operating characteristic (ROC) curves, we found a threshold between malignant and benign lesions for highest sensitivity and specificity (both 86%) around 1.13 Ϯ 0.10 ϫ 10-3 mm 2 /second. For a threshold of 0.95 Ϯ 0.10 ϫ 10-3 mm 2 /second, specificity was 100% but sensitivity was very low. Inter-and intraobserver studies showed good reproducibility. Conclusion: The ADC may help to differentiate benign and malignant lesions with good specificity, and may increase the overall specificity of breast MRI.
Breast Cancer Research, 2019
Background Available data proving the value of DWI for breast cancer diagnosis is mainly for enhancing masses; DWI may be less sensitive and specific in non-mass enhancement (NME) lesions. The objective of this study was to assess the diagnostic accuracy of DWI using different ROI measurement approaches and ADC metrics in breast lesions presenting as NME lesions on dynamic contrast-enhanced (DCE) MRI. Methods In this retrospective study, 95 patients who underwent multiparametric MRI with DCE and DWI from September 2007 to July 2013 and who were diagnosed with a suspicious NME (BI-RADS 4/5) were included. Twenty-nine patients were excluded for lesion non-visibility on DWI (n = 24: 12 benign and 12 malignant) and poor DWI quality (n = 5: 1 benign and 4 malignant). Two readers independently assessed DWI and DCE-MRI findings in two separate randomized readings using different ADC metrics and ROI approaches. NME lesions were classified as either benign (> 1.3 × 10−3 mm2/s) or malignan...
Assessment of Breast Lesions With Diffusion-Weighted MRI: Comparing the Use of Different b Values
American Journal of Roentgenology, 2009
sitive to the self-diffusion of water protons. As a result, it provides quantitative and qualitative information that reflects changes at a cellular level and unique insights about tumor cellularity and integrity of cell membranes. By using the DWI sequence, one can calculate the apparent diffusion coefficient (ADC), a quantitative measure that is directly proportional to the water diffusion [16]. High cell proliferation in malignant tumors increases cellular density, creating more barriers to the extracellular water diffusion, reducing the ADC, and resulting in signal loss. This sequence appears to be a useful tool for tumor detection and characterization [12], as well as for monitoring and predicting treatment response [17].