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Pötsch N, Clauser P, Kapetas P, Baykara Ulusan M, Helbich T, Baltzer P. Enhancing the Kaiser score for lesion characterization in unenhanced breast MRI. Eur J Radiol 2024; 176:111520. [PMID: 38820953 DOI: 10.1016/j.ejrad.2024.111520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/15/2024] [Accepted: 05/19/2024] [Indexed: 06/02/2024]
Abstract
PURPOSE To adapt the methodology of the Kaiser score, a clinical decision rule for lesion characterization in breast MRI, for unenhanced protocols. METHOD In this retrospective IRB-approved cross-sectional study, we included 93 consecutive patients who underwent breast MRI between 2021 and 2023 for further work-up of BI-RADS 0, 3-5 in conventional imaging or for staging purposes (BI-RADS 6). All patients underwent biopsy for histologic verification or were followed for a minimum of 12 months. MRI scans were conducted using 1.5 T or 3 T scanners using dedicated breast coils and a protocol in line with international recommendations including DWI and ADC. Lesion characterization relied solely on T2w and DWI/ADC-derived features (such as lesion type, margins, shape, internal signal, surrounding tissue findings, ADC value). Statistical analysis was done using decision tree analysis aiming to distinguish benign (histology/follow-up) from malignant outcomes. RESULTS We analyzed a total of 161 lesions (81 of them non-mass) with a malignancy rate of 40%. Lesion margins (spiculated, irregular, or circumscribed) were identified as the most important criterion within the decision tree, followed by the ADC value as second most important criterion. The resulting score demonstrated a strong diagnostic performance with an AUC of 0.840, providing both rule-in and rule-out criteria. In an independent test set of 65 lesions the diagnostic performance was verified by two readers (AUC 0.77 and 0.87, kappa: 0.62). CONCLUSIONS We developed a clinical decision rule for unenhanced breast MRI including lesion margins and ADC value as the most important criteria, achieving high diagnostic accuracy.
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Affiliation(s)
- N Pötsch
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna and General Hospital, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - P Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna and General Hospital, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - P Kapetas
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna and General Hospital, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - M Baykara Ulusan
- Department of Radiology, University of Health Sciences Istanbul Training and Research Hospital, Org. Abdurrahman Nafiz Gurman Cad, No:1 Fatih, İstanbul, Turkey
| | - T Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna and General Hospital, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - P Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna and General Hospital, Waehringer Guertel 18-20, 1090 Vienna, Austria.
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Pötsch N, Sodano C, Baltzer PAT. Performance of Diffusion-weighted Imaging-based Noncontrast MRI Protocols for Diagnosis of Breast Cancer: A Systematic Review and Meta-Analysis. Radiology 2024; 311:e232508. [PMID: 38771179 DOI: 10.1148/radiol.232508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Background Diffusion-weighted imaging (DWI) is increasingly recognized as a powerful diagnostic tool and tested alternative to contrast-enhanced (CE) breast MRI. Purpose To perform a systematic review and meta-analysis that assesses the diagnostic performance of DWI-based noncontrast MRI protocols (ncDWI) for the diagnosis of breast cancer. Materials and Methods A systematic literature search in PubMed for articles published from January 1985 to September 2023 was performed. Studies were excluded if they investigated malignant lesions or selected patients and/or lesions only, used DWI as an adjunct technique to CE MRI, or were technical studies. Statistical analysis included pooling of diagnostic accuracy and investigating between-study heterogeneity. Additional subgroup comparisons of ncDWI to CE MRI and standard mammography were performed. Results A total of 28 studies were included, with 4406 lesions (1676 malignant, 2730 benign) in 3787 patients. The pooled sensitivity and specificity of ncDWI were 86.5% (95% CI: 81.4, 90.4) and 83.5% (95% CI: 76.9, 88.6), and both measures presented with high between-study heterogeneity (I 2 = 81.6% and 91.6%, respectively; P < .001). CE MRI (18 studies) had higher sensitivity than ncDWI (95.1% [95% CI: 92.9, 96.7] vs 88.9% [95% CI: 82.4, 93.1], P = .004) at similar specificity (82.2% [95% CI: 75.0, 87.7] vs 82.0% [95% CI: 74.8, 87.5], P = .97). Compared with ncDWI, mammography (five studies) showed no evidence of a statistical difference for sensitivity (80.3% [95% CI: 56.3, 93.3] vs 56.7%; [95% CI: 41.9, 70.4], respectively; P = .09) or specificity (89.9% [95% CI: 85.5, 93.1] vs 90% [95% CI: 61.3, 98.1], respectively; P = .62), but ncDWI had a higher area under the summary receiver operating characteristic curve (0.93 [95% CI: 0.91, 0.95] vs 0.78 [95% CI: 0.74, 0.81], P < .001). Conclusion A direct comparison with CE MRI showed a modestly lower sensitivity at similar specificity for ncDWI, and higher diagnostic performance indexes for ncDWI than standard mammography. Heterogeneity was high, thus these results must be interpreted with caution. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Kataoka and Iima in this issue.
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Affiliation(s)
- Nina Pötsch
- From the Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna and General Hospital, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Claudia Sodano
- From the Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna and General Hospital, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Pascal A T Baltzer
- From the Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna and General Hospital, Waehringer Guertel 18-20, 1090 Vienna, Austria
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Kim YS, Lee SH, Kim SY, Kim ES, Park AR, Chang JM, Park VY, Yoon JH, Kang BJ, Yun BL, Kim TH, Ko ES, Chu AJ, Kim JY, Youn I, Chae EY, Choi WJ, Kim HJ, Kang SH, Ha SM, Moon WK. Unenhanced Breast MRI With Diffusion-Weighted Imaging for Breast Cancer Detection: Effects of Training on Performance and Agreement of Subspecialty Radiologists. Korean J Radiol 2024; 25:11-23. [PMID: 38184765 PMCID: PMC10788600 DOI: 10.3348/kjr.2023.0528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 01/08/2024] Open
Abstract
OBJECTIVE To investigate whether reader training improves the performance and agreement of radiologists in interpreting unenhanced breast magnetic resonance imaging (MRI) scans using diffusion-weighted imaging (DWI). MATERIALS AND METHODS A study of 96 breasts (35 cancers, 24 benign, and 37 negative) in 48 asymptomatic women was performed between June 2019 and October 2020. High-resolution DWI with b-values of 0, 800, and 1200 sec/mm² was performed using a 3.0-T system. Sixteen breast radiologists independently reviewed the DWI, apparent diffusion coefficient maps, and T1-weighted MRI scans and recorded the Breast Imaging Reporting and Data System (BI-RADS) category for each breast. After a 2-h training session and a 5-month washout period, they re-evaluated the BI-RADS categories. A BI-RADS category of 4 (lesions with at least two suspicious criteria) or 5 (more than two suspicious criteria) was considered positive. The per-breast diagnostic performance of each reader was compared between the first and second reviews. Inter-reader agreement was evaluated using a multi-rater κ analysis and intraclass correlation coefficient (ICC). RESULTS Before training, the mean sensitivity, specificity, and accuracy of the 16 readers were 70.7% (95% confidence interval [CI]: 59.4-79.9), 90.8% (95% CI: 85.6-94.2), and 83.5% (95% CI: 78.6-87.4), respectively. After training, significant improvements in specificity (95.2%; 95% CI: 90.8-97.5; P = 0.001) and accuracy (85.9%; 95% CI: 80.9-89.8; P = 0.01) were observed, but no difference in sensitivity (69.8%; 95% CI: 58.1-79.4; P = 0.58) was observed. Regarding inter-reader agreement, the κ values were 0.57 (95% CI: 0.52-0.63) before training and 0.68 (95% CI: 0.62-0.74) after training, with a difference of 0.11 (95% CI: 0.02-0.18; P = 0.01). The ICC was 0.73 (95% CI: 0.69-0.74) before training and 0.79 (95% CI: 0.76-0.80) after training (P = 0.002). CONCLUSION Brief reader training improved the performance and agreement of interpretations by breast radiologists using unenhanced MRI with DWI.
