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Kim JY, Partridge SC. Non-contrast Breast MR Imaging. Radiol Clin North Am 2024; 62:661-678. [PMID: 38777541 PMCID: PMC11116814 DOI: 10.1016/j.rcl.2023.12.009] [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] [Indexed: 05/25/2024]
Abstract
Considering the high cost of dynamic contrast-enhanced MR imaging and various contraindications and health concerns related to administration of intravenous gadolinium-based contrast agents, there is emerging interest in non-contrast-enhanced breast MR imaging. Diffusion-weighted MR imaging (DWI) is a fast, unenhanced technique that has wide clinical applications in breast cancer detection, characterization, prognosis, and predicting treatment response. It also has the potential to serve as a non-contrast MR imaging screening method. Standardized protocols and interpretation strategies can help to enhance the clinical utility of breast DWI. A variety of other promising non-contrast MR imaging techniques are in development, but currently, DWI is closest to clinical integration, while others are still mostly used in the research setting.
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Affiliation(s)
- Jin You Kim
- Department of Radiology and Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Savannah C Partridge
- Department of Radiology, University of Washington, Seattle, WA, USA; Fred Hutchinson Cancer Center, Seattle, WA, USA.
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2
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Zuiani C, Mansutti I, Caronia G, Linda A, Londero V, Girometti R. Added value of the EUSOBI diffusion levels in breast MRI. Eur Radiol 2024; 34:3352-3363. [PMID: 37932389 PMCID: PMC11126436 DOI: 10.1007/s00330-023-10418-4] [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: 07/28/2023] [Revised: 09/04/2023] [Accepted: 09/21/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES To investigate whether using the diffusion levels (DLs) proposed by the European Society of Breast Imaging (EUSOBI) improves the diagnostic accuracy of breast MRI. MATERIALS AND METHODS This retrospective study included 145 women who, between September 2019 and June 2020, underwent breast 1.5-T MRI with DWI. Reader 1 and reader 2 (R1-R2) independently assessed breast lesions using the BI-RADS on dynamic contrast-enhanced imaging and T2-weighted imaging. DWI was subsequently disclosed, allowing readers able to measure lesions ADC and subjectively express the overall risk of malignancy on a 1-5 Likert scale. ADCs were interpreted as a range of values corresponding to the EUSOBI DLs. The analysis evaluated the inter-reader agreement in measuring ADC and DLs, the per-DL malignancy rate, and accuracy for malignancy using ROC analysis against histological examination or a 3-year follow-up. RESULTS Lesions were malignant and showed non-mass enhancement in 67.7% and 76.1% of cases, respectively. ADC was measurable in 63.2%/66.7% of lesions (R1/R2), with a minimal discrepancy on Bland-Altman analysis and 0.948 (95%CI 0.925-0.965)/0.989 (95%CI 0.988-0.991) intraclass correlation coefficient in measuring ADC/DLs. The malignancy rate (R1/R2) increased from 0.5/0.5% ("very high" DL) to 96.0/96.8% ("very low" DL), as expected. Likert categorization showed larger areas under the curve than the BI-RADS for both R1 (0.91 versus 0.87; p = 0.0208) and R2 (0.91 versus 0.89; p = 0.1171), with improved specificity (81.5% versus 78.5% for R1 and 84.4% versus 81.2% for R2). CONCLUSION Though ADC was not measurable in about one-third of lesions, DLs were categorized with excellent inter-reader agreement, improving the specificity for malignancy. CLINICAL RELEVANCE STATEMENT DLs proposed by the EUSOBI are a reproducible tool to interpret the ADC of breast lesions and, in turn, to improve the specificity of breast MRI and reduce unnecessary breast biopsies. KEY POINTS • The European Society of Breast Imaging proposed diffusion levels for the interpretation of the apparent diffusion coefficient in diffusion-weighted imaging of the breast. • Adding diffusion levels to the interpretation of magnetic resonance imaging improved the diagnostic accuracy for breast cancer, especially in terms of specificity. • Diffusion levels can favor a more widespread and standardized use of diffusion-weighted imaging of the breast.
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Affiliation(s)
- Chiara Zuiani
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria Della Misericordia, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Iris Mansutti
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria Della Misericordia, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Guido Caronia
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria Della Misericordia, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Anna Linda
- Institute of Radiology, University Hospital S. Maria Della Misericordia, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Viviana Londero
- Institute of Radiology, University Hospital S. Maria Della Misericordia, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria Della Misericordia, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy.
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3
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Skwierawska D, Laun FB, Wenkel E, Kapsner LA, Janka R, Uder M, Ohlmeyer S, Bickelhaupt S. Diffusion-Weighted Imaging for Skin Pathologies of the Breast-A Feasibility Study. Diagnostics (Basel) 2024; 14:934. [PMID: 38732348 PMCID: PMC11083106 DOI: 10.3390/diagnostics14090934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/19/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
Several breast pathologies can affect the skin, and clinical pathways might differ significantly depending on the underlying diagnosis. This study investigates the feasibility of using diffusion-weighted imaging (DWI) to differentiate skin pathologies in breast MRIs. This retrospective study included 88 female patients who underwent diagnostic breast MRI (1.5 or 3T), including DWI. Skin areas were manually segmented, and the apparent diffusion coefficients (ADCs) were compared between different pathologies: inflammatory breast cancer (IBC; n = 5), benign skin inflammation (BSI; n = 11), Paget's disease (PD; n = 3), and skin-involved breast cancer (SIBC; n = 11). Fifty-eight women had healthy skin (H; n = 58). The SIBC group had a significantly lower mean ADC than the BSI and IBC groups. These differences persisted for the first-order features of the ADC (mean, median, maximum, and minimum) only between the SIBC and BSI groups. The mean ADC did not differ significantly between the BSI and IBC groups. Quantitative DWI assessments demonstrated differences between various skin-affecting pathologies, but did not distinguish clearly between all of them. More extensive studies are needed to assess the utility of quantitative DWI in supplementing the diagnostic assessment of skin pathologies in breast imaging.
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Affiliation(s)
- Dominika Skwierawska
- Institute of Radiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany
| | - Frederik B. Laun
- Institute of Radiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany
| | - Evelyn Wenkel
- Radiologie München, Burgstraße 7, 80331 München, Germany
- Medical Faculty, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Lorenz A. Kapsner
- Institute of Radiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany
- Chair of Medical Informatics, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Wetterkreuz 15, 91058 Erlangen-Tennenlohe, Germany
| | - Rolf Janka
- Institute of Radiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany
| | - Michael Uder
- Institute of Radiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany
| | - Sabine Ohlmeyer
- Institute of Radiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany
| | - Sebastian Bickelhaupt
- Institute of Radiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany
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4
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Nguyen DL, Greenwood HI, Rahbar H, Grimm LJ. Evolving Treatment Paradigms for Low-Risk Ductal Carcinoma In Situ: Imaging Needs. AJR Am J Roentgenol 2024; 222:e2330503. [PMID: 38090808 DOI: 10.2214/ajr.23.30503] [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] [Indexed: 01/05/2024]
Abstract
Ductal carcinoma in situ (DCIS) is a nonobligate precursor to invasive cancer that classically presents as asymptomatic calcifications on screening mammography. The increase in DCIS diagnoses with organized screening programs has raised concerns about overdiagnosis, while a patientcentric push for more personalized care has increased awareness about DCIS overtreatment. The standard of care for most new DCIS diagnoses is surgical excision, but nonsurgical management via active monitoring is gaining attention, and multiple clinical trials are ongoing. Imaging, along with demographic and pathologic information, is a critical component of active monitoring efforts. Commonly used imaging modalities including mammography, ultrasound, and MRI, as well as newer modalities such as contrast-enhanced mammography and dedicated breast PET, can provide prognostic information to risk stratify patients for DCIS active monitoring eligibility. Furthermore, radiologists will be responsible for closely surveilling patients on active monitoring and identifying if invasive progression occurs. Active monitoring is a paradigm shift for DCIS care, but the success or failure will rely heavily on the interpretations and guidance of radiologists.
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Affiliation(s)
- Derek L Nguyen
- Department of Diagnostic Radiology, Duke University School of Medicine, Box 3808, Durham, NC 27710
| | - Heather I Greenwood
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | - Habib Rahbar
- Department of Radiology, University of Washington, Seattle, WA
- Fred Hutchinson Cancer Center, Seattle, WA
| | - Lars J Grimm
- Department of Diagnostic Radiology, Duke University School of Medicine, Box 3808, Durham, NC 27710
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5
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Hong M, Fan S, Yu Z, Gao C, Fang Z, Du L, Wang S, Chen X, Xu M, Zhou C. Evaluating Upstaging in Ductal Carcinoma In Situ Using Preoperative
MRI‐Based
Radiomics. J Magn Reson Imaging 2022. [DOI: 10.1002/jmri.28539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 11/12/2022] [Accepted: 11/14/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Minping Hong
- School of First Clinical Medicine Zhejiang Chinese Medical University Hangzhou China
- Department of Radiology Jiaxin TCM Hospital Affiliated to Zhejiang Chinese Medical University Zhejiang China
- Department of Radiology The First Affiliated Hospital of Zhejiang Chinese Medical University Zhejiang China
| | - Sijia Fan
- School of First Clinical Medicine Zhejiang Chinese Medical University Hangzhou China
- Department of Radiology The First Affiliated Hospital of Zhejiang Chinese Medical University Zhejiang China
- Department of Radiology, Affiliated Hangzhou First People's Hospital Zhejiang University School of Medicine Zhejiang China
| | - Zhexuan Yu
- School of First Clinical Medicine Zhejiang Chinese Medical University Hangzhou China
| | - Chen Gao
- School of First Clinical Medicine Zhejiang Chinese Medical University Hangzhou China
- Department of Radiology The First Affiliated Hospital of Zhejiang Chinese Medical University Zhejiang China
| | - Zhen Fang
- School of First Clinical Medicine Zhejiang Chinese Medical University Hangzhou China
- Department of Radiology The First Affiliated Hospital of Zhejiang Chinese Medical University Zhejiang China
| | - Liang Du
- School of First Clinical Medicine Zhejiang Chinese Medical University Hangzhou China
- Department of Radiology The First Affiliated Hospital of Zhejiang Chinese Medical University Zhejiang China
- Department of Radiology Hangzhou TCM Hospital of Zhejiang Chinese Medical University Zhejiang China
| | - Shiwei Wang
- School of First Clinical Medicine Zhejiang Chinese Medical University Hangzhou China
- Department of Radiology The First Affiliated Hospital of Zhejiang Chinese Medical University Zhejiang China
| | - Xiaobo Chen
- School of First Clinical Medicine Zhejiang Chinese Medical University Hangzhou China
- Department of Radiology The First Affiliated Hospital of Zhejiang Chinese Medical University Zhejiang China
| | - Maosheng Xu
- School of First Clinical Medicine Zhejiang Chinese Medical University Hangzhou China
- Department of Radiology The First Affiliated Hospital of Zhejiang Chinese Medical University Zhejiang China
| | - Changyu Zhou
- School of First Clinical Medicine Zhejiang Chinese Medical University Hangzhou China
- Department of Radiology The First Affiliated Hospital of Zhejiang Chinese Medical University Zhejiang China
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Grimm LJ, Rahbar H, Abdelmalak M, Hall AH, Ryser MD. Ductal Carcinoma in Situ: State-of-the-Art Review. Radiology 2021; 302:246-255. [PMID: 34931856 PMCID: PMC8805655 DOI: 10.1148/radiol.211839] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Ductal carcinoma in situ (DCIS) is a nonobligate precursor of invasive cancer, and its detection, diagnosis, and management are controversial. DCIS incidence grew with the expansion of screening mammography programs in the 1980s and 1990s, and DCIS is viewed as a major driver of overdiagnosis and overtreatment. For pathologists, the diagnosis and classification of DCIS is challenging due to undersampling and interobserver variability. Understanding the progression from normal breast tissue to DCIS and, ultimately, to invasive cancer is limited by a paucity of natural history data with multiple proposed evolutionary models of DCIS initiation and progression. Although radiologists are familiar with the classic presentation of DCIS as asymptomatic calcifications at mammography, the expanded pool of modalities, advanced imaging techniques, and image analytics have identified multiple potential biomarkers of histopathologic characteristics and prognosis. Finally, there is growing interest in the nonsurgical management of DCIS, including active surveillance, to reduce overtreatment and provide patients with more personalized management options. However, current biomarkers are not adept at enabling identification of occult invasive disease at biopsy or accurately predicting the risk of progression to invasive disease. Several active surveillance trials are ongoing and are expected to better identify women with low-risk DCIS who may avoid surgery.
