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Palm T, Wenkel E, Ohlmeyer S, Janka R, Uder M, Weiland E, Bickelhaupt S, Ladd ME, Zaitsev M, Hensel B, Laun FB. Diffusion kurtosis imaging does not improve differentiation performance of breast lesions in a short clinical protocol. Magn Reson Imaging 2019; 63:205-216. [DOI: 10.1016/j.mri.2019.08.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/26/2019] [Accepted: 08/15/2019] [Indexed: 01/08/2023]
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Surov A, Meyer HJ, Wienke A. Can apparent diffusion coefficient (ADC) distinguish breast cancer from benign breast findings? A meta-analysis based on 13 847 lesions. BMC Cancer 2019; 19:955. [PMID: 31615463 PMCID: PMC6794799 DOI: 10.1186/s12885-019-6201-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 09/24/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The purpose of the present meta-analysis was to provide evident data about use of Apparent Diffusion Coefficient (ADC) values for distinguishing malignant and benign breast lesions. METHODS MEDLINE library and SCOPUS database were screened for associations between ADC and malignancy/benignancy of breast lesions up to December 2018. Overall, 123 items were identified. The following data were extracted from the literature: authors, year of publication, study design, number of patients/lesions, lesion type, mean value and standard deviation of ADC, measure method, b values, and Tesla strength. The methodological quality of the 123 studies was checked according to the QUADAS-2 instrument. The meta-analysis was undertaken by using RevMan 5.3 software. DerSimonian and Laird random-effects models with inverse-variance weights were used without any further correction to account for the heterogeneity between the studies. Mean ADC values including 95% confidence intervals were calculated separately for benign and malign lesions. RESULTS The acquired 123 studies comprised 13,847 breast lesions. Malignant lesions were diagnosed in 10,622 cases (76.7%) and benign lesions in 3225 cases (23.3%). The mean ADC value of the malignant lesions was 1.03 × 10- 3 mm2/s and the mean value of the benign lesions was 1.5 × 10- 3 mm2/s. The calculated ADC values of benign lesions were over the value of 1.00 × 10- 3 mm2/s. This result was independent on Tesla strength, choice of b values, and measure methods (whole lesion measure vs estimation of ADC in a single area). CONCLUSION An ADC threshold of 1.00 × 10- 3 mm2/s can be recommended for distinguishing breast cancers from benign lesions.
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Affiliation(s)
- Alexey Surov
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany. .,Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
| | - Hans Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Magdeburger Str. 8, 06097, Halle, Germany
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Threshold Isocontouring on High b-Value Diffusion-Weighted Images in Magnetic Resonance Mammography. J Comput Assist Tomogr 2019; 43:434-442. [PMID: 31082949 DOI: 10.1097/rct.0000000000000868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Motivated by the similar appearance of malignant breast lesions in high b-value diffusion-weighted imaging (DWI) and positron emission tomography, the purpose of this work was to evaluate the applicability of a threshold isocontouring approach commonly used in positron emission tomography to analyze DWI data acquired from female human breasts with minimal interobserver variability. METHODS Twenty-three female participants (59.4 ± 10.0 years) with 23 lesions initially classified as suggestive of cancers in x-ray mammography screening were subsequently imaged on a 1.5-T magnetic resonance imaging scanner. Diffusion-weighted imaging was performed prior to biopsy with b values of 0, 100, 750, and 1500 s/mm. Isocontouring with different threshold levels was performed on the highest b-value image to determine the voxels used for subsequent evaluation of diffusion metrics. The coefficient of variation was computed by specifying 4 different regions of interest drawn around the lesion. Additionally, a receiver operating statistical analysis was performed. RESULTS Using a relative threshold level greater than or equal to 0.85 almost completely suppresses the intra-individual and inter-individual variability. Among 4 studied diffusion metrics, the diffusion coefficients from the intravoxel incoherent motion model returned the highest area under curve value of 0.9. The optimal cut-off diffusivity was found to be 0.85 μm/ms with a sensitivity of 87.5% and specificity of 90.9%. CONCLUSION Threshold isocontouring on high b-value maps is a viable approach to reliably evaluate DWI data of suspicious focal lesions in magnetic resonance mammography.