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Affiliation(s)
- Yeon Soo Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Su Hyun Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Soo-Yeon Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eun Sil Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ah Reum Park
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung Min Chang
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Vivian Youngjean Park
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung Hyun Yoon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Bong Joo Kang
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Bo La Yun
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Radiology, Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - Tae Hee Kim
- Department of Radiology, Ajou University Medical Center, Suwon, Republic of Korea
| | - Eun Sook Ko
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Seoul, Republic of Korea
| | - A Jung Chu
- Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Jin You Kim
- Department of Radiology, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Inyoung Youn
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun Young Chae
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Woo Jung Choi
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hee Jeong Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soo Hee Kang
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Su Min Ha
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.
| | - Woo Kyung Moon
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
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Gullo RL, Partridge SC, Shin HJ, Thakur SB, Pinker K. Update on DWI for Breast Cancer Diagnosis and Treatment Monitoring. AJR Am J Roentgenol 2024; 222:e2329933. [PMID: 37850579 PMCID: PMC11196747 DOI: 10.2214/ajr.23.29933] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
DWI is a noncontrast MRI technique that measures the diffusion of water molecules within biologic tissue. DWI is increasingly incorporated into routine breast MRI examinations. Currently, the main applications of DWI are breast cancer detection and characterization, prognostication, and prediction of treatment response to neoadjuvant chemotherapy. In addition, DWI is promising as a noncontrast MRI alternative for breast cancer screening. Problems with suboptimal resolution and image quality have restricted the mainstream use of DWI for breast imaging, but these shortcomings are being addressed through several technologic advancements. In this review, we present an up-to-date assessment of the use of DWI for breast cancer imaging, including a summary of the clinical literature and recommendations for future use.
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Affiliation(s)
- Roberto Lo Gullo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Savannah C Partridge
- Department of Radiology, University of Washington School of Medicine, University of Washington, Seattle, WA, USA 98109, USA
| | - Hee Jung Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Sunitha B Thakur
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Katja Pinker
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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Lee K, Jeong YJ, Choo KS, Nam SB, Kim HY, Jung YJ, Lee SJ, Joo JH, Kim JY, Kim JJ, Kim JY, Yun MS, Nam KJ. Comparison of Fused Diffusion-Weighted Imaging Using Unenhanced MRI and Abbreviated Post-Contrast-Enhanced MRI in Patients with Breast Cancer. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1563. [PMID: 37763682 PMCID: PMC10534817 DOI: 10.3390/medicina59091563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/25/2023] [Accepted: 08/26/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: To determine the percentage of breast cancers detectable by fused diffusion-weighted imaging (DWI) using unenhanced magnetic resonance imaging (MRI) and abbreviated post-contrast-enhanced MRI. Materials and Methods: Between October 2016 and October 2017, 194 consecutive women (mean age, 54.2 years; age range, 28-82 years) with newly diagnosed unilateral breast cancer, who underwent preoperative 3.0 T breast MRI with DWI, were evaluated. Both fused DWI and abbreviated MRI were independently reviewed by two radiologists for the detection of index cancer (which showed the most suspicious findings in both breasts), location, lesion conspicuity, lesion type, and lesion size. Moreover, the relationship between cancer detection and histopathological results of surgical specimens was evaluated. Results: Index cancer detection rates were comparable between fused DWI and abbreviated MRI (radiologist 1: 174/194 [89.7%] vs. 184/194 [94.8%], respectively, p = 0.057; radiologist 2: 174/194 [89.7%] vs. 183/194 [94.3%], respectively, p = 0.092). In both radiologists, abbreviated MRI showed a significantly higher lesion conspicuity than fused DWI (radiologist 1: 9.37 ± 2.24 vs. 8.78 ± 3.03, respectively, p < 0.001; radiologist 2: 9.16 ± 2.32 vs. 8.39 ± 2.93, respectively, p < 0.001). The κ value for the interobserver agreement of index cancer detection was 0.67 on fused DWI and 0.85 on abbreviated MRI. For lesion conspicuity, the intraclass correlation coefficients were 0.72 on fused DWI and 0.82 on abbreviated MRI. Among the histopathological factors, tumor invasiveness was associated with cancer detection on both fused DWI (p = 0.011) and abbreviated MRI (p = 0.004, radiologist 1), lymphovascular invasion on abbreviated MRI (p = 0.032, radiologist 1), and necrosis on fused DWI (p = 0.031, radiologist 2). Conclusions: Index cancer detection was comparable between fused DWI and abbreviated MRI, although abbreviated MRI showed a significantly better lesion conspicuity.
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Affiliation(s)
- Kyeyoung Lee
- Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan-si 50612, Republic of Korea; (K.L.); (K.S.C.)
| | - Yeo Jin Jeong
- Department of Health Promotion Center, Pusan National University Yangsan Hospital, Yangsan-si 50612, Republic of Korea;
| | - Ki Seok Choo
- Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan-si 50612, Republic of Korea; (K.L.); (K.S.C.)
| | - Su Bong Nam
- Department of Plastic and Reconstructive Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan-si 50612, Republic of Korea;
| | - Hyun Yul Kim
- Department of Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan-si 50612, Republic of Korea; (H.Y.K.); (Y.J.J.); (S.J.L.)
| | - Youn Joo Jung
- Department of Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan-si 50612, Republic of Korea; (H.Y.K.); (Y.J.J.); (S.J.L.)
| | - Seung Ju Lee
- Department of Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan-si 50612, Republic of Korea; (H.Y.K.); (Y.J.J.); (S.J.L.)
| | - Ji Hyeon Joo
- Department of Radiation Oncology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan-si 50612, Republic of Korea;
| | - Jin You Kim
- Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Hospital, Pusan National University School of Medicine, Busan 49241, Republic of Korea; (J.Y.K.); (J.J.K.)
| | - Jin Joo Kim
- Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Hospital, Pusan National University School of Medicine, Busan 49241, Republic of Korea; (J.Y.K.); (J.J.K.)
| | - Jee Yeon Kim
- Department of Pathology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan-si 50612, Republic of Korea;
| | - Mi Sook Yun
- Division of Biostatistics, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan-si 50612, Republic of Korea;
| | - Kyung Jin Nam
- Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan-si 50612, Republic of Korea; (K.L.); (K.S.C.)
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Park GE, Kang BJ, Kim SH, Jung NY. The Role of Diffusion-Weighted Imaging Based on Maximum-Intensity Projection in Young Patients with Marked Background Parenchymal Enhancement on Contrast-Enhanced Breast MRI. Life (Basel) 2023; 13:1744. [PMID: 37629601 PMCID: PMC10455098 DOI: 10.3390/life13081744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/03/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
Diffusion-weighted imaging (DWI) utilizing maximum-intensity projection (MIP) was suggested as a cost-effective alternative tool without the risk of gadolinium-based contrast agents. The purpose of this study was to investigate whether DWI MIPs played a supportive role in young (≤60) patients with marked background parenchymal enhancement (BPE) on contrast-enhanced MRI (CE-MRI). The research included 1303 patients with varying degrees of BPE, and correlations between BPE on CE-MRI, the background diffusion signal (BDS) on DWI, and clinical parameters were analyzed. Lesion detection scores were compared between CE-MRI and DWI, with DWI showing higher scores. Among the 186 lesions in 181 patients with marked BPE on CE-MRI, the main lesion on MIPs of CE-MRI was partially or completely seen in 88.7% of cases, while it was not seen in 11.3% of cases. On the other hand, the main lesion on MIPs of DWI was seen in 91.4% of cases, with only 8.6% of cases showing no visibility. DWI achieved higher scores for lesion detection compared to CE-MRI. The presence of a marked BDS was significantly associated with a lower likelihood of a higher DWI score (p < 0.001), and non-mass lesions were associated with a decreased likelihood of a higher DWI score compared with mass lesions (p = 0.196). In conclusion, the inclusion of MIPs of DWI in the preoperative evaluation of breast cancer patients, particularly young women with marked BPE, proved highly beneficial in improving the overall diagnostic process.