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Affiliation(s)
- Lars J. Grimm
- From the Departments of Radiology (L.J.G.), Pathology (M.A., A.H.H.), and Population Health Sciences (M.D.R.), Duke University, 2301 Erwin Rd, Box 3808, Durham, NC 27710; and Department of Radiology, University of Washington, Seattle, Wash (H.R.)
| | - Habib Rahbar
- From the Departments of Radiology (L.J.G.), Pathology (M.A., A.H.H.), and Population Health Sciences (M.D.R.), Duke University, 2301 Erwin Rd, Box 3808, Durham, NC 27710; and Department of Radiology, University of Washington, Seattle, Wash (H.R.)
| | - Monica Abdelmalak
- From the Departments of Radiology (L.J.G.), Pathology (M.A., A.H.H.), and Population Health Sciences (M.D.R.), Duke University, 2301 Erwin Rd, Box 3808, Durham, NC 27710; and Department of Radiology, University of Washington, Seattle, Wash (H.R.)
| | - Allison H. Hall
- From the Departments of Radiology (L.J.G.), Pathology (M.A., A.H.H.), and Population Health Sciences (M.D.R.), Duke University, 2301 Erwin Rd, Box 3808, Durham, NC 27710; and Department of Radiology, University of Washington, Seattle, Wash (H.R.)
| | - Marc D. Ryser
- From the Departments of Radiology (L.J.G.), Pathology (M.A., A.H.H.), and Population Health Sciences (M.D.R.), Duke University, 2301 Erwin Rd, Box 3808, Durham, NC 27710; and Department of Radiology, University of Washington, Seattle, Wash (H.R.)
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7
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Mori N, Abe H, Mugikura S, Miyashita M, Mori Y, Oguma Y, Hirasawa M, Sato S, Takase K. Discriminating low-grade ductal carcinoma in situ (DCIS) from non-low-grade DCIS or DCIS upgraded to invasive carcinoma: effective texture features on ultrafast dynamic contrast-enhanced magnetic resonance imaging. Breast Cancer 2021; 28:1141-1153. [PMID: 33900583 DOI: 10.1007/s12282-021-01257-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 04/20/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE To investigate effective model composed of features from ultrafast dynamic contrast-enhanced magnetic resonance imaging (UF-MRI) for distinguishing low- from non-low-grade ductal carcinoma in situ (DCIS) lesions or DCIS lesions upgraded to invasive carcinoma (upgrade DCIS lesions) among lesions diagnosed as DCIS on pre-operative biopsy. MATERIALS AND METHODS Eighty-six consecutive women with 86 DCIS lesions diagnosed by biopsy underwent UF-MRI including pre- and 18 post-contrast ultrafast scans (temporal resolution of 3 s/phase). The last phase of UF-MRI was used to perform 3D segmentation. The time point at 6 s after the aorta started to enhance was used to obtain subtracted images. From the 3D segmentation and subtracted images, enhancement, shape, and texture features were calculated and compared between low- and non-low-grade or upgrade DCIS lesions using univariate analysis. Feature selection by least absolute shrinkage and selection operator (LASSO) algorithm and k-fold cross-validation were performed to evaluate the diagnostic performance. RESULTS Surgical specimens revealed 16 low-grade DCIS lesions, 37 non-low-grade lesions and 33 upgrade DCIS lesions. In univariate analysis, five shape and seven texture features were significantly different between low- and non-low-grade lesions or upgrade DCIS lesions, whereas enhancement features were not. The six features including surface/volume ratio, irregularity, diff variance, uniformity, sum average, and variance were selected using LASSO algorism and the mean area under the receiver operating characteristic curve for training and validation folds were 0.88 and 0.88, respectively. CONCLUSION The model with shape and texture features of UF-MRI could effectively distinguish low- from non-low-grade or upgrade DCIS lesions.
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Affiliation(s)
- Naoko Mori
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Seiryo 1-1, Sendai, 980-8574, Japan. .,Department of Radiology, The University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL, 60637, USA.
| | - Hiroyuki Abe
- Department of Radiology, The University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL, 60637, USA
| | - Shunji Mugikura
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Seiryo 1-1, Sendai, 980-8574, Japan.,Department of Image Statistics, Tohoku Medical Megabank Organization, Tohoku University, Seiryo 2-1, Sendai, 980-8574, Japan
| | - Minoru Miyashita
- Department of Surgical Oncology, Tohoku University Graduate School of Medicine, Seiryo 1-1, Sendai, 980-8574, Japan
| | - Yu Mori
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Seiryo 1-1, Sendai, 980-8574, Japan
| | - Yo Oguma
- Tohoku University School of Medicine, Seiryo 1-1, Sendai, 980-8574, Japan
| | - Minami Hirasawa
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Seiryo 1-1, Sendai, 980-8574, Japan
| | - Satoko Sato
- Department of Anatomic Pathology, Tohoku University Graduate School of Medicine, Seiryo 1-1, Sendai, 980-8574, Japan
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Seiryo 1-1, Sendai, 980-8574, Japan
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Clauser P, Krug B, Bickel H, Dietzel M, Pinker K, Neuhaus VF, Marino MA, Moschetta M, Troiano N, Helbich TH, Baltzer PAT. Diffusion-weighted Imaging Allows for Downgrading MR BI-RADS 4 Lesions in Contrast-enhanced MRI of the Breast to Avoid Unnecessary Biopsy. Clin Cancer Res 2021; 27:1941-1948. [PMID: 33446565 PMCID: PMC8406278 DOI: 10.1158/1078-0432.ccr-20-3037] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/13/2020] [Accepted: 01/06/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE Diffusion-weighted imaging with the calculation of an apparent diffusion coefficient (ADC) has been proposed as a quantitative biomarker on contrast-enhanced MRI (CE-MRI) of the breast. There is a need to approve a generalizable ADC cutoff. The purpose of this study was to evaluate whether a predefined ADC cutoff allows downgrading of BI-RADS 4 lesions on CE-MRI, avoiding unnecessary biopsies. EXPERIMENTAL DESIGN This was a retrospective, multicentric, cross-sectional study. Data from five centers were pooled on the individual lesion level. Eligible patients had a BI-RADS 4 rating on CE-MRI. For each center, two breast radiologists evaluated the images. Data on lesion morphology (mass, non-mass), size, and ADC were collected. Histology was the standard of reference. A previously suggested ADC cutoff (≥1.5 × 10-3 mm2/second) was applied. A negative likelihood ratio of 0.1 or lower was considered as a rule-out criterion for breast cancer. Diagnostic performance indices were calculated by ROC analysis. RESULTS There were 657 female patients (mean age, 42; SD, 14.1) with 696 BI-RADS 4 lesions included. Disease prevalence was 59.5% (414/696). The area under the ROC curve was 0.784. Applying the investigated ADC cutoff, sensitivity was 96.6% (400/414). The potential reduction of unnecessary biopsies was 32.6% (92/282). CONCLUSIONS An ADC cutoff of ≥1.5 × 10-3 mm2/second allows downgrading of lesions classified as BI-RADS 4 on breast CE-MRI. One-third of unnecessary biopsies could thus be avoided.
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Affiliation(s)
- Paola Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Barbara Krug
- Department of Diagnostical and Interventional Radiology, University Hospital Cologne, Cologne, Germany
| | - Hubert Bickel
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Matthias Dietzel
- Department of Radiology, Friedrich-Alexander-University Hospital Erlangen-Nürnberg, Erlangen, Germany
| | - Katja Pinker
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Victor-Frederic Neuhaus
- Department of Diagnostical and Interventional Radiology, University Hospital Cologne, Cologne, Germany
| | - Maria Adele Marino
- Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico Universitario G. Martino, University of Messina, Messina, Italy
| | - Marco Moschetta
- DETO Breast Care Unit, University of Bari Medical School, Bari, Italy
| | - Nicoletta Troiano
- DETO Breast Care Unit, University of Bari Medical School, Bari, Italy
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Pascal A T Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria.