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Bickelhaupt S, Paech D, Laun F, Steudle F, Kuder T, Mlynarska A, Bach M, Lederer W, Teiner S, Schneider S, Ladd M, Daniel H, Stieber A, Kopp-Schneider A, Delorme S, Schlemmer HP. Maximum intensity breast diffusion MRI for BI-RADS 4 lesions detected on X-ray mammography. Clin Radiol 2017; 72:900.e1-900.e8. [DOI: 10.1016/j.crad.2017.05.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 05/12/2017] [Accepted: 05/23/2017] [Indexed: 12/13/2022]
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Bickelhaupt S, Steudle F, Paech D, Mlynarska A, Kuder TA, Lederer W, Daniel H, Freitag M, Delorme S, Schlemmer HP, Laun FB. On a fractional order calculus model in diffusion weighted breast imaging to differentiate between malignant and benign breast lesions detected on X-ray screening mammography. PLoS One 2017; 12:e0176077. [PMID: 28453516 PMCID: PMC5409173 DOI: 10.1371/journal.pone.0176077] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 04/05/2017] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To evaluate a fractional order calculus (FROC) model in diffusion weighted imaging to differentiate between malignant and benign breast lesions in breast cancer screening work-up using recently introduced parameters (βFROC, DFROC and μFROC). MATERIALS AND METHODS This retrospective analysis within a prospective IRB-approved study included 51 participants (mean 58.4 years) after written informed consent. All patients had suspicious screening mammograms and indication for biopsy. Prior to biopsy, full diagnostic contrast-enhanced MRI examination was acquired including diffusion-weighted-imaging (DWI, b = 0,100,750,1500 s/mm2). Conventional apparent diffusion coefficient Dapp and FROC parameters (βFROC, DFROC and μFROC) as suggested further indicators of diffusivity components were measured in benign and malignant lesions. Receiver operating characteristics (ROC) were calculated to evaluate the diagnostic performance of the parameters. RESULTS 29/51 patients histopathologically revealed malignant lesions. The analysis revealed an AUC for Dapp of 0.89 (95% CI 0.80-0.98). For FROC derived parameters, AUC was 0.75 (0.60-0.89) for DFROC, 0.59 (0.43-0.75) for βFROC and 0.59 (0.42-0.77) for μFROC. Comparison of the AUC curves revealed a significantly higher AUC of Dapp compared to the FROC parameters DFROC (p = 0.009), βFROC (p = 0.003) and μFROC (p = 0.001). CONCLUSION In contrast to recent description in brain tumors, the apparent diffusion coefficient Dapp showed a significantly higher AUC than the recently proposed FROC parameters βFROC, DFROC and μFROC for differentiating between malignant and benign breast lesions. This might be related to the intrinsic high heterogeneity within breast tissue or to the lower maximal b-value used in our study.
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Affiliation(s)
- Sebastian Bickelhaupt
- German Cancer Research Center (dkfz), Department of Radiology, Heidelberg, Im Neuenheimer Feld 280, Heidelberg, Germany
| | - Franziska Steudle
- German Cancer Research Center (dkfz), Department of Radiology, Heidelberg, Im Neuenheimer Feld 280, Heidelberg, Germany
| | - Daniel Paech
- German Cancer Research Center (dkfz), Department of Radiology, Heidelberg, Im Neuenheimer Feld 280, Heidelberg, Germany
| | - Anna Mlynarska
- German Cancer Research Center (dkfz), Medical Physics in Radiology, Heidelberg, Im Neuenheimer Feld 280, Heidelberg, Germany
| | - Tristan Anselm Kuder
- German Cancer Research Center (dkfz), Medical Physics in Radiology, Heidelberg, Im Neuenheimer Feld 280, Heidelberg, Germany
| | - Wolfgang Lederer
- Radiological Clinic at the ATOS Clinic Heidelberg, Heidelberg, Bismarckplatz 9–15, Heidelberg, Germany
| | - Heidi Daniel
- Radiology Center Mannheim (RZM), Mannheim, Rosengartenplatz 7, Mannheim, Germany
| | - Martin Freitag
- German Cancer Research Center (dkfz), Department of Radiology, Heidelberg, Im Neuenheimer Feld 280, Heidelberg, Germany
| | - Stefan Delorme
- German Cancer Research Center (dkfz), Department of Radiology, Heidelberg, Im Neuenheimer Feld 280, Heidelberg, Germany
| | - Heinz-Peter Schlemmer
- German Cancer Research Center (dkfz), Department of Radiology, Heidelberg, Im Neuenheimer Feld 280, Heidelberg, Germany
| | - Frederik Bernd Laun
- German Cancer Research Center (dkfz), Medical Physics in Radiology, Heidelberg, Im Neuenheimer Feld 280, Heidelberg, Germany
- University Hospital Erlangen, Department of Radiology, Maximiliansplatz 3, Erlangen, Germany
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