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Affiliation(s)
- Ga-Eun Park
- Department of Radiology, Seoul Saint Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (G.-E.P.); (B.-J.K.); (S.-h.K.)
| | - Bong-Joo Kang
- Department of Radiology, Seoul Saint Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (G.-E.P.); (B.-J.K.); (S.-h.K.)
| | - Sung-hun Kim
- Department of Radiology, Seoul Saint Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (G.-E.P.); (B.-J.K.); (S.-h.K.)
| | - Na-Young Jung
- Department of Radiology, Uijeongbu Eulji Medical Center, College of Medicine, Eulji University, Uijeongbu 11759, Republic of Korea
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Shahbazi-Gahrouei D, Aminolroayaei F, Nematollahi H, Ghaderian M, Gahrouei SS. Advanced Magnetic Resonance Imaging Modalities for Breast Cancer Diagnosis: An Overview of Recent Findings and Perspectives. Diagnostics (Basel) 2022; 12:2741. [PMID: 36359584 PMCID: PMC9689118 DOI: 10.3390/diagnostics12112741] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 10/26/2022] [Accepted: 11/07/2022] [Indexed: 08/28/2023] Open
Abstract
Breast cancer is the most prevalent cancer among women and the leading cause of death. Diffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI) are advanced magnetic resonance imaging (MRI) procedures that are widely used in the diagnostic and treatment evaluation of breast cancer. This review article describes the characteristics of new MRI methods and reviews recent findings on breast cancer diagnosis. This review study was performed on the literature sourced from scientific citation websites such as Google Scholar, PubMed, and Web of Science until July 2021. All relevant works published on the mentioned scientific citation websites were investigated. Because of the propensity of malignancies to limit diffusion, DWI can improve MRI diagnostic specificity. Diffusion tensor imaging gives additional information about diffusion directionality and anisotropy over traditional DWI. Recent findings showed that DWI and DTI and their characteristics may facilitate earlier and more accurate diagnosis, followed by better treatment. Overall, with the development of instruments and novel MRI modalities, it may be possible to diagnose breast cancer more effectively in the early stages.
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Affiliation(s)
- Daryoush Shahbazi-Gahrouei
- Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran
| | - Fahimeh Aminolroayaei
- Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran
| | - Hamide Nematollahi
- Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran
| | - Mohammad Ghaderian
- Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran
| | - Sogand Shahbazi Gahrouei
- Department of Management, School of Humanities, Najafabad Branch, Islamic Azad University, Najafabad 8514143131, Iran
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8
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Mürtz P, Tsesarskiy M, Sprinkart AM, Block W, Savchenko O, Luetkens JA, Attenberger U, Pieper CC. Simplified intravoxel incoherent motion DWI for differentiating malignant from benign breast lesions. Eur Radiol Exp 2022; 6:48. [PMID: 36171532 PMCID: PMC9519819 DOI: 10.1186/s41747-022-00298-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/27/2022] [Indexed: 11/27/2022] Open
Abstract
Background To evaluate simplified intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) for differentiating malignant versus benign breast lesions as (i) stand-alone tool and (ii) add-on to dynamic contrast-enhanced magnetic resonance imaging. Methods 1.5-T DWI data (b = 0, 50, 250, 800 s/mm2) were retrospectively analysed for 126 patients with malignant or benign breast lesions. Apparent diffusion coefficient (ADC) ADC (0, 800) and IVIM-based parameters D1′ = ADC (50, 800), D2′ = ADC (250, 800), f1′ = f (0, 50, 800), f2′ = f (0, 250, 800) and D*′ = D* (0, 50, 250, 800) were voxel-wise calculated without fitting procedures. Regions of interest were analysed in vital tumour and perfusion hot spots. Beside the single parameters, the combined use of D1′ with f1′ and D2′ with f2′ was evaluated. Lesion differentiation was investigated for lesions (i) with hyperintensity on DWI with b = 800 s/mm2 (n = 191) and (ii) with suspicious contrast-enhancement (n = 135). Results All lesions with suspicious contrast-enhancement appeared also hyperintense on DWI with b = 800 s/mm2. For task (i), best discrimination was reached for the combination of D1′ and f1′ using perfusion hot spot regions-of-interest (accuracy 93.7%), which was higher than that of ADC (86.9%, p = 0.003) and single IVIM parameters D1′ (88.0%) and f1′ (87.4%). For task (ii), best discrimination was reached for single parameter D1′ using perfusion hot spot regions-of-interest (92.6%), which were slightly but not significantly better than that of ADC (91.1%) and D2′ (88.1%). Adding f1′ to D1′ did not improve discrimination. Conclusions IVIM analysis yielded a higher accuracy than ADC. If stand-alone DWI is used, perfusion analysis is of special relevance.
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Affiliation(s)
- Petra Mürtz
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Mark Tsesarskiy
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Alois M Sprinkart
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Wolfgang Block
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.,Department of Radiotherapy and Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.,Department of Neuroradiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Oleksandr Savchenko
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Julian A Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Ulrike Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Claus C Pieper
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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Characterizing Errors in Pharmacokinetic Parameters from Analyzing Quantitative Abbreviated DCE-MRI Data in Breast Cancer. ACTA ACUST UNITED AC 2021; 7:253-267. [PMID: 34201654 PMCID: PMC8293327 DOI: 10.3390/tomography7030023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/15/2021] [Accepted: 06/21/2021] [Indexed: 12/13/2022]
Abstract
This study characterizes the error that results when performing quantitative analysis of abbreviated dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) data of the breast with the Standard Kety-Tofts (SKT) model and its Patlak variant. More specifically, we used simulations and patient data to determine the accuracy with which abbreviated time course data could reproduce the pharmacokinetic parameters, Ktrans (volume transfer constant) and ve (extravascular/extracellular volume fraction), when compared to the full time course data. SKT analysis of simulated abbreviated time courses (ATCs) based on the imaging parameters from two available datasets (collected with a 3T MRI scanner) at a temporal resolution of 15 s (N = 15) and 7.23 s (N = 15) found a concordance correlation coefficient (CCC) greater than 0.80 for ATCs of length 3.0 and 2.5 min, respectively, for the Ktrans parameter. Analysis of the experimental data found that at least 90% of patients met this CCC cut-off of 0.80 for the ATCs of the aforementioned lengths. Patlak analysis of experimental data found that 80% of patients from the 15 s resolution dataset and 90% of patients from the 7.27 s resolution dataset met the 0.80 CCC cut-off for ATC lengths of 1.25 and 1.09 min, respectively. This study provides evidence for both the feasibility and potential utility of performing a quantitative analysis of abbreviated breast DCE-MRI in conjunction with acquisition of current standard-of-care high resolution scans without significant loss of information in the community setting.
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Ha SM, Chang JM, Lee SH, Kim ES, Kim SY, Kim YS, Cho N, Moon WK. Detection of Contralateral Breast Cancer Using Diffusion-Weighted Magnetic Resonance Imaging in Women with Newly Diagnosed Breast Cancer: Comparison with Combined Mammography and Whole-Breast Ultrasound. Korean J Radiol 2021; 22:867-879. [PMID: 33856137 PMCID: PMC8154781 DOI: 10.3348/kjr.2020.1183] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/14/2020] [Accepted: 12/27/2020] [Indexed: 12/02/2022] Open
Abstract
Objective To compare the screening performance of diffusion-weighted (DW) MRI and combined mammography and ultrasound (US) in detecting clinically occult contralateral breast cancer in women with newly diagnosed breast cancer. Materials and Methods Between January 2017 and July 2018, 1148 women (mean age ± standard deviation, 53.2 ± 10.8 years) with unilateral breast cancer and no clinical abnormalities in the contralateral breast underwent 3T MRI, digital mammography, and radiologist-performed whole-breast US. In this retrospective study, three radiologists independently and blindly reviewed all DW MR images (b = 1000 s/mm2 and apparent diffusion coefficient map) of the contralateral breast and assigned a Breast Imaging Reporting and Data System category. For combined mammography and US evaluation, prospectively assessed results were used. Using histopathology or 1-year follow-up as the reference standard, cancer detection rate and the patient percentage with cancers detected among all women recommended for tissue diagnosis (positive predictive value; PPV2) were compared. Results Of the 30 cases of clinically occult contralateral cancers (13 invasive and 17 ductal carcinoma in situ [DCIS]), DW MRI detected 23 (76.7%) cases (11 invasive and 12 DCIS), whereas combined mammography and US detected 12 (40.0%, five invasive and seven DCIS) cases. All cancers detected by combined mammography and US, except two DCIS cases, were detected by DW MRI. The cancer detection rate of DW MRI (2.0%; 95% confidence interval [CI]: 1.3%, 3.0%) was higher than that of combined mammography and US (1.0%; 95% CI: 0.5%, 1.8%; p = 0.009). DW MRI showed higher PPV2 (42.1%; 95% CI: 26.3%, 59.2%) than combined mammography and US (18.5%; 95% CI: 9.9%, 30.0%; p = 0.001). Conclusion In women with newly diagnosed breast cancer, DW MRI detected significantly more contralateral breast cancers with fewer biopsy recommendations than combined mammography and US.