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9
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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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10
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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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11
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Intravoxel incoherent motion magnetic resonance imaging: basic principles and clinical applications. Pol J Radiol 2020; 85:e624-e635. [PMID: 33376564 PMCID: PMC7757509 DOI: 10.5114/pjr.2020.101476] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 06/03/2020] [Indexed: 12/26/2022] Open
Abstract
The purpose of this article was to show basic principles, acquisition, advantages, disadvantages, and clinical applications of intravoxel incoherent motion (IVIM) magnetic resonance imaging (MRI). IVIM MRI as a method was introduced in the late 1980s, but recently it started attracting more interest thanks to its applications in many fields, particularly in oncology and neuroradiology. This imaging technique has been developed with the objective of obtaining not only a functional analysis of different organs but also different types of lesions. Among many accessible tools in diagnostic imaging, IVIM MRI aroused the interest of many researchers in terms of studying its applicability in the evaluation of abdominal organs and diseases. The major conclusion of this article is that IVIM MRI seems to be a very auspicious method to investigate the human body, and that nowadays the most promising clinical application for IVIM perfusion MRI is oncology. However, due to lack of standardisation of image acquisition and analysis, further studies are needed to validate this method in clinical practice.
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12
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A multiparametric approach to diagnosing breast lesions using diffusion-weighted imaging and ultrafast dynamic contrast-enhanced MRI. Magn Reson Imaging 2020; 71:154-160. [DOI: 10.1016/j.mri.2020.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 02/06/2020] [Accepted: 04/12/2020] [Indexed: 12/30/2022]
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13
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Kishimoto AO, Kataoka M, Iima M, Honda M, Miyake KK, Ohashi A, Ota R, Kataoka T, Sakurai T, Toi M, Togashi K. Evaluation of Malignant Breast Lesions Using High-resolution Readout-segmented Diffusion-weighted Echo-planar Imaging: Comparison with Pathology. Magn Reson Med Sci 2020; 20:204-215. [PMID: 32611938 PMCID: PMC8203479 DOI: 10.2463/mrms.mp.2020-0021] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
PURPOSE We aimed to investigate the performance of high resolution-diffusion-weighted imaging (HR-DWI) using readout-segmented echo-planar imaging in visualizing malignant breast lesions and evaluating their extent, using pathology as a reference. METHODS This retrospective study included patients who underwent HR-DWI with surgically confirmed malignant breast lesions. Two radiologists blinded to the final diagnosis evaluated HR-DWI independently and identified the lesions, measuring their maximum diameters. Another radiologist confirmed if those lesions were identical to the pathology. The maximum diameters of the lesions between HR-DWI and pathology were compared, and their correlations were calculated using Spearman's correlation coefficient. Apparent diffusion coefficient (ADC) values of the lesions were measured. RESULTS Ninety-five mass/64 non-mass lesions were pathologically confirmed in 104 females. Both radiologists detected the same 93 mass lesions (97.9%). Spearman's correlation coefficient for mass lesions were 0.89 and 0.90 (P < 0.0001 and 0001) for the two radiologists, respectively. The size differences within 10 mm were 90.3% (84/93) and 94.6% (88/93) respectively. One radiologist detected 35 non-mass lesions (54.7%) and another radiologist detected 32 non-mass lesions (50.0%), of which 28 lesions were confirmed as identical. Spearman's correlation coefficient for non-mass lesions were 0.59 and 0.22 (P = 0.0002 and 0.22), respectively. The mean ADC value of mass lesions and non-mass lesions were 0.80 and 0.89 × 10-3 mm2/s, respectively. CONCLUSION Using HR-DWI, malignant mass lesions were depicted with excellent agreement with the pathological evaluation. Approximately half of the non-mass lesions could not be identified, suggesting a current limitation of HR-DWI.
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Affiliation(s)
- Ayami Ohno Kishimoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University
| | - Masako Kataoka
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University
| | - Mami Iima
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University.,Institute for Advancement of Clinical and Translational Science (iACT), Kyoto University Hospital
| | - Maya Honda
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University
| | - Kanae Kawai Miyake
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University
| | - Akane Ohashi
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University
| | - Rie Ota
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University
| | - Tatsuki Kataoka
- Department of Diagnostic Pathology, Kyoto University Hospital
| | - Takaki Sakurai
- Department of Diagnostic Pathology, Kyoto University Hospital
| | - Masakazu Toi
- Department of Breast Surgery, Kyoto University Hospital
| | - Kaori Togashi
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University
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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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Fujiwara S, Mori Y, de la Mora DM, Akamatsu Y, Yoshida K, Shibata Y, Masuda T, Ogasawara K, Yoshioka Y. Feasibility of IVIM parameters from diffusion-weighted imaging at 11.7T MRI for detecting ischemic changes in common carotid artery occlusion rats. Sci Rep 2020; 10:8404. [PMID: 32439877 PMCID: PMC7242437 DOI: 10.1038/s41598-020-65310-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 05/01/2020] [Indexed: 12/14/2022] Open
Abstract
This study aimed to investigate whether intravoxel incoherent motion (IVIM) parameters can identify ischemic changes in the rat cerebral cortex using a preclinical ultra-high-field 11.7 Tesla magnetic resonance imaging (11.7TMRI) scanner. In nine female Wistar rats (eight weeks old), diffusion-weighted imaging (DWI) for IVIM analysis was successfully performed before (Pre) and after unilateral (UCCAO) and bilateral (BCCAO) common carotid artery occlusion. From the acquired DWI signals averaged in six regions of interest (ROI) placed on the cortex, volume fraction of perfusion compartment (F), pseudo diffusion coefficient (D*), F × D* and apparent diffusion coefficient (ADC) were determined as IVIM parameters in the following three DWI signal models: the bi-exponential, kurtosis, and tri-exponential model. For a subgroup analysis, four rats that survived two weeks after BCCAO were assigned to the long survival (LS) group, whereas the non-LS group consisted of the remaining five animals. Each IVIM parameter change among three phases (Pre, UCCAO and BCCAO) was statistically examined in each ROI. Then, the change in each rat group was also examined for subgroup analysis. All three models were able to identify cerebral ischemic change and damage as IVIM parameter change among three phases. Furthermore, the kurtosis model could identify the parameter changes in more regions than the other two models. In the subgroup analysis with the kurtosis model, ADC in non-LS group significantly decreased between UCCAO and BCCAO but not in LS group. IVIM parameters at 11.7TMRI may help us to detect the subtle ischemic change; in particular, with the kurtosis model.
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Affiliation(s)
- Shunrou Fujiwara
- Department of Neurosurgery, Iwate Medical University, 1-1-1 Idaidori, Yahaba, Iwate, 028-3694, Japan. .,Graduate School of Frontier Science, Osaka University, 3-1 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Yuki Mori
- Center for Translational Neuromedicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | | | - Yosuke Akamatsu
- Department of Neurosurgery, Iwate Medical University, 1-1-1 Idaidori, Yahaba, Iwate, 028-3694, Japan
| | - Kenji Yoshida
- Department of Neurosurgery, Iwate Medical University, 1-1-1 Idaidori, Yahaba, Iwate, 028-3694, Japan
| | - Yuji Shibata
- Department of Pathology, Iwate Medical University, 1-1-1 Idaidori, Yahaba, Iwate, 028-3694, Japan
| | - Tomoyuki Masuda
- Department of Pathology, Iwate Medical University, 1-1-1 Idaidori, Yahaba, Iwate, 028-3694, Japan
| | - Kuniaki Ogasawara
- Department of Neurosurgery, Iwate Medical University, 1-1-1 Idaidori, Yahaba, Iwate, 028-3694, Japan
| | - Yoshichika Yoshioka
- Graduate School of Frontier Science, Osaka University, 3-1 Yamadaoka, Suita, Osaka, 565-0871, Japan.,Center for Information and Neural Networks (CiNet), NICT and Osaka University, 3-1 Yamadaoka, Suita, Osaka, 565-0871, Japan
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16
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Pesapane F, Suter MB, Rotili A, Penco S, Nigro O, Cremonesi M, Bellomi M, Jereczek-Fossa BA, Pinotti G, Cassano E. Will traditional biopsy be substituted by radiomics and liquid biopsy for breast cancer diagnosis and characterisation? Med Oncol 2020; 37:29. [PMID: 32180032 DOI: 10.1007/s12032-020-01353-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 02/26/2020] [Indexed: 02/06/2023]
Abstract
The diagnosis of breast cancer currently relies on radiological and clinical evaluation, confirmed by histopathological examination. However, such approach has some limitations as the suboptimal sensitivity, the long turnaround time for recall tests, the invasiveness of the procedure and the risk that some features of target lesions may remain undetected, making re-biopsy a necessity. Recent technological advances in the field of artificial intelligence hold promise in addressing such medical challenges not only in cancer diagnosis, but also in treatment assessment, and monitoring of disease progression. In the perspective of a truly personalised medicine, based on the early diagnosis and individually tailored treatments, two new technologies, namely radiomics and liquid biopsy, are rising as means to obtain information from diagnosis to molecular profiling and response assessment, without the need of a biopsied tissue sample. Radiomics works through the extraction of quantitative peculiar features of cancer from radiological data, while liquid biopsy gets the whole of the malignancy's biology from something as easy as a blood sample. Both techniques hopefully will identify diagnostic and prognostic information of breast cancer potentially reducing the need for invasive (and often difficult to perform) biopsies and favouring an approach that is as personalised as possible for each patient. Nevertheless, such techniques will not substitute tissue biopsy in the near future, and even in further times they will require the aid of other parameters to be correctly interpreted and acted upon.