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Affiliation(s)
- Su Min Ha
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jung Min Chang
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Su Hyun Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Eun Sil Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Soo Yeon Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yeon Soo Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Nariya Cho
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Woo Kyung Moon
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.
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11
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Alaref A, Hassan A, Sharma Kandel R, Mishra R, Gautam J, Jahan N. Magnetic Resonance Imaging Features in Different Types of Invasive Breast Cancer: A Systematic Review of the Literature. Cureus 2021; 13:e13854. [PMID: 33859904 PMCID: PMC8038870 DOI: 10.7759/cureus.13854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 03/12/2021] [Indexed: 12/04/2022] Open
Abstract
Breast cancer is the most common malignancy affecting women worldwide, and early diagnosis of breast cancer is the key to its successful and effective treatment. Traditional imaging techniques such as mammography and ultrasound are used to detect and configure breast abnormalities; unfortunately, these modalities have low sensitivity and specificity, particularly in young patients with dense breast tissue, breast implants, or post-surgical scar/architecture distortions. Therefore, breast magnetic resonance imaging (MRI) has been superior in the characterization and detection of breast cancer, especially that with invasive features. This review article explores the importance of breast MRI in the early detection of invasive breast cancer versus traditional tools, including mammography and ultrasound, while also analyzing the use of MRI as a screening tool for high-risk women. We will also discuss the different MRI features for invasive ductal carcinoma and lobular carcinoma and the role of breast MRI in the detection of ductal carcinoma in situ with a focus on the utilization of new techniques, including MR spectroscopy and diffusion-weighted imaging.
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Affiliation(s)
- Amer Alaref
- Diagnostic Radiology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Diagnostic Radiology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, CAN
- Diagnostic Imaging, Northern Ontario School of Medicine, Sudbury, CAN
| | - Abdallah Hassan
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Rajan Sharma Kandel
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Rohi Mishra
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Jeevan Gautam
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Nusrat Jahan
- Cardiology, Rush University Medical Center, Chicago, USA
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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12
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Kim JJ, Kim JY. Fusion of high b-value diffusion-weighted and unenhanced T1-weighted images to diagnose invasive breast cancer: factors associated with false-negative results. Eur Radiol 2021; 31:4860-4871. [PMID: 33443601 DOI: 10.1007/s00330-020-07644-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/06/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES We sought factors associated with false-negative results in the diagnosis of invasive breast cancer via non-contrast breast magnetic resonance imaging (MRI) using fused high b-value diffusion-weighted imaging (DWI) and unenhanced T1-weighted images (T1WI). METHODS Between 2018 and 2019, 316 consecutive women (mean age, 54.6 years) with invasive breast cancer who underwent preoperative breast MRI, including fused high b-value DWI and unenhanced T1WI, were retrospectively evaluated. Malignancy confidence ratings of the most suspicious breast lesions evident on fused DWI were derived by two radiologists using a 6-point Likert-type scale. Both clinicopathological and imaging features were analyzed. Multivariate regression analysis was performed to identify factors associated with false-negative DWI results in the diagnosis of invasive breast cancer. RESULTS Of the 316 breast cancers, fused DWI yielded 289 (91.5%) true-positive and 27 (8.5%) false-negative results. Multivariate analysis showed that small tumor size (≤ 1 cm) (odds ratio [OR], 5.95; 95% confidence interval [CI], 2.11, 16.81; p = 0.001), presence of calcifications in the tumor (OR, 3.41; 95% CI, 1.27, 9.15; p = 0.015), and a moderate/marked background diffusion signal (ORs, 4.23 and 19.18; 95% CI, 1.31, 13.67 and 6.51, 56.46; p = 0.016 and p < 0.001, respectively) were significantly associated with false-negative results. In subgroup analysis of 141 screening-detected cancers, a marked background diffusion signal (OR, 7.94; 95% CI, 2.30, 27.35; p = 0.001) remained significantly associated with false-negative results in the multivariate analysis. CONCLUSIONS In addition to histopathological features, a higher background diffusion signal was associated with false-negative results in the diagnosis of invasive breast cancer via non-contrast MRI using fused high b-value DWI and unenhanced T1WI. KEY POINTS • Subcentimeter tumors and presence of calcifications in the tumor are associated with false-negative diffusion-weighted imaging results in the diagnosis of invasive breast cancer. • A higher degree of background diffusion signal may lead to false-negative interpretation of diffusion-weighted imaging in patients with invasive breast cancer.
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Affiliation(s)
- Jin Joo Kim
- Department of Radiology, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, 1-10, Ami-Dong, Seo-gu, Busan, 602-739, Republic of Korea
| | - Jin You Kim
- Department of Radiology, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, 1-10, Ami-Dong, Seo-gu, Busan, 602-739, Republic of Korea.
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13
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Abstract
Breast MR imaging is the most sensitive imaging method for the detection of breast cancer and detects more aggressive malignancies than mammography and ultrasound examination. Despite these advantages, breast MR imaging has low use rates for breast cancer screening. Abbreviated breast MR imaging, in which a limited number of breast imaging sequences are obtained, has been proposed as a way to solve cost and patient tolerance issues while preserving the high cancer detection rate of breast MR imaging. This review discusses abbreviated breast MR imaging, including protocols, multicenter clinical trial results, clinical workflow implementation challenges, and future directions.
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Affiliation(s)
- Laura Heacock
- Department of Radiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY 10016, USA.
| | - Alana A Lewin
- Department of Radiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY 10016, USA
| | - Hildegard K Toth
- Department of Radiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY 10016, USA
| | - Linda Moy
- Department of Radiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY 10016, USA
| | - Beatriu Reig
- Department of Radiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY 10016, USA
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14
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Shin HJ, Lee SH, Moon WK. Diffusion-Weighted Imaging as a Stand-Alone Breast Imaging Modality. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2021; 82:29-48. [PMID: 36237448 PMCID: PMC9432391 DOI: 10.3348/jksr.2020.0215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 12/03/2022]
Abstract
확산강조영상은 유방암의 진단과 스크리닝에 있어 독립적 검사 방법으로서의 기대되는 결과를 보여주는 빠른 비조영증강 검사 방법이다. 현재까지의 연구 결과 유방암 진단에 있어 독립적 검사 방법으로서 확산강조영상의 민감도는 역동적 조영증강 검사보다는 낮으나 유방촬영술보다는 높으며, 이로써 유방암 스크리닝에 대한 유용한 대안이 될 수 있을 것으로 보인다. 확산강조영상의 표준화된 영상 획득과 판독을 통해 영상 화질이 개선될 수 있고, 판독 결과의 다양성도 감소할 것으로 기대된다. 또한, 최신 기법과 후처리 기법을 사용한 고해상도 확산강조영상을 시행함으로써 1 cm 미만의 작은 암의 발견율을 증가시킬 수 있고, 가음성 및 가양성 결과를 감소시킬 것으로 보인다. 현재 한국에서 진행 중인 고위험군 여성에서의 확산강조영상 스크리닝에 대한 다기관 연구 결과가 나온다면 독립적 검사로서의 확산강조영상의 사용을 촉진시킬 수 있을 것으로 기대된다.
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Affiliation(s)
- Hee Jung Shin
- Department of Radiology, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Su Hyun Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Woo Kyung Moon
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
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15
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Lee SH, Shin HJ, Moon WK. Diffusion-Weighted Magnetic Resonance Imaging of the Breast: Standardization of Image Acquisition and Interpretation. Korean J Radiol 2020; 22:9-22. [PMID: 32901461 PMCID: PMC7772373 DOI: 10.3348/kjr.2020.0093] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/06/2020] [Accepted: 05/09/2020] [Indexed: 12/12/2022] Open
Abstract
Diffusion-weighted (DW) magnetic resonance imaging (MRI) is a rapid, unenhanced imaging technique that measures the motion of water molecules within tissues and provides information regarding the cell density and tissue microstructure. DW MRI has demonstrated the potential to improve the specificity of breast MRI, facilitate the evaluation of tumor response to neoadjuvant chemotherapy and can be employed in unenhanced MRI screening. However, standardization of the acquisition and interpretation of DW MRI is challenging. Recently, the European Society of Breast Radiology issued a consensus statement, which described the acquisition parameters and interpretation of DW MRI. The current article describes the basic principles, standardized acquisition protocols and interpretation guidelines, and the clinical applications of DW MRI in breast imaging.
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Affiliation(s)
- Su Hyun Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Hee Jung Shin
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woo Kyung Moon
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.
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16
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Daimiel Naranjo I, Lo Gullo R, Saccarelli C, Thakur SB, Bitencourt A, Morris EA, Jochelson MS, Sevilimedu V, Martinez DF, Pinker-Domenig K. Diagnostic value of diffusion-weighted imaging with synthetic b-values in breast tumors: comparison with dynamic contrast-enhanced and multiparametric MRI. Eur Radiol 2020; 31:356-367. [PMID: 32780207 PMCID: PMC7755636 DOI: 10.1007/s00330-020-07094-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 05/22/2020] [Accepted: 07/21/2020] [Indexed: 12/24/2022]
Abstract
Objectives To assess DWI for tumor visibility and breast cancer detection by the addition of different synthetic b-values. Methods Eighty-four consecutive women who underwent a breast-multiparametric-MRI (mpMRI) with enhancing lesions on DCE-MRI (BI-RADS 2–5) were included in this IRB-approved retrospective study from September 2018 to March 2019. Three readers evaluated DW acquired b-800 and synthetic b-1000, b-1200, b-1500, and b-1800 s/mm2 images for lesion visibility and preferred b-value based on lesion conspicuity. Image quality (1–3 scores) and breast composition (BI-RADS) were also recorded. Diagnostic parameters for DWI were determined using a 1–5 malignancy score based on qualitative imaging parameters (acquired + preferred synthetic b-values) and ADC values. BI-RADS classification was used for DCE-MRI and quantitative ADC values + BI-RADS were used for mpMRI. Results Sixty-four malignant (average = 23 mm) and 39 benign (average = 8 mm) lesions were found in 80 women. Although b-800 achieved the best image quality score, synthetic b-values 1200–1500 s/mm2 were preferred for lesion conspicuity, especially in dense breast. b-800 and synthetic b-1000/b-1200 s/mm2 values allowed the visualization of 84–90% of cancers visible with DCE-MRI performing better than b-1500/b-1800 s/mm2. DWI was more specific (86.3% vs 65.7%, p < 0.001) but less sensitive (62.8% vs 90%, p < 0.001) and accurate (71% vs 80.7%, p = 0.003) than DCE-MRI for breast cancer detection, where mpMRI was the most accurate modality accounting for less false positive cases. Conclusion The addition of synthetic b-values enhances tumor conspicuity and could potentially improve tumor visualization particularly in dense breast. However, its supportive role for DWI breast cancer detection is still not definite. Key Points • The addition of synthetic b-values (1200–1500 s/mm2) to acquired DWI afforded a better lesion conspicuity without increasing acquisition time and was particularly useful in dense breasts. • Despite the use of synthetic b-values, DWI was less sensitive and accurate than DCE-MRI for breast cancer detection. • A multiparametric MRI modality still remains the best approach having the highest accuracy for breast cancer detection and thus reducing the number of unnecessary biopsies. Electronic supplementary material The online version of this article (10.1007/s00330-020-07094-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Isaac Daimiel Naranjo
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Roberto Lo Gullo
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA.,Department of Radiology, Breast Imaging Division, Istituto Europeo di Oncologia, Via Giuseppe Ripamonti, 435, 20141, Milano, Italy
| | - Carolina Saccarelli
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Sunitha B Thakur
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA.,Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Almir Bitencourt
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA.,Department of Imaging, A.C.Camargo Cancer Center, SP, São Paulo, Brazil
| | - Elizabeth A Morris
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Maxine S Jochelson
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Varadan Sevilimedu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Danny F Martinez
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Katja Pinker-Domenig
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA. .,Department of Biomedical Imaging and Image-guided Therapy Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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17
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Ha SM, Chang JM, Lee SH, Kim ES, Kim SY, Cho N, Moon WK. Diffusion-weighted MRI at 3.0 T for detection of occult disease in the contralateral breast in women with newly diagnosed breast cancer. Breast Cancer Res Treat 2020; 182:283-297. [PMID: 32447596 DOI: 10.1007/s10549-020-05697-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/18/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE Diffusion-weighted magnetic resonance imaging (DW-MRI) offers unenhanced method to detect breast cancer without cost and safety concerns associated with dynamic contrast-enhanced (DCE) MRI. Our purpose was to evaluate the performance of DW-MRI at 3.0T in detection of clinically and mammographically occult contralateral breast cancer in patients with unilateral breast cancer. METHODS Between 2017 and 2018, 1130 patients (mean age 53.3 years; range 26-84 years) with newly diagnosed unilateral breast cancer who underwent breast MRI and had no abnormalities on clinical and mammographic examinations of contralateral breast were included. Three experienced radiologists independently reviewed DW-MRI (b = 0 and 1000 s/mm2) and DCE-MRI and assigned a BI-RADS category. Using histopathology or 1-year clinical follow-up, performance measures of DW-MRI were compared with DCE-MRI. RESULTS A total of 21 (1.9%, 21/1130) cancers were identified (12 ductal carcinoma in situ and 9 invasive ductal carcinoma; mean invasive tumor size, 8.0 mm) in the contralateral breast. Cancer detection rate of DW-MRI was 13-15 with mean of 14 per 1000 examinations (95% confidence interval [CI] 9-23 per 1000 examinations), which was lower than that of DCE-MRI (18-19 with mean of 18 per 1000 examinations, P = 0.01). A lower abnormal interpretation rate (14.0% versus 17.0%, respectively, P < 0.001) with higher specificity (87.3% versus 84.6%, respectively, P < 0.001) but lower sensitivity (77.8% versus 96.8%, respectively, P < 0.001) was noted for DW-MRI compared to DCE-MRI. CONCLUSIONS DW-MRI at 3.0T has the potential as a cost-effective tool for evaluation of contralateral breast in women with newly diagnosed breast cancer.
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Affiliation(s)
- Su Min Ha
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Jung Min Chang
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea.
| | - Su Hyun Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Eun Sil Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Soo-Yeon Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Nariya Cho
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Woo Kyung Moon
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea
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18
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Value of an abbreviated protocol of breast magnetic resonance imaging for screening high-risk patients. RADIOLOGIA 2020. [DOI: 10.1016/j.rxeng.2019.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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19
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Girometti R, Marconi V, Linda A, Di Mico L, Bondini F, Zuiani C, Sardanelli F. Preoperative assessment of breast cancer: Multireader comparison of contrast-enhanced MRI versus the combination of unenhanced MRI and digital breast tomosynthesis. Breast 2019; 49:174-182. [PMID: 31838292 PMCID: PMC7375544 DOI: 10.1016/j.breast.2019.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 11/22/2019] [Accepted: 11/26/2019] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To compare the sensitivity for breast cancer (BC) and BC size estimation of preoperative contrast-enhanced magnetic resonance imaging (CEMRI) versus combined unenhanced magnetic resonance imaging (UMRI) and digital breast tomosynthesis (DBT). PATIENTS AND METHODS We retrospectively included 56 women who underwent DBT and preoperative 1.5 T CEMRI between January 2016-February 2017. Three readers with 2-10 years of experience in CEMRI and DBT, blinded to pathology, independently reviewed CEMRI (diffusion-weighted imaging [DWI], T2-weighted imaging, pre- and post-contrast T1-weighted imaging) and a combination of UMRI (DWI and pre-contrast T1-weighted imaging) and DBT. We calculated per-lesion sensitivity of CEMRI and UMRI + DBT, and the agreement between CEMRI, UMRI and DBT versus pathology in assessing cancer size (Bland-Altman analysis). Logistic regression was performed to assess features predictive of cancer missing. RESULTS We included 70 lesions (64% invasive BC, 36% ductal carcinoma in situ or invasive BC with in situ component). UMRI + DBT showed lower sensitivity (86-89%) than CEMRI (94-100%), with a significant difference for the most experienced reader only (p = 0.008). False-positives were fewer with UMRI + DBT (4-5) than with CEMRI (18-25), regardless of the reader (p = 0.001-0.005). For lesion size, UMRI showed closer limits of agreement with pathology than CEMRI or DBT. Cancer size ≤1 cm was the only independent predictor for cancer missing for both imaging strategies (Odds ratio 8.62 for CEMRI and 19.16 for UMRI + DBT). CONCLUSIONS UMRI + DBT showed comparable sensitivity and less false-positives than CEMRI in the preoperative assessment of BC. UMRI was the most accurate tool to assess cancer size.