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Affiliation(s)
- Filippo Pesapane
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Via Giuseppe Ripamonti, 435, 20141, Milan, MI, Italy.
| | | | - Anna Rotili
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Via Giuseppe Ripamonti, 435, 20141, Milan, MI, Italy
| | - Silvia Penco
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Via Giuseppe Ripamonti, 435, 20141, Milan, MI, Italy
| | - Olga Nigro
- Medical Oncology, ASST Sette Laghi, Viale Borri 57, 21100, Varese, VA, Italy
| | - Marta Cremonesi
- Radiation Research Unit, IEO European Institute of Oncology IRCCS, Via Giuseppe Ripamonti, 435, 20141, Milan, MI, Italy
| | - Massimo Bellomi
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Department of Radiology, IEO European Institute of Oncology IRCCS, Via Giuseppe Ripamonti, 435, 20141, Milan, MI, Italy
| | - Barbara Alicja Jereczek-Fossa
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Department of Radiation Oncology, IEO European Institute of Oncology IRCCS, Via Giuseppe Ripamonti, 435, 20141, Milan, MI, Italy
| | - Graziella Pinotti
- Medical Oncology, ASST Sette Laghi, Viale Borri 57, 21100, Varese, VA, Italy
| | - Enrico Cassano
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Via Giuseppe Ripamonti, 435, 20141, Milan, MI, Italy
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Mori N, Mugikura S, Miyashita M, Mori Y, Maekawa Y, Nagasaka T, Takase K. Turbo Spin-echo Diffusion-weighted Imaging Compared with Single-shot Echo-planar Diffusion-weighted Imaging: Image Quality and Diagnostic Performance When Differentiating between Ductal Carcinoma in situ and Invasive Ductal Carcinoma. Magn Reson Med Sci 2020; 20:60-68. [PMID: 32147641 PMCID: PMC7952202 DOI: 10.2463/mrms.mp.2019-0195] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Purpose: To compare the image quality between turbo spin-echo (TSE)-diffusion weighted imaging (DWI) and single-shot echo-planar imaging (EPI)-DWI, and to verify the diagnostic performance of the apparent diffusion coefficient (ADC) parameters of the two techniques by using histogram analysis in terms of differentiation between ductal carcinoma in situ (DCIS) and invasive ductal carcinoma (IDC) lesions. Methods: Ninety-four women with 94 lesions diagnosed as breast cancer by surgery underwent IRB-approved preoperative magnetic resonance imaging, including TSE and EPI-DWI with b-values of 50 and 850 s/mm2. Twenty lesions were identified as DCIS and 74 as IDC. Image quality [signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and geometric distortion] was evaluated quantitatively and compared between the TSE and EPI-DWI. A histogram analysis of the entire tumor voxel-based ADC data was performed, and the 10th, 25th, 50th, 75th, and 90th percentile values of each technique were compared between DCIS and IDC lesions. Results: The SNR and CNR of TSE-DWI were significantly higher than those of EPI-DWI (P < 0.0001 and < 0.0001). The geometric distortion of TSE-DWI was significantly lower than that of EPI-DWI (P < 0.0001). In TSE-DWI, the 10th, 25th, 50th, and 75th percentile values were significantly different between the DCIS and IDC lesions (P = 0.0010, 0.0004, 0.0008, and 0.0044, respectively). In EPI-DWI, the 50th and 75th percentile values were significantly different between the two groups (P = 0.0009 and 0.0093). There was no significant difference in the area under the curve of the receiver operating characteristic analysis of the 10th, 25th, 50th, and 75th percentile values of TSE-DWI, and the 50th and 75th percentile values of EPI-DWI (P = 0.29). Conclusion: The image quality of TSE-DWI was better than that of EPI-DWI. DCIS lesions were distinguished from IDC lesions with a wider range of percentile values in TSE-DWI than in EPI-DWI, although diagnostic performance was not significantly different between the techniques.
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Affiliation(s)
- Naoko Mori
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine
| | - Shunji Mugikura
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine
| | - Minoru Miyashita
- Department of Surgical Oncology, Tohoku University Graduate School of Medicine
| | - Yu Mori
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine
| | - Yui Maekawa
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine
| | - Tatsuo Nagasaka
- Department of Radiological Technology, Tohoku University Graduate School of Medicine
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine
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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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Baltzer P, Mann RM, Iima M, Sigmund EE, Clauser P, Gilbert FJ, Martincich L, Partridge SC, Patterson A, Pinker K, Thibault F, Camps-Herrero J, Le Bihan D. Diffusion-weighted imaging of the breast-a consensus and mission statement from the EUSOBI International Breast Diffusion-Weighted Imaging working group. Eur Radiol 2019; 30:1436-1450. [PMID: 31786616 PMCID: PMC7033067 DOI: 10.1007/s00330-019-06510-3] [Citation(s) in RCA: 233] [Impact Index Per Article: 46.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 09/03/2019] [Accepted: 10/10/2019] [Indexed: 01/03/2023]
Abstract
The European Society of Breast Radiology (EUSOBI) established an International Breast DWI working group. The working group consists of clinical breast MRI experts, MRI physicists, and representatives from large vendors of MRI equipment, invited based upon proven expertise in breast MRI and/or in particular breast DWI, representing 25 sites from 16 countries. The aims of the working group are (a) to promote the use of breast DWI into clinical practice by issuing consensus statements and initiate collaborative research where appropriate; (b) to define necessary standards and provide practical guidance for clinical application of breast DWI; (c) to develop a standardized and translatable multisite multivendor quality assurance protocol, especially for multisite research studies; (d) to find consensus on optimal methods for image processing/analysis, visualization, and interpretation; and (e) to work collaboratively with system vendors to improve breast DWI sequences. First consensus recommendations, presented in this paper, include acquisition parameters for standard breast DWI sequences including specifications of b values, fat saturation, spatial resolution, and repetition and echo times. To describe lesions in an objective way, levels of diffusion restriction/hindrance in the breast have been defined based on the published literature on breast DWI. The use of a small ROI placed on the darkest part of the lesion on the ADC map, avoiding necrotic, noisy or non-enhancing lesion voxels is currently recommended. The working group emphasizes the need for standardization and quality assurance before ADC thresholds are applied. The working group encourages further research in advanced diffusion techniques and tailored DWI strategies for specific indications. Key Points • The working group considers breast DWI an essential part of a multiparametric breast MRI protocol and encourages its use. • Basic requirements for routine clinical application of breast DWI are provided, including recommendations on b values, fat saturation, spatial resolution, and other sequence parameters. • Diffusion levels in breast lesions are defined based on meta-analysis data and methods to obtain a reliable ADC value are detailed.
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Affiliation(s)
- Pascal Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna/Vienna General Hospital, Wien, Austria
| | - Ritse M Mann
- Department of Radiology, Radboud University Medical Centre, Nijmegen, Netherlands. .,Department of Radiology, The Netherlands Cancer Institute, Amsterdam, Netherlands.
| | - Mami Iima
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Eric E Sigmund
- Department of Radiology, New York University School of Medicine, NYU Langone Health, Ney York, NY, 10016, USA
| | - Paola Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna/Vienna General Hospital, Wien, Austria
| | - Fiona J Gilbert
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | | | - Savannah C Partridge
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Andrew Patterson
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Katja Pinker
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna/Vienna General Hospital, Wien, Austria.,MSKCC, New York, NY, 10065, USA
| | | | | | - Denis Le Bihan
- NeuroSpin, Frédéric Joliot Institute, Gif Sur Yvette, France
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Greenwood HI, Wilmes LJ, Kelil T, Joe BN. Role of Breast MRI in the Evaluation and Detection of DCIS: Opportunities and Challenges. J Magn Reson Imaging 2019; 52:697-709. [PMID: 31746088 DOI: 10.1002/jmri.26985] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 10/15/2019] [Accepted: 10/16/2019] [Indexed: 12/29/2022] Open
Abstract
Historically, breast magnetic resonance imaging (MRI) was not considered an effective modality in the evaluation of ductal carcinoma in situ (DCIS). Over the past decade this has changed, with studies demonstrating that MRI is the most sensitive imaging tool for detection of all grades of DCIS. It has been suggested that not only is breast MRI the most sensitive imaging tool for detection but it may also detect the most clinically relevant DCIS lesions. The role and outcomes of MRI in the preoperative setting for patients with DCIS remains controversial; however, several studies have shown benefit in the preoperative evaluation of extent of disease as well as predicting an underlying invasive component. The most common presentation of DCIS on MRI is nonmass enhancement (NME) in a linear or segmental distribution pattern. Maximizing breast MRI spatial resolution is therefore beneficial, given the frequent presentation of DCIS as NME on MRI. Emerging MRI techniques, such as diffusion-weighted imaging (DWI), have shown promising potential to discriminate DCIS from benign and invasive lesions. Future opportunities including advanced imaging visual techniques, radiomics/radiogenomics, and machine learning / artificial intelligence may also be applicable to the detection and treatment of DCIS. Level of Evidence: 3 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2019. J. Magn. Reson. Imaging 2020;52:697-709.
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Affiliation(s)
- Heather I Greenwood
- University of California San Francisco, Department of Radiology and Biomedical Imaging, San Francisco, California, USA
| | - Lisa J Wilmes
- University of California San Francisco, Department of Radiology and Biomedical Imaging, San Francisco, California, USA
| | - Tatiana Kelil
- University of California San Francisco, Department of Radiology and Biomedical Imaging, San Francisco, California, USA
| | - Bonnie N Joe
- University of California San Francisco, Department of Radiology and Biomedical Imaging, San Francisco, California, USA
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Surov A, Meyer HJ, Wienke A. Can apparent diffusion coefficient (ADC) distinguish breast cancer from benign breast findings? A meta-analysis based on 13 847 lesions. BMC Cancer 2019; 19:955. [PMID: 31615463 PMCID: PMC6794799 DOI: 10.1186/s12885-019-6201-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 09/24/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The purpose of the present meta-analysis was to provide evident data about use of Apparent Diffusion Coefficient (ADC) values for distinguishing malignant and benign breast lesions. METHODS MEDLINE library and SCOPUS database were screened for associations between ADC and malignancy/benignancy of breast lesions up to December 2018. Overall, 123 items were identified. The following data were extracted from the literature: authors, year of publication, study design, number of patients/lesions, lesion type, mean value and standard deviation of ADC, measure method, b values, and Tesla strength. The methodological quality of the 123 studies was checked according to the QUADAS-2 instrument. The meta-analysis was undertaken by using RevMan 5.3 software. DerSimonian and Laird random-effects models with inverse-variance weights were used without any further correction to account for the heterogeneity between the studies. Mean ADC values including 95% confidence intervals were calculated separately for benign and malign lesions. RESULTS The acquired 123 studies comprised 13,847 breast lesions. Malignant lesions were diagnosed in 10,622 cases (76.7%) and benign lesions in 3225 cases (23.3%). The mean ADC value of the malignant lesions was 1.03 × 10- 3 mm2/s and the mean value of the benign lesions was 1.5 × 10- 3 mm2/s. The calculated ADC values of benign lesions were over the value of 1.00 × 10- 3 mm2/s. This result was independent on Tesla strength, choice of b values, and measure methods (whole lesion measure vs estimation of ADC in a single area). CONCLUSION An ADC threshold of 1.00 × 10- 3 mm2/s can be recommended for distinguishing breast cancers from benign lesions.