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Affiliation(s)
- Rossano Girometti
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital "S. Maria Della Misericordia", P.le S. Maria Della Misercordia N, 15, 33100, Udine, Italy.
| | - Valentina Marconi
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital "S. Maria Della Misericordia", P.le S. Maria Della Misercordia N, 15, 33100, Udine, Italy.
| | - Anna Linda
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital "S. Maria Della Misericordia", P.le S. Maria Della Misercordia N, 15, 33100, Udine, Italy.
| | - Luisa Di Mico
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital "S. Maria Della Misericordia", P.le S. Maria Della Misercordia N, 15, 33100, Udine, Italy.
| | - Federica Bondini
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital "S. Maria Della Misericordia", P.le S. Maria Della Misercordia N, 15, 33100, Udine, Italy.
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital "S. Maria Della Misericordia", P.le S. Maria Della Misercordia N, 15, 33100, Udine, Italy.
| | - Francesco Sardanelli
- Radiology Unit, IRCCS Policlinico San Donato, Milan, Italy; Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Milan, Italy.
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Amornsiripanitch N, Bickelhaupt S, Shin HJ, Dang M, Rahbar H, Pinker K, Partridge SC. Diffusion-weighted MRI for Unenhanced Breast Cancer Screening. Radiology 2019; 293:504-520. [PMID: 31592734 PMCID: PMC6884069 DOI: 10.1148/radiol.2019182789] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 06/18/2019] [Accepted: 07/10/2019] [Indexed: 01/12/2023]
Abstract
Diffusion-weighted (DW) MRI is a rapid technique that measures the mobility of water molecules within tissue, reflecting the cellular microenvironment. At DW MRI, breast cancers typically exhibit reduced diffusivity and appear hyperintense to surrounding tissues. On the basis of this characteristic, DW MRI may offer an unenhanced method to detect breast cancer without the costs and safety concerns associated with dynamic contrast material-enhanced MRI, the current reference standard in the setting of high-risk screening. This application of DW MRI has not been widely explored but is particularly timely given the growing health concerns related to the long-term use of gadolinium-based contrast material. Moreover, increasing breast density notification legislation across the United States is raising awareness of the limitations of mammography in women with dense breasts, emphasizing the need for additional cost-effective supplemental screening examinations. Preliminary studies suggest unenhanced MRI with DW MRI may provide higher sensitivity than screening mammography for the detection of breast malignancies. Larger prospective multicenter trials are needed to validate single-center findings and assess the performance of DW MRI for generalized breast cancer screening. Standardization of DW MRI acquisition and interpretation is essential to ensure reliable sensitivity and specificity, and an optimal approach for screening using readily available techniques is proposed here.
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Affiliation(s)
- Nita Amornsiripanitch
- From the Department of Breast Imaging, University of Massachusetts Memorial Medical Center, Worcester, Mass (N.A.); Medical Imaging and Radiology–Cancer Prevention, German Cancer Research Center, Heidelberg, Germany (S.B.); Department of Radiology, Asan Medical Center, University of Ulsan, Seoul, South Korea (H.J.S.); Department of Radiology, University of Washington, 825 Eastlake Ave E, G2-600, Seattle, WA 98109 (M.D., H.R., S.C.P.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (K.P.); and Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (K.P.)
| | - Sebastian Bickelhaupt
- From the Department of Breast Imaging, University of Massachusetts Memorial Medical Center, Worcester, Mass (N.A.); Medical Imaging and Radiology–Cancer Prevention, German Cancer Research Center, Heidelberg, Germany (S.B.); Department of Radiology, Asan Medical Center, University of Ulsan, Seoul, South Korea (H.J.S.); Department of Radiology, University of Washington, 825 Eastlake Ave E, G2-600, Seattle, WA 98109 (M.D., H.R., S.C.P.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (K.P.); and Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (K.P.)
| | - Hee Jung Shin
- From the Department of Breast Imaging, University of Massachusetts Memorial Medical Center, Worcester, Mass (N.A.); Medical Imaging and Radiology–Cancer Prevention, German Cancer Research Center, Heidelberg, Germany (S.B.); Department of Radiology, Asan Medical Center, University of Ulsan, Seoul, South Korea (H.J.S.); Department of Radiology, University of Washington, 825 Eastlake Ave E, G2-600, Seattle, WA 98109 (M.D., H.R., S.C.P.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (K.P.); and Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (K.P.)
| | - Madeline Dang
- From the Department of Breast Imaging, University of Massachusetts Memorial Medical Center, Worcester, Mass (N.A.); Medical Imaging and Radiology–Cancer Prevention, German Cancer Research Center, Heidelberg, Germany (S.B.); Department of Radiology, Asan Medical Center, University of Ulsan, Seoul, South Korea (H.J.S.); Department of Radiology, University of Washington, 825 Eastlake Ave E, G2-600, Seattle, WA 98109 (M.D., H.R., S.C.P.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (K.P.); and Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (K.P.)
| | - Habib Rahbar
- From the Department of Breast Imaging, University of Massachusetts Memorial Medical Center, Worcester, Mass (N.A.); Medical Imaging and Radiology–Cancer Prevention, German Cancer Research Center, Heidelberg, Germany (S.B.); Department of Radiology, Asan Medical Center, University of Ulsan, Seoul, South Korea (H.J.S.); Department of Radiology, University of Washington, 825 Eastlake Ave E, G2-600, Seattle, WA 98109 (M.D., H.R., S.C.P.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (K.P.); and Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (K.P.)
| | - Katja Pinker
- From the Department of Breast Imaging, University of Massachusetts Memorial Medical Center, Worcester, Mass (N.A.); Medical Imaging and Radiology–Cancer Prevention, German Cancer Research Center, Heidelberg, Germany (S.B.); Department of Radiology, Asan Medical Center, University of Ulsan, Seoul, South Korea (H.J.S.); Department of Radiology, University of Washington, 825 Eastlake Ave E, G2-600, Seattle, WA 98109 (M.D., H.R., S.C.P.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (K.P.); and Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (K.P.)
| | - Savannah C. Partridge
- From the Department of Breast Imaging, University of Massachusetts Memorial Medical Center, Worcester, Mass (N.A.); Medical Imaging and Radiology–Cancer Prevention, German Cancer Research Center, Heidelberg, Germany (S.B.); Department of Radiology, Asan Medical Center, University of Ulsan, Seoul, South Korea (H.J.S.); Department of Radiology, University of Washington, 825 Eastlake Ave E, G2-600, Seattle, WA 98109 (M.D., H.R., S.C.P.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (K.P.); and Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (K.P.)
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21
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Marquina Martínez D, Cruz Ciria S, García Barrado AI, Suñén Amador I, García Mur C. Value of an abbreviated protocol of breast magnetic resonance imaging for screening high-risk patients. RADIOLOGIA 2019; 62:198-204. [PMID: 31623849 DOI: 10.1016/j.rx.2019.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 06/28/2019] [Accepted: 08/14/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Value the utility of breast MRI abbreviated protocols for the screening of breast cancer in high-risk patients compared to the full protocol. METHODS We performed a retrospective review of 157 breast MRI of 82 high-risk patients practiced in our hospital between January 2011 and January 2017. Clinical, radiological and anatomopathological parameters were analyzed. Reading of the different protocols (MIP, abbreviated and full) was made by an expert radiologist. Subsequent statistical analysis was done. RESULTS A total amount of 12 findings classified as BI-RADS 4 and 5 were identified and performed a biopsy, resulting 11 of them to be malignant (91.67%) and 1 benign (8.33%). The malignant wounds included 4 intraductal carcinoma (33.33%) and 7 infiltrating ductal carcinoma (58.33%). All injuries were detected with the three protocols and no significant differences were found between their respective area under the ROC curve (p=0.0650). CONCLUSIONS In our study there are no significant differences between the different protocols (MIP, abbreviated and full), which places the abbreviated protocol as a promising tool for breast cancer screening in high-risk patients.
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Affiliation(s)
- D Marquina Martínez
- Sección de Radiología Mamaria, Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, España; Servicio de Radiodiagnóstico, Hospital San Jorge, Huesca, España.
| | - S Cruz Ciria
- Sección de Radiología Mamaria, Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, España; Servicio de Radiodiagnóstico, Hospital San Jorge, Huesca, España
| | - A I García Barrado
- Sección de Radiología Mamaria, Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, España
| | - I Suñén Amador
- Sección de Radiología Mamaria, Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, España
| | - C García Mur
- Sección de Radiología Mamaria, Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, España
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22
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Iima M, Honda M, Sigmund EE, Ohno Kishimoto A, Kataoka M, Togashi K. Diffusion MRI of the breast: Current status and future directions. J Magn Reson Imaging 2019; 52:70-90. [PMID: 31520518 DOI: 10.1002/jmri.26908] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 08/12/2019] [Indexed: 12/30/2022] Open
Abstract
Diffusion-weighted imaging (DWI) is increasingly being incorporated into routine breast MRI protocols in many institutions worldwide, and there are abundant breast DWI indications ranging from lesion detection and distinguishing malignant from benign tumors to assessing prognostic biomarkers of breast cancer and predicting treatment response. DWI has the potential to serve as a noncontrast MR screening method. Beyond apparent diffusion coefficient (ADC) mapping, which is a commonly used quantitative DWI measure, advanced DWI models such as intravoxel incoherent motion (IVIM), non-Gaussian diffusion MRI, and diffusion tensor imaging (DTI) are extensively exploited in this field, allowing the characterization of tissue perfusion and architecture and improving diagnostic accuracy without the use of contrast agents. This review will give a summary of the clinical literature along with future directions. Level of Evidence: 5 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;52:70-90.
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Affiliation(s)
- Mami Iima
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Clinical Innovative Medicine, Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital, Kyoto, Japan
| | - Maya Honda
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Eric E Sigmund
- Department of Radiology, NYU Langone Health, New York, New York, USA.,Center for Advanced Imaging and Innovation (CAI2R), New York, New York, USA
| | - Ayami Ohno Kishimoto
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masako Kataoka
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kaori Togashi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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23
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Diffusion-Weighted Imaging With Apparent Diffusion Coefficient Mapping for Breast Cancer Detection as a Stand-Alone Parameter: Comparison With Dynamic Contrast-Enhanced and Multiparametric Magnetic Resonance Imaging. Invest Radiol 2019; 53:587-595. [PMID: 29620604 DOI: 10.1097/rli.0000000000000465] [Citation(s) in RCA: 114] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE The aims of this study were to compare dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) with apparent diffusion coefficient mapping as a stand-alone parameter without any other supportive sequence for breast cancer detection and to assess its combination as multiparametric MRI (mpMRI) of the breast. MATERIALS AND METHODS In this institutional review board-approved single-center study, prospectively acquired data of 106 patients who underwent breast MRI from 12/2010 to 09/2014 for an imaging abnormality (Breast Imaging Reporting and Data System 0, 4/5) were retrospectively analyzed. Four readers independently assessed DWI and DCE as well as combined as mpMRI. Breast Imaging Reporting and Data System categories, lesion size, and mean apparent diffusion coefficient values were recorded. Histopathology was used as the gold standard. Appropriate statistical tests were used to compare diagnostic values. RESULTS There were 69 malignant and 41 benign tumors in 106 patients. Four patients presented with bilateral lesions. Dynamic contrast-enhanced MRI was the most sensitive test for breast cancer detection, with an average sensitivity of 100%. Diffusion-weighted imaging alone was less sensitive (82%; P < 0.001) but more specific than DCE-MRI (86.8% vs 76.6%; P = 0.002). Diagnostic accuracy was 83.7% for DWI and 90.6% for DCE-MRI. Multiparametric MRI achieved a sensitivity of 96.8%, not statistically different from DCE-MRI (P = 0.12) and with a similar specificity as DWI (83.8%; P = 0.195), maximizing diagnostic accuracy to 91.9%. There was almost perfect interreader agreement for DWI (κ = 0.864) and DCE-MRI (κ = 0.875) for differentiation of benign and malignant lesions. CONCLUSION Dynamic contrast-enhanced MRI is most sensitive for breast cancer detection and thus still indispensable. Multiparametric MRI using DCE-MRI and DWI maintains a high sensitivity, increases specificity, and maximizes diagnostic accuracy, often preventing unnecessary breast biopsies. Diffusion-weighted imaging should not be used as a stand-alone parameter because it detects significantly fewer cancers in comparison with DCE-MRI and mpMRI.
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24
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Potential of Noncontrast Magnetic Resonance Imaging With Diffusion-Weighted Imaging in Characterization of Breast Lesions: Intraindividual Comparison With Dynamic Contrast-Enhanced Magnetic Resonance Imaging. Invest Radiol 2019; 53:229-235. [PMID: 29190227 DOI: 10.1097/rli.0000000000000433] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The aim of this study was to assess the potential of noncontrast magnetic resonance imaging (NC-MRI) with diffusion-weighted imaging (DWI) in characterization of breast lesions in comparison to dynamic contrast-enhanced MRI (DCE-MRI) at 3 T. MATERIALS AND METHODS Consecutive patients with conventional imaging (mammography, ultrasound) BI-RADS 4/5 findings were included in this institutional review board-approved single-center study. All underwent 3 T breast MRI including readout-segmented DWI, DCE, and T2-weighted sequences. Final diagnosis was defined by histopathology or follow-up (>24 months). Two experienced radiologists (R1, R2) independently assigned lesion conspicuity (0 = minimal to 3 = excellent) and BI-RADS scores to NC-MRI (readout-segmented DWI including apparent diffusion coefficient maps) and DCE-MRI (DCE and T2-weighted). Receiver operating characteristics, κ statistics, and visual grading characteristics analysis were applied. RESULTS Sixty-seven malignant and 56 benign lesions were identified in 113 patients (mean age, 54 ± 14 years). Areas under the receiver operating characteristics curves were similar: DCE-MRI: 0.901 (R1), 0.905 (R2); NC-MRI: 0.882 (R1), 0.854 (R2); P > 0.05, respectively. The κ agreement was 0.968 (DCE-MRI) and 0.893 (NC-MRI). Visual grading characteristics analysis revealed superior lesion conspicuity by DCE-MRI (0.661, P < 0.001). CONCLUSIONS Diagnostic performance and interreader agreement of both NC-MRI and DCE-MRI is high, indicating a potential use of NC-MRI as an alternative to DCE-MRI. However, inferior lesion conspicuity and lower interreader agreement of NC-MRI need to be considered.
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25
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Leithner D, Moy L, Morris EA, Marino MA, Helbich TH, Pinker K. Abbreviated MRI of the Breast: Does It Provide Value? J Magn Reson Imaging 2018; 49:e85-e100. [PMID: 30194749 PMCID: PMC6408315 DOI: 10.1002/jmri.26291] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/26/2018] [Accepted: 07/26/2018] [Indexed: 12/13/2022] Open
Abstract
MRI of the breast is the most sensitive test for breast cancer detection and outperforms conventional imaging with mammography, digital breast tomosynthesis, or ultrasound. However, the long scan time and relatively high costs limit its widespread use. Hence, it is currently only routinely implemented in the screening of women at an increased risk of breast cancer. To overcome these limitations, abbreviated dynamic contrast‐enhanced (DCE)‐MRI protocols have been introduced that substantially shorten image acquisition and interpretation time while maintaining a high diagnostic accuracy. Efforts to develop abbreviated MRI protocols reflect the increasing scrutiny of the disproportionate contribution of radiology to the rising overall healthcare expenditures. Healthcare policy makers are now focusing on curbing the use of advanced imaging examinations such as MRI while continuing to promote the quality and appropriateness of imaging. An important cornerstone of value‐based healthcare defines value as the patient's outcome over costs. Therefore, the concept of a fast, abbreviated MRI exam is very appealing, given its high diagnostic accuracy coupled with the possibility of a marked reduction in the cost of an MRI examination. Given recent concerns about gadolinium‐based contrast agents, unenhanced MRI techniques such as diffusion‐weighted imaging (DWI) are also being investigated for breast cancer diagnosis. Although further larger prospective studies, standardized imaging protocol, and reproducibility studies are necessary, initial results with abbreviated MRI protocols suggest that it seems feasible to offer screening breast DCE‐MRI to a broader population. This article aims to give an overview of abbreviated and fast breast MRI protocols, their utility for breast cancer detection, and their emerging role in the new value‐based healthcare paradigm that has replaced the fee‐for‐service model. Level of Evidence: 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:e85–e100.