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Affiliation(s)
- Alexey Surov
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany. .,Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
| | - Hans Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Magdeburger Str. 8, 06097, Halle, Germany
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Shehata M, Grimm L, Ballantyne N, Lourenco A, Demello LR, Kilgore MR, Rahbar H. Ductal Carcinoma in Situ: Current Concepts in Biology, Imaging, and Treatment. JOURNAL OF BREAST IMAGING 2019; 1:166-176. [PMID: 31538141 DOI: 10.1093/jbi/wbz039] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Indexed: 12/27/2022]
Abstract
Ductal carcinoma in situ (DCIS) of the breast is a group of heterogeneous epithelial proliferations confined to the milk ducts that nearly always present in asymptomatic women on breast cancer screening. A stage 0, preinvasive breast cancer, increased detection of DCIS was initially hailed as a means to prevent invasive breast cancer through surgical treatment with adjuvant radiation and/or endocrine therapies. However, controversy in the medical community has emerged in the past two decades that a fraction of DCIS represents overdiagnosis, leading to unnecessary treatments and resulting morbidity. The imaging hallmarks of DCIS include linearly or segmentally distributed calcifications on mammography or nonmass enhancement on breast MRI. Imaging features have been shown to reflect the biological heterogeneity of DCIS lesions, with recent studies indicating MRI may identify a greater fraction of higher-grade lesions than mammography does. There is strong interest in the surgical, imaging, and oncology communities to better align DCIS management with biology, which has resulted in trials of active surveillance and therapy that is less aggressive. However, risk stratification of DCIS remains imperfect, which has limited the development of precision therapy approaches matched to DCIS aggressiveness. Accordingly, there are opportunities for breast imaging radiologists to assist the oncology community by leveraging advanced imaging techniques to identify appropriate patients for the less aggressive DCIS treatments.
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Affiliation(s)
- Mariam Shehata
- University of Washington School of Medicine, Department of Radiology, Seattle, WA
| | - Lars Grimm
- Duke University Medical School, Department of Radiology, Durham, NC
| | - Nancy Ballantyne
- Duke University Medical School, Department of Radiology, Durham, NC
| | - Ana Lourenco
- Brown University Medical School, Department of Radiology, Providence, RI
| | - Linda R Demello
- Brown University Medical School, Department of Radiology, Providence, RI
| | - Mark R Kilgore
- University of Washington School of Medicine, Department of Anatomic Pathology, Seattle, WA.,Seattle Cancer Care Alliance, Seattle, WA
| | - Habib Rahbar
- University of Washington School of Medicine, Department of Radiology, Seattle, WA.,Seattle Cancer Care Alliance, Seattle, WA
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Cui X, Chen H, Cai S, Tang Q, Fang X. Correlation of apparent diffusion coefficient and intravoxel incoherent motion imaging parameters with Ki-67 expression in extrahepatic cholangiocarcinoma. Magn Reson Imaging 2019; 63:80-84. [PMID: 31425800 DOI: 10.1016/j.mri.2019.08.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 07/22/2019] [Accepted: 08/15/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE To investigate the correlation of magnetic resonance imaging (MRI), apparent diffusion coefficient (ADC) and intravoxel incoherent motion imaging parameters with Ki-67 expression in cholangiocarcinoma. METHODS A total of 42 extrahepatic cholangiocarcinoma (EHCC) cases confirmed by surgical pathology were analyzed retrospectively. Subjects underwent MRI at 3.0 T and intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) sequential scanning prior to surgery, and postoperative Ki-67 expression was recorded by immunohistochemistry (IHC). The patients were divided into 4 groups (I-IV) based on increasing Ki-67 expression from - to +++. ADC values and IVIM-DWI parameters were calculated, including true diffusion coefficient (D), perfusion fraction (f), and pseudo-diffusion coefficient (D*). The comparison among groups was analyzed by univariate ANOVA (normal distribution) or Kruskal-Wallis H (non-normal distribution). Spearman correlation analysis was used to analyze the correlation of each parameter with Ki-67 expression. The diagnostic efficiency of each parameter was compared using the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. RESULTS Except for D*, other values had statistically significant differences between groups (P < 0.05). ADC, D and f values had negative correlations with Ki-67 expression (r values were -0.607, -0.795, -0.531, respectively, P < 0.05). The AUCs were 0.701, 0.880, 0.623, respectively (P < 0.0001). CONCLUSION IVIM-DWI technology can reflect the proliferative activity of EHCC cells to a certain extent, and has clinical value for predicting the degree of malignancy of a tumor.
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Affiliation(s)
- Xingyu Cui
- Department of Radiology, Wuxi People's Hospital, Nanjing Medical University, Wuxi, Jiangsu Province, China
| | - Hongwei Chen
- Department of Radiology, Wuxi People's Hospital, Nanjing Medical University, Wuxi, Jiangsu Province, China.
| | - Song Cai
- Department of Radiology, Traditional Chinese Medicine Hospital of Wuxi City, Wuxi, Jiangsu Province, China
| | - Qunfeng Tang
- Department of Radiology, Wuxi People's Hospital, Nanjing Medical University, Wuxi, Jiangsu Province, China
| | - Xiangming Fang
- Department of Radiology, Wuxi People's Hospital, Nanjing Medical University, Wuxi, Jiangsu Province, China
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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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Nissan N, Furman-Haran E, Allweis T, Menes T, Golan O, Kent V, Barsuk D, Paluch-Shimon S, Haas I, Brodsky M, Bordsky A, Granot LF, Halshtok-Neiman O, Faermann R, Shalmon A, Gotlieb M, Konen E, Sklair-Levy M. Noncontrast Breast MRI During Pregnancy Using Diffusion Tensor Imaging: A Feasibility Study. J Magn Reson Imaging 2018; 49:508-517. [DOI: 10.1002/jmri.26228] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 06/01/2018] [Indexed: 01/09/2023] Open
Affiliation(s)
- Noam Nissan
- Department of Radiology; Sheba Medical Center; Israel
- Sackler School of Medicine; Tel Aviv University; Israel
| | - Edna Furman-Haran
- Department of Biological Services; Weizmann Institute of Science; Israel
| | - Tanir Allweis
- Department of General Surgery; Kaplan Medical Center; Israel
| | - Tehillah Menes
- Department of General Surgery; Souraski Medical Center; Israel
| | - Orit Golan
- Department of Radiology; Souraski Medical Center; Israel
| | - Varda Kent
- Department of Radiology; Assaf Harofeh Medical Center; Israel
| | - Daphna Barsuk
- Department of General Surgery; Assuta Medical Center; Israel
| | | | - Ilana Haas
- Department of General Surgery; Meir Medical Center; Israel
| | - Malka Brodsky
- Meirav Center of Breast Care, Sheba Medical Center; Israel
| | - Asia Bordsky
- Department of General Surgery; Bnai Zion Medical Center; Israel
| | | | - Osnat Halshtok-Neiman
- Department of Radiology; Sheba Medical Center; Israel
- Sackler School of Medicine; Tel Aviv University; Israel
| | - Renata Faermann
- Department of Radiology; Sheba Medical Center; Israel
- Sackler School of Medicine; Tel Aviv University; Israel
| | - Anat Shalmon
- Department of Radiology; Sheba Medical Center; Israel
- Sackler School of Medicine; Tel Aviv University; Israel
| | - Michael Gotlieb
- Department of Radiology; Sheba Medical Center; Israel
- Sackler School of Medicine; Tel Aviv University; Israel
| | - Eli Konen
- Department of Radiology; Sheba Medical Center; Israel
- Sackler School of Medicine; Tel Aviv University; Israel
| | - Miri Sklair-Levy
- Department of Radiology; Sheba Medical Center; Israel
- Sackler School of Medicine; Tel Aviv University; Israel
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Amornsiripanitch N, Lam DL, Rahbar H. Advances in Breast MRI in the Setting of Ductal Carcinoma In Situ. Semin Roentgenol 2018; 53:261-269. [PMID: 30449344 DOI: 10.1053/j.ro.2018.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Diana L Lam
- University of Washington, Seattle Cancer Care Alliance, Seattle, WA.
| | - Habib Rahbar
- University of Washington, Seattle Cancer Care Alliance, Seattle, WA.
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Kim JY, Kim JJ, Lee JW, Lee NK, Lee G, Kang T, Park H, Son YH, Grimm R. Risk stratification of ductal carcinoma in situ using whole-lesion histogram analysis of the apparent diffusion coefficient. Eur Radiol 2018; 29:485-493. [PMID: 30073498 DOI: 10.1007/s00330-018-5666-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 07/01/2018] [Accepted: 07/13/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To investigate the value of the whole-lesion histogram apparent diffusion coefficient (ADC) metrics for differentiating low-risk from non-low-risk ductal carcinoma in situ (DCIS). METHODS The authors identified 93 women with pure DCIS who had undergone preoperative MR imaging and diffusion-weighted imaging from 2013 to 2016. Histogram analysis of pixel-based ADC data of the whole tumour volume was performed by two radiologists using a software tool. The results were compared between low-risk and non-low-risk DCIS. Associations between quantitative ADC metrics and low-risk DCIS were evaluated by receiver operating characteristics (ROC) curve and logistic regression analyses. RESULTS In whole-lesion histogram analysis, mean ADC and 5th, 50th and 95th percentiles of ADC were significantly different between low-risk and non-low-risk DCIS (1.522, 1.207, 1.536 and 1.854 × 10-3 mm2/s versus 1.270, 0.917, 1.261 and 1.657 × 10-3 mm2/s, respectively; p = .004, p = .003, p = .004 and p = .024, respectively). ROC curve analysis for differentiating low-risk DCIS revealed that 5th percentile ADC yielded the largest area under the curve (0.786) among the metrics of whole-lesion histogram, and the optimal cut-off point was 1.078 × 10-3 mm2/s (sensitivity 80%, specificity 75.9%, p = .001). Multivariate regression analysis revealed that a high 5th percentile of ADC (> 1.078× 10-3 mm2/s; odds ratio [OR] = 10.494, p = .016), small tumour size (≤ 2 cm; OR = 12.692, p = .008) and low Ki-67 status (< 14%; OR = 10.879, p = .046) were significantly associated with low-risk DCIS. CONCLUSIONS Assessment with whole-lesion histogram analysis of the ADC could be helpful for identifying patients with low-risk DCIS. KEY POINTS • Whole-lesion histogram ADC metrics could be helpful for differentiating low-risk from non-low-risk DCIS. • A high 5th percentile ADC was a significant factor associated with low-risk DCIS. • Risk stratification of DCIS is important for their management.
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Affiliation(s)
- Jin You Kim
- Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, 1-10, Ami-Dong, Seo-gu, Busan, 602-739, Republic of Korea. .,Medical Research Institute, Pusan National University School of Medicine, Busan, Republic of Korea.
| | - Jin Joo Kim
- Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, 1-10, Ami-Dong, Seo-gu, Busan, 602-739, Republic of Korea
| | - Ji Won Lee
- Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, 1-10, Ami-Dong, Seo-gu, Busan, 602-739, Republic of Korea
| | - Nam Kyung Lee
- Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, 1-10, Ami-Dong, Seo-gu, Busan, 602-739, Republic of Korea
| | - Geewon Lee
- Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, 1-10, Ami-Dong, Seo-gu, Busan, 602-739, Republic of Korea
| | - Taewoo Kang
- Busan Cancer Center, Pusan National University Hospital, Busan, Republic of Korea
| | - Heesung Park
- Busan Cancer Center, Pusan National University Hospital, Busan, Republic of Korea
| | | | - Robert Grimm
- Siemens Healthineers, MR Application Predevelopment, Erlangen, Germany
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Mohamed RE, Zytoon HA, Amin MA. Diagnostic interplay of proton magnetic resonance spectroscopy and diffusion weighted images with apparent diffusion coefficient values in suspicious breast lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2018.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Greenwood HI, Dodelzon K, Katzen JT. Impact of Advancing Technology on Diagnosis and Treatment of Breast Cancer. Surg Clin North Am 2018; 98:703-724. [PMID: 30005769 DOI: 10.1016/j.suc.2018.03.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
New emerging breast imaging techniques have shown great promise in breast cancer screening, evaluation of extent of disease, and response to neoadjuvant therapy. Tomosynthesis, allows 3-dimensional imaging of the breast, and increases breast cancer detection. Fast abbreviated MRI has reduced time and costs associated with traditional breast MRI while maintaining cancer detection. Diffusion-weighted imaging is a functional MRI technique that does not require contrast and has shown potential in screening, lesion characterization and also evaluation of treatment response. New image-guided preoperative localizations are available that have increased patient satisfaction and decreased operating room delays.
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Affiliation(s)
- Heather I Greenwood
- Department of Radiology, University of California San Francisco, UCSF Medical Center at Mount Zion, 1600 Divisadero Street Room C-250, San Francisco, CA 94115, USA.
| | - Katerina Dodelzon
- Department of Radiology, Weill Cornell Medical Center, New York-Presbyterian, 425 East 61st Street, 9th Floor, New York, NY 10065, USA
| | - Janine T Katzen
- Department of Radiology, Weill Cornell Medical Center, New York-Presbyterian, 425 East 61st Street, 9th Floor, New York, NY 10065, USA
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Abd El-Aleem RA, Abo El-Hamd E, Yousef HA, Radwan ME, Mohammed RAA. The added value of qualitative and quantitative diffusion-weighted magnetic resonance imaging (DW-MRI) in differentiating benign from malignant breast lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2017.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Aydin H, Guner B, Esen Bostanci I, Bulut ZM, Aribas BK, Dogan L, Gulcelik MA. Is there any relationship between adc values of diffusion-weighted imaging and the histopathological prognostic factors of invasive ductal carcinoma? Br J Radiol 2018; 91:20170705. [PMID: 29299933 DOI: 10.1259/bjr.20170705] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE MRI is being used increasingly as a modality that can provide important information about breast cancer. Diffusion-weighted imaging (DWI) is an imaging technique from which apparent diffusion coefficient (ADC) values can be calculated in addition to obtaining important structural information which cannot be obtained from other imaging studies. We did not find any significant relationships between ADC values and prognostic factors, but did provide some explanations for conflicting results in the literature. METHODS The ADC results of 61 females with invasive ductal carcinomas were evaluated. DWI was performed and ADC values were calculated from the area in which restriction of diffusion was the highest in ADC mapping. B value was 500 and region of interest (ROI) was designated between 49 and 100 mm2. Calculations were performed automatically by the device. Tissue samples were obtained for prognostic factor evaluation. The relationships between ADC and prognostic factors were investigated. Comparisons between groups were made with one-way ANOVA and Kruskal Wallis test. Pairwise comparisons were made with Dunn's test. Analyses of categorical variables were made with Chi-square test. RESULTS We found a weak negative correlation between ADC and Ki-67 values (r = -0.279; p = 0.029). When we compared ADC values in regard to tumour type, we found no significant differences for tumour grade, Ki-67 positivity, estrogen receptor positivity, progesterone receptor positivity, C-erb B2, lymphovascular invasion and ductal carcinoma in situ or lobular carcinoma in situ component. On a side note, we found that mean ADC values decreased as tumour grade increased; however, this was not statistically significant. CONCLUSION The literature contains studies that report conflicting results which may be caused by differences in B values, ROI area and magnetic field strength. Multicentre studies and systematic reviews of these findings may produce crucial data for the use of DWI in breast cancer. Advances in knowledge: To determine if any significant relationship exists between DWI findings and prognostic factors of breast cancer.
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Affiliation(s)
- Hale Aydin
- 1 Department of Radiology, Dr AY Ankara Oncology Research and Training Hospital , Ankara , Turkey
| | - Bahar Guner
- 1 Department of Radiology, Dr AY Ankara Oncology Research and Training Hospital , Ankara , Turkey
| | - Isil Esen Bostanci
- 1 Department of Radiology, Dr AY Ankara Oncology Research and Training Hospital , Ankara , Turkey
| | - Zarife Melda Bulut
- 2 Department of Pathology, Dr AY Ankara Oncology Research and Training Hospital , Ankara , Turkey
| | - Bilgin Kadri Aribas
- 1 Department of Radiology, Dr AY Ankara Oncology Research and Training Hospital , Ankara , Turkey
| | - Lutfi Dogan
- 3 Department of General Surgery, Dr AY Ankara Oncology Research and Training Hospital , Ankara , Turkey
| | - Mehmet Ali Gulcelik
- 3 Department of General Surgery, Dr AY Ankara Oncology Research and Training Hospital , Ankara , Turkey.,Department of General Surgery, Gulhane Research and Training Hospital, Ankara , Turkey
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Iima M, Kataoka M, Kanao S, Onishi N, Kawai M, Ohashi A, Sakaguchi R, Toi M, Togashi K. Intravoxel Incoherent Motion and Quantitative Non-Gaussian Diffusion MR Imaging: Evaluation of the Diagnostic and Prognostic Value of Several Markers of Malignant and Benign Breast Lesions. Radiology 2017; 287:432-441. [PMID: 29095673 DOI: 10.1148/radiol.2017162853] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Purpose To investigate the performance of integrated approaches that combined intravoxel incoherent motion (IVIM) and non-Gaussian diffusion parameters compared with the Breast Imaging and Reporting Data System (BI-RADS) to establish multiparameter thresholds scores or probabilities by using Bayesian analysis to distinguish malignant from benign breast lesions and their correlation with molecular prognostic factors. Materials and Methods Between May 2013 and March 2015, 411 patients were prospectively enrolled and 199 patients (allocated to training [n = 99] and validation [n = 100] sets) were included in this study. IVIM parameters (flowing blood volume fraction [fIVIM] and pseudodiffusion coefficient [D*]) and non-Gaussian diffusion parameters (theoretical apparent diffusion coefficient [ADC] at b value of 0 sec/mm2 [ADC0] and kurtosis [K]) by using IVIM and kurtosis models were estimated from diffusion-weighted image series (16 b values up to 2500 sec/mm2), as well as a synthetic ADC (sADC) calculated by using b values of 200 and 1500 (sADC200-1500) and a standard ADC calculated by using b values of 0 and 800 sec/mm2 (ADC0-800). The performance of two diagnostic approaches (combined parameter thresholds and Bayesian analysis) combining IVIM and diffusion parameters was evaluated and compared with BI-RADS performance. The Mann-Whitney U test and a nonparametric multiple comparison test were used to compare their performance to determine benignity or malignancy and as molecular prognostic biomarkers and subtypes of breast cancer. Results Significant differences were found between malignant and benign breast lesions for IVIM and non-Gaussian diffusion parameters (ADC0, K, fIVIM, fIVIM · D*, sADC200-1500, and ADC0-800; P < .05). Sensitivity and specificity for the validation set by radiologists A and B were as follows: sensitivity, 94.7% and 89.5%, and specificity, 75.0% and 79.2% for sADC200-1500, respectively; sensitivity, 94.7% and 96.1%, and specificity, 75.0% and 66.7%, for the combined thresholds approach, respectively; sensitivity, 92.1% and 92.1%, and specificity, 83.3% and 66.7%, for Bayesian analysis, respectively; and sensitivity and specificity, 100% and 79.2%, for BI-RADS, respectively. The significant difference in values of sADC200-1500 in progesterone receptor status (P = .002) was noted. sADC200-1500 was significantly different between histologic subtypes (P = .006). Conclusion Approaches that combined various IVIM and non-Gaussian diffusion MR imaging parameters may provide BI-RADS-equivalent scores almost comparable to BI-RADS categories without the use of contrast agents. Non-Gaussian diffusion parameters also differed by biologic prognostic factors. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Mami Iima
- From the Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin-kawaharacho, Sakyo-ku, Kyoto 606-8507, Japan (M.I., M. Kataoka, S.K., N.O., M. Kawai, A.O., R.S., K.T.); Hakubi Center for Advanced Research, Kyoto University, Kyoto, Japan (M.I.); and Department of Breast Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan (M.T.)
| | - Masako Kataoka
- From the Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin-kawaharacho, Sakyo-ku, Kyoto 606-8507, Japan (M.I., M. Kataoka, S.K., N.O., M. Kawai, A.O., R.S., K.T.); Hakubi Center for Advanced Research, Kyoto University, Kyoto, Japan (M.I.); and Department of Breast Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan (M.T.)
| | - Shotaro Kanao
- From the Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin-kawaharacho, Sakyo-ku, Kyoto 606-8507, Japan (M.I., M. Kataoka, S.K., N.O., M. Kawai, A.O., R.S., K.T.); Hakubi Center for Advanced Research, Kyoto University, Kyoto, Japan (M.I.); and Department of Breast Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan (M.T.)
| | - Natsuko Onishi
- From the Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin-kawaharacho, Sakyo-ku, Kyoto 606-8507, Japan (M.I., M. Kataoka, S.K., N.O., M. Kawai, A.O., R.S., K.T.); Hakubi Center for Advanced Research, Kyoto University, Kyoto, Japan (M.I.); and Department of Breast Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan (M.T.)
| | - Makiko Kawai
- From the Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin-kawaharacho, Sakyo-ku, Kyoto 606-8507, Japan (M.I., M. Kataoka, S.K., N.O., M. Kawai, A.O., R.S., K.T.); Hakubi Center for Advanced Research, Kyoto University, Kyoto, Japan (M.I.); and Department of Breast Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan (M.T.)
| | - Akane Ohashi
- From the Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin-kawaharacho, Sakyo-ku, Kyoto 606-8507, Japan (M.I., M. Kataoka, S.K., N.O., M. Kawai, A.O., R.S., K.T.); Hakubi Center for Advanced Research, Kyoto University, Kyoto, Japan (M.I.); and Department of Breast Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan (M.T.)
| | - Rena Sakaguchi
- From the Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin-kawaharacho, Sakyo-ku, Kyoto 606-8507, Japan (M.I., M. Kataoka, S.K., N.O., M. Kawai, A.O., R.S., K.T.); Hakubi Center for Advanced Research, Kyoto University, Kyoto, Japan (M.I.); and Department of Breast Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan (M.T.)
| | - Masakazu Toi
- From the Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin-kawaharacho, Sakyo-ku, Kyoto 606-8507, Japan (M.I., M. Kataoka, S.K., N.O., M. Kawai, A.O., R.S., K.T.); Hakubi Center for Advanced Research, Kyoto University, Kyoto, Japan (M.I.); and Department of Breast Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan (M.T.)
| | - Kaori Togashi
- From the Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin-kawaharacho, Sakyo-ku, Kyoto 606-8507, Japan (M.I., M. Kataoka, S.K., N.O., M. Kawai, A.O., R.S., K.T.); Hakubi Center for Advanced Research, Kyoto University, Kyoto, Japan (M.I.); and Department of Breast Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan (M.T.)