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Affiliation(s)
- Doris Leithner
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Linda Moy
- Department of Radiology, Center for Biomedical Imaging, NYU School of Medicine, New York, New York, USA
| | - Elizabeth A Morris
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Maria A Marino
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Biomedical Sciences and Morphologic and Functional Imaging, University of Messina, Messina, Italy
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University Vienna, Vienna, Austria
| | - Katja Pinker
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University Vienna, Vienna, Austria
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26
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Park JH, Yun BL, Jang M, Ahn HS, Kim SM, Lee SH, Kang E, Kim EK, Park SY. Comparison of the Diagnostic Performance of Synthetic Versus Acquired High b-Value (1500 s/mm2
) Diffusion-Weighted MRI in Women With Breast Cancers. J Magn Reson Imaging 2018; 49:857-863. [DOI: 10.1002/jmri.26259] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 06/26/2018] [Indexed: 11/09/2022] Open
Affiliation(s)
- Jung Hyun Park
- Department of Radiology; Seoul National University Bundang Hospital; Nam Gyeongi-do Republic of Korea
| | - Bo La Yun
- Department of Radiology; Seoul National University Bundang Hospital; Nam Gyeongi-do Republic of Korea
| | - Mijung Jang
- Department of Radiology; Seoul National University Bundang Hospital; Nam Gyeongi-do Republic of Korea
| | - Hye Shin Ahn
- Department of Radiology; Chung-Ang University Hospital, Chung-Ang University College of Medicine; Seoul Republic of Korea
| | - Sun Mi Kim
- Department of Radiology; Seoul National University Bundang Hospital; Nam Gyeongi-do Republic of Korea
| | - Soo Hyun Lee
- Department of Radiology; College of Medicine, Chungbuk National University; Cheongju Republic of Korea
| | - Eunyoung Kang
- Department of Surgery; Seoul National University College of Medicine, Seoul National University Bundang Hospital; Seongnam Republic of Korea
| | - Eun-Kyu Kim
- Department of Surgery; Seoul National University College of Medicine, Seoul National University Bundang Hospital; Seongnam Republic of Korea
| | - So Yeon Park
- Department of Pathology; Seoul National University College of Medicine, Seoul National University Bundang Hospital; Seongnam Republic of Korea
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27
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Feng J, Xu J, Jiang S, Yin H, Zhao Y, Gui J, Wang K, Lv X, Ren F, Pogue BW, Paulsen KD. Addition of T2-guided optical tomography improves noncontrast breast magnetic resonance imaging diagnosis. Breast Cancer Res 2017; 19:117. [PMID: 29065920 PMCID: PMC5655871 DOI: 10.1186/s13058-017-0902-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 09/18/2017] [Indexed: 11/10/2022] Open
Abstract
Background While dynamic contrast-enhanced magnetic resonance imaging (DCE MRI) is recognized as the most sensitive examination for breast cancer detection, it has a substantial false positive rate and gadolinium (Gd) contrast agents are not universally well tolerated. As a result, alternatives to diagnosing breast cancer based on endogenous contrast are of growing interest. In this study, endogenous near-infrared spectral tomography (NIRST) guided by T2 MRI was evaluated to explore whether the combined imaging modality, which does not require contrast injection or involve ionizing radiation, can achieve acceptable diagnostic performance. Methods Twenty-four subjects—16 with pathologically confirmed malignancy and 8 with benign abnormalities—were simultaneously imaged with MRI and NIRST prior to definitive pathological diagnosis. MRIs were evaluated independently by three breast radiologists blinded to the pathological results. Optical image reconstructions were constrained by grayscale values in the T2 MRI. MRI and NIRST images were used, alone and in combination, to estimate the diagnostic performance of the data. Outcomes were compared to DCE results. Results Sensitivity, specificity, accuracy, and area under the curve (AUC) of noncontrast MRI when combined with T2-guided NIRST were 94%, 100%, 96%, and 0.95, respectively, whereas these values were 94%, 63%, 88%, and 0.81 for DCE MRI alone, and 88%, 88%, 88%, and 0.94 when DCE-guided NIRST was added. Conclusion In this study, the overall accuracy of imaging diagnosis improved to 96% when T2-guided NIRST was added to noncontrast MRI alone, relative to 88% for DCE MRI, suggesting that similar or better diagnostic accuracy can be achieved without requiring a contrast agent. Electronic supplementary material The online version of this article (doi:10.1186/s13058-017-0902-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jinchao Feng
- Thayer School of Engineering, Dartmouth College, 14 Engineering Drive, Hanover, NH, 03755, USA.,Information Technology of Faculty, Beijing University of Technology, Beijing, 100124, China
| | - Junqing Xu
- Department of Radiology, Xijing Hospital, Xi'an, 710032, China
| | - Shudong Jiang
- Thayer School of Engineering, Dartmouth College, 14 Engineering Drive, Hanover, NH, 03755, USA
| | - Hong Yin
- Department of Radiology, Xijing Hospital, Xi'an, 710032, China.
| | - Yan Zhao
- Thayer School of Engineering, Dartmouth College, 14 Engineering Drive, Hanover, NH, 03755, USA
| | - Jiang Gui
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, 03755, USA
| | - Ke Wang
- Department of Radiology, Xijing Hospital, Xi'an, 710032, China
| | - Xiuhua Lv
- Department of Radiology, Xijing Hospital, Xi'an, 710032, China
| | - Fang Ren
- Department of Radiology, Xijing Hospital, Xi'an, 710032, China
| | - Brian W Pogue
- Thayer School of Engineering, Dartmouth College, 14 Engineering Drive, Hanover, NH, 03755, USA
| | - Keith D Paulsen
- Thayer School of Engineering, Dartmouth College, 14 Engineering Drive, Hanover, NH, 03755, USA.
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28
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Kang JW, Shin HJ, Shin KC, Chae EY, Choi WJ, Cha JH, Kim HH. Unenhanced magnetic resonance screening using fused diffusion-weighted imaging and maximum-intensity projection in patients with a personal history of breast cancer: role of fused DWI for postoperative screening. Breast Cancer Res Treat 2017; 165:119-128. [PMID: 28577079 DOI: 10.1007/s10549-017-4322-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 05/29/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To assess the diagnostic performance of unenhanced abbreviated protocol (AP) comprising fused diffusion-weighted imaging (DWI) using T1-weighted imaging (T1WI) with DWI maximum-intensity projections (DWI MIPs) for screening patients with a personal history of breast cancer (PHBC). METHODS This institutional review board-approved retrospective observational study included 343 patients with PHBC who underwent 3T breast magnetic resonance imaging (MRI) between November 2013 and September 2015. Three breast radiologists reviewed the DWI MIPs of the AP to identify lesions, and the remaining axial AP images to characterize the detected lesions and establish the breast imaging reporting and data system final assessment. The conventional protocol (CP) images were also evaluated in the same way. The decision-making times were recorded. RESULTS MRI acquisition time was approximately 5 min for AP. The mean times to read MIPs and remaining images were shorter in AP than in CP (5.5 and 22.1 s vs. 7.8 and 29.6 s). On DWI MIPs, the readers detected 9, 8, and 9 of 9 pathologically proven cancers, with negative predictive values (NPVs) of 100.0, 99.6, and 100.0%. Complete AP showed sensitivities of 88.9, 100.0, and 88.9% and specificities of 94.8, 93.4, and 95.1%. Complete CP showed sensitivities of 100.0, 100.0, and 88.9% and specificities of 93.4, 94.0, and 96.3%. CONCLUSIONS An unenhanced AP had a short acquisition time of 5 min, and DWI MIPs showed NPVs greater than 99% across readers. The diagnostic performance of complete AP was equivalent to that of CP for screening patients with PHBC.
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Affiliation(s)
- Ji Won Kang
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan, College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Hee Jung Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan, College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 05505, South Korea.
| | - Ki Chang Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan, College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Eun Young Chae
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan, College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Woo Jung Choi
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan, College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Joo Hee Cha
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan, College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Hak Hee Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan, College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 05505, South Korea
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