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Abstract
Diffusion-weighted imaging (DWI) holds promise to address some of the shortcomings of routine clinical breast magnetic resonance imaging (MRI) and to expand the capabilities of imaging in breast cancer management. DWI reflects tissue microstructure, and provides unique information to aid in characterization of breast lesions. Potential benefits under investigation include improving diagnostic accuracy and guiding treatment decisions. As a result, DWI is increasingly being incorporated into breast MRI protocols and multicenter trials are underway to validate single-institution findings and to establish clinical guidelines. Advancements in DWI acquisition and modeling approaches are helping to improve image quality and extract additional biologic information from breast DWI scans, which may extend diagnostic and prognostic value.
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Affiliation(s)
- Savannah C Partridge
- *Department of Radiology, Breast Imaging Section, Seattle Cancer Care Alliance, University of Washington, Seattle, WA †University of Massachusetts Memorial Medical Center, Worcester, MA
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Partridge SC, Nissan N, Rahbar H, Kitsch AE, Sigmund EE. Diffusion-weighted breast MRI: Clinical applications and emerging techniques. J Magn Reson Imaging 2016; 45:337-355. [PMID: 27690173 DOI: 10.1002/jmri.25479] [Citation(s) in RCA: 215] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 08/29/2016] [Indexed: 12/28/2022] Open
Abstract
Diffusion-weighted MRI (DWI) holds potential to improve the detection and biological characterization of breast cancer. DWI is increasingly being incorporated into breast MRI protocols to address some of the shortcomings of routine clinical breast MRI. Potential benefits include improved differentiation of benign and malignant breast lesions, assessment and prediction of therapeutic efficacy, and noncontrast detection of breast cancer. The breast presents a unique imaging environment with significant physiologic and inter-subject variations, as well as specific challenges to achieving reliable high quality diffusion-weighted MR images. Technical innovations are helping to overcome many of the image quality issues that have limited widespread use of DWI for breast imaging. Advanced modeling approaches to further characterize tissue perfusion, complexity, and glandular organization may expand knowledge and yield improved diagnostic tools. LEVEL OF EVIDENCE 5 J. Magn. Reson. Imaging 2016 J. Magn. Reson. Imaging 2017;45:337-355.
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Affiliation(s)
- Savannah C Partridge
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington, USA.,Breast Imaging, Seattle Cancer Care Alliance, Seattle, Washington, USA
| | - Noam Nissan
- Department of Biological Regulation, Weizmann Institute of Science, Rehovot, Israel
| | - Habib Rahbar
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington, USA.,Breast Imaging, Seattle Cancer Care Alliance, Seattle, Washington, USA
| | - Averi E Kitsch
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington, USA.,Breast Imaging, Seattle Cancer Care Alliance, Seattle, Washington, USA
| | - Eric E Sigmund
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
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Bickel H, Pinker K, Polanec S, Magometschnigg H, Wengert G, Spick C, Bogner W, Bago-Horvath Z, Helbich TH, Baltzer P. Diffusion-weighted imaging of breast lesions: Region-of-interest placement and different ADC parameters influence apparent diffusion coefficient values. Eur Radiol 2016; 27:1883-1892. [DOI: 10.1007/s00330-016-4564-3] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 08/11/2016] [Indexed: 01/01/2023]
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Dijkstra H, Dorrius MD, Wielema M, Pijnappel RM, Oudkerk M, Sijens PE. Quantitative DWI implemented after DCE-MRI yields increased specificity for BI-RADS 3 and 4 breast lesions. J Magn Reson Imaging 2016; 44:1642-1649. [PMID: 27273694 DOI: 10.1002/jmri.25331] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 05/19/2016] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To assess if specificity can be increased when semiautomated breast lesion analysis of quantitative diffusion-weighted imaging (DWI) is implemented after dynamic contrast-enhanced (DCE-) magnetic resonance imaging (MRI) in the workup of BI-RADS 3 and 4 breast lesions larger than 1 cm. MATERIALS AND METHODS In all, 120 consecutive patients (mean-age, 48 years; age range, 23-75 years) with 139 breast lesions (≥1 cm) were examined (2010-2014) with 1.5T DCE-MRI and DWI (b = 0, 50, 200, 500, 800, 1000 s/mm2 ) and the BI-RADS classification and histopathology were obtained. For each lesion malignancy was excluded using voxelwise semiautomated breast lesion analysis based on previously defined thresholds for the apparent diffusion coefficient (ADC) and the three intravoxel incoherent motion (IVIM) parameters: molecular diffusion (Dslow ), microperfusion (Dfast ), and the fraction of Dfast (ffast ). The sensitivity (Se), specificity (Sp), and negative predictive value (NPV) based on only IVIM parameters combined in parallel (Dslow , Dfast , and ffast ), or the ADC or the BI-RADS classification by DCE-MRI were compared. Subsequently, the Se, Sp, and NPV of the combination of the BI-RADS classification by DCE-MRI followed by the IVIM parameters in parallel (or the ADC) were compared. RESULTS In all, 23 of 139 breast lesions were benign. Se and Sp of DCE-MRI was 100% and 30.4% (NPV = 100%). Se and Sp of IVIM parameters in parallel were 92.2% and 52.2% (NPV = 57.1%) and for the ADC 95.7% and 17.4%, respectively (NPV = 44.4%). In all, 26 of 139 lesions were classified as BI-RADS 3 (n = 7) or BI-RADS 4 (n = 19). DCE-MRI combined with ADC (Se = 99.1%, Sp = 34.8%) or IVIM (Se = 99.1%, Sp = 56.5%) did significantly improve (P = 0.016) Sp of DCE-MRI alone for workup of BI-RADS 3 and 4 lesions (NPV = 92.9%). CONCLUSION Quantitative DWI has a lower NPV compared to DCE-MRI for evaluation of breast lesions and may therefore not be able to replace DCE-MRI; when implemented after DCE-MRI as problem solver for BI-RADS 3 and 4 lesions, the combined specificity improves significantly. J. Magn. Reson. Imaging 2016;44:1642-1649.
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Affiliation(s)
- Hildebrand Dijkstra
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging - North East Netherlands, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, The Netherlands
| | - Monique D Dorrius
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging - North East Netherlands, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, The Netherlands
| | - Mirjam Wielema
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging - North East Netherlands, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, The Netherlands
| | - Ruud M Pijnappel
- University of Utrecht, University Medical Center Utrecht, Department of Radiology, Utrecht, The Netherlands
| | - Matthijs Oudkerk
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging - North East Netherlands, Groningen, The Netherlands
| | - Paul E Sijens
- University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, The Netherlands
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Iima M, Le Bihan D. Clinical Intravoxel Incoherent Motion and Diffusion MR Imaging: Past, Present, and Future. Radiology 2016; 278:13-32. [PMID: 26690990 DOI: 10.1148/radiol.2015150244] [Citation(s) in RCA: 348] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The concept of diffusion magnetic resonance (MR) imaging emerged in the mid-1980s, together with the first images of water diffusion in the human brain, as a way to probe tissue structure at a microscopic scale, although the images were acquired at a millimetric scale. Since then, diffusion MR imaging has become a pillar of modern clinical imaging. Diffusion MR imaging has mainly been used to investigate neurologic disorders. A dramatic application of diffusion MR imaging has been acute brain ischemia, providing patients with the opportunity to receive suitable treatment at a stage when brain tissue might still be salvageable, thus avoiding terrible handicaps. On the other hand, it was found that water diffusion is anisotropic in white matter, because axon membranes limit molecular movement perpendicularly to the nerve fibers. This feature can be exploited to produce stunning maps of the orientation in space of the white matter tracts and brain connections in just a few minutes. Diffusion MR imaging is now also rapidly expanding in oncology, for the detection of malignant lesions and metastases, as well as monitoring. Water diffusion is usually largely decreased in malignant tissues, and body diffusion MR imaging, which does not require any tracer injection, is rapidly becoming a modality of choice to detect, characterize, or even stage malignant lesions, especially for breast or prostate cancer. After a brief summary of the key methodological concepts beyond diffusion MR imaging, this article will give a review of the clinical literature, mainly focusing on current outstanding issues, followed by some innovative proposals for future improvements.
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Affiliation(s)
- Mami Iima
- From the Department of Diagnostic Imaging and Nuclear Medicine (M.I.) and the Human Brain Research Center (D.L.B.), Kyoto University Graduate School of Medicine, and the Hakubi Center for Advanced Research (M.I.), Kyoto University, Kyoto, Japan; and NeuroSpin, CEA/DSV/I2BM, Bât 145, Point Courrier 156, CEA-Saclay Center, F-91191 Gif-sur-Yvette, France (D.L.B.)
| | - Denis Le Bihan
- From the Department of Diagnostic Imaging and Nuclear Medicine (M.I.) and the Human Brain Research Center (D.L.B.), Kyoto University Graduate School of Medicine, and the Hakubi Center for Advanced Research (M.I.), Kyoto University, Kyoto, Japan; and NeuroSpin, CEA/DSV/I2BM, Bât 145, Point Courrier 156, CEA-Saclay Center, F-91191 Gif-sur-Yvette, France (D.L.B.)
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Park SY, Oh YT, Jung DC, Cho NH, Choi YD, Rha KH, Hong SJ. Diffusion-weighted imaging predicts upgrading of Gleason score in biopsy-proven low grade prostate cancers. BJU Int 2016; 119:57-66. [PMID: 26823024 DOI: 10.1111/bju.13436] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To analyse whether diffusion-weighted imaging (DWI) predicts Gleason score (GS) upgrading in biopsy-proven low grade prostate cancer (PCa). PATIENTS AND METHODS A total of 132 patients who had biopsy-proven low grade (GS < 7) PCa, 3T DWI results, and surgical confirmation were retrospectively included in the study. Clinical variables (prostate-specific antigen, greatest percentage of cancer in a biopsy core and percentage of positive cores) and DWI variables (minimum apparent diffusion coefficient [ADCmin ] and mean ADC [ADCmean ]) were evaluated. ADCmin was measured, by two independent, blinded readers, using a region of interest (ROI) of 5-10 mm2 at the area of lowest ADC value within a cancer, while ADCmean was measured using an ROI covering more than half of a cancer. Logistic regression and receiver-operating characteristic curve analyses were performed. RESULTS The rate of GS upgrading was 46.1% (61/132). In both univariate and multivariate analyses, ADCmin and ADCmean were persistently significant for predicting GS upgrading (P < 0.05), whereas clinical variables were not (P > 0.05). In both readers' results, the area under the curve (AUC) of ADCmin was significantly greater than that of ADCmean (reader 1: AUC 0.760 vs 0.711; P < 0.001; reader 2: AUC 0.752 vs 0.714; P = 0.003). CONCLUSION Our results showed that DWI may predict GS upgrading of biopsy-proven low grade PCa. The variable ADCmin in PCa may perform better than ADCmean .
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Affiliation(s)
- Sung Yoon Park
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Young Taik Oh
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Dae Chul Jung
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Nam Hoon Cho
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Young Deuk Choi
- Department of Urology, Yonsei University College of Medicine, Seoul, Korea
| | - Koon Ho Rha
- Department of Urology, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Joon Hong
- Department of Urology, Yonsei University College of Medicine, Seoul, Korea
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Hussein H, Chung C, Moshonov H, Miller N, Kulkarni SR, Scaranelo AM. Evaluation of Apparent Diffusion Coefficient to Predict Grade, Microinvasion, and Invasion in Ductal Carcinoma In Situ of the Breast. Acad Radiol 2015; 22:1483-8. [PMID: 26391856 DOI: 10.1016/j.acra.2015.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Revised: 08/03/2015] [Accepted: 08/07/2015] [Indexed: 01/10/2023]
Abstract
RATIONALE AND OBJECTIVES To evaluate the role of apparent diffusion coefficient (ADC) in distinguishing ductal carcinoma in situ (DCIS) grades and identifying microinvasive and/or invasive disease in the preoperative evaluation of patients with core biopsy-proven DCIS. MATERIALS AND METHODS Research Ethics Board-approved study with informed consent from 81 women (age, 36-84 years) scheduled for core-biopsy with results of 82 noninvasive breast carcinomas. All patients were assessed preoperatively by diffusion sequence in addition to contrast magnetic resonance imaging (MRI). Lesion morphology and ADC values were recorded. The Kruskal-Wallis or one-way analysis of variance test and Pearson correlation coefficient were used to study the association between ADC and MRI lesion characteristics. Logistic regression analysis was used to evaluate the ability of ADC to predict the presence of invasion. RESULTS Surgical pathology demonstrated associated invasive cancer in 26.8%, microinvasion in 14.6%, and pure DCIS in 58.5%. The minimum regions of interest (ROI)-based ADC was significantly different among the following three groups (P < .001, Kruskal-Wallis test): 0.98 × 10(-3) mm(2)/s ± 0.25 for pure DCIS, 0.82 × 10(-3) mm(2)/s ± 0.20 for DCIS with microinvasion, and 0.71 × 10(-3) mm(2)/s ± 0.27 for DCIS with invasive disease. Based on logistic regression analysis, the minimum ROI-based ADC of 0.56 × 10(-3) mm(2)/s was a significant predictor for invasive disease (odds ratio = 0.02, 95% confidence interval [0.002, 0.207], P = .001). Regardless of the field strength (1.5 vs. 3.0 T) ADC values of high-grade and non-high-grade DCIS were not significantly different. CONCLUSIONS Pure DCIS had the highest "ROI-based" ADC measured using 1.5 T or 3.0 T. The ADC was able to identify microinvasion or invasive cancer in biopsy-proven DCIS lesions but not to distinguish the DCIS grades.
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Cho GY, Moy L, Kim SG, Baete SH, Moccaldi M, Babb JS, Sodickson DK, Sigmund EE. Evaluation of breast cancer using intravoxel incoherent motion (IVIM) histogram analysis: comparison with malignant status, histological subtype, and molecular prognostic factors. Eur Radiol 2015; 26:2547-58. [PMID: 26615557 DOI: 10.1007/s00330-015-4087-3] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 10/23/2015] [Indexed: 12/19/2022]
Abstract
PURPOSE To examine heterogeneous breast cancer through intravoxel incoherent motion (IVIM) histogram analysis. MATERIALS AND METHODS This HIPAA-compliant, IRB-approved retrospective study included 62 patients (age 48.44 ± 11.14 years, 50 malignant lesions and 12 benign) who underwent contrast-enhanced 3 T breast MRI and diffusion-weighted imaging. Apparent diffusion coefficient (ADC) and IVIM biomarkers of tissue diffusivity (Dt), perfusion fraction (fp), and pseudo-diffusivity (Dp) were calculated using voxel-based analysis for the whole lesion volume. Histogram analysis was performed to quantify tumour heterogeneity. Comparisons were made using Mann-Whitney tests between benign/malignant status, histological subtype, and molecular prognostic factor status while Spearman's rank correlation was used to characterize the association between imaging biomarkers and prognostic factor expression. RESULTS The average values of the ADC and IVIM biomarkers, Dt and fp, showed significant differences between benign and malignant lesions. Additional significant differences were found in the histogram parameters among tumour subtypes and molecular prognostic factor status. IVIM histogram metrics, particularly fp and Dp, showed significant correlation with hormonal factor expression. CONCLUSION Advanced diffusion imaging biomarkers show relationships with molecular prognostic factors and breast cancer malignancy. This analysis reveals novel diagnostic metrics that may explain some of the observed variability in treatment response among breast cancer patients. KEY POINTS • Novel IVIM biomarkers characterize heterogeneous breast cancer. • Histogram analysis enables quantification of tumour heterogeneity. • IVIM biomarkers show relationships with breast cancer malignancy and molecular prognostic factors.
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Affiliation(s)
- Gene Young Cho
- Center for Advanced Imaging Innovation and Research (CAI2R), New York University School of Medicine, 660 First Ave. 4th Floor, New York City, NY, 10016, USA. .,Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY, 10016, USA.
| | - Linda Moy
- Center for Advanced Imaging Innovation and Research (CAI2R), New York University School of Medicine, 660 First Ave. 4th Floor, New York City, NY, 10016, USA.,Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY, 10016, USA
| | - Sungheon G Kim
- Center for Advanced Imaging Innovation and Research (CAI2R), New York University School of Medicine, 660 First Ave. 4th Floor, New York City, NY, 10016, USA.,Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY, 10016, USA
| | - Steven H Baete
- Center for Advanced Imaging Innovation and Research (CAI2R), New York University School of Medicine, 660 First Ave. 4th Floor, New York City, NY, 10016, USA.,Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY, 10016, USA
| | - Melanie Moccaldi
- New York University Langone Medical Center - Cancer Institute, New York, NY, 10016, USA
| | - James S Babb
- Center for Advanced Imaging Innovation and Research (CAI2R), New York University School of Medicine, 660 First Ave. 4th Floor, New York City, NY, 10016, USA.,Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY, 10016, USA
| | - Daniel K Sodickson
- Center for Advanced Imaging Innovation and Research (CAI2R), New York University School of Medicine, 660 First Ave. 4th Floor, New York City, NY, 10016, USA.,Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY, 10016, USA
| | - Eric E Sigmund
- Center for Advanced Imaging Innovation and Research (CAI2R), New York University School of Medicine, 660 First Ave. 4th Floor, New York City, NY, 10016, USA.,Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY, 10016, USA
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Early-stage invasive ductal carcinoma: Association of tumor apparent diffusion coefficient values with axillary lymph node metastasis. Eur J Radiol 2015; 84:2137-43. [PMID: 26318821 DOI: 10.1016/j.ejrad.2015.08.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 07/31/2015] [Accepted: 08/13/2015] [Indexed: 11/23/2022]
Abstract
PURPOSE To evaluate any association between tumor apparent diffusion coefficient (ADC) values and axillary lymph node metastasis (ALNM) in early-stage invasive ductal carcinoma. MATERIALS AND METHODS Records of 270 invasive ductal carcinoma patients with stages T1 and T2 disease who underwent breast magnetic resonance imaging, including diffusion-weighted imaging with b values of 0 and 1000s/mm(2) were reviewed retrospectively. The tumor ADC values were analyzed for their utility in predicting ALNM using multivariate regression analysis and receiver operating characteristic (ROC) curve analysis. RESULTS Of the 270 patients, 58 (21.5%) experienced ALNM. The mean tumor ADC values were significantly lower in patients with ALNM than in those without metastasis (0.880 × 10(-3) vs. 0.999 × 10(-3)mm(2)/s, P<0.001). A ROC curve demonstrated a tumor ADC value of 0.991 × 10(-3)mm(2)/s to be the optimal cut-off for predicting ALNM. In a multivariate analysis, lower tumor ADC (≤ 0.991 × 10(-3)mm(2)/s; adjusted odds ratio (OR)=5.861, P<0.001), large tumor size (>2 cm; adjusted OR=3.156, P=0.002) and the presence of lymphovascular invasion (adjusted OR=4.125, P<0.001) were independent variables associated with ALNM. When tumor ADC value was added to known risk factors (i.e., tumor size and lymphovascular invasion), a significant improvement in the accuracy of risk prediction for axillary node metastasis was shown (c-statistic=0.758 vs. 0.816, P=0.026). CONCLUSION In early-stage invasive ductal carcinoma, lower tumor ADC values are associated with the presence of ALNM.
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Rahbar H, Parsian S, Lam DL, Dontchos BN, Andeen NK, Rendi MH, Lehman CD, Partridge SC. Can MRI biomarkers at 3 T identify low-risk ductal carcinoma in situ? Clin Imaging 2015; 40:125-9. [PMID: 26365872 DOI: 10.1016/j.clinimag.2015.07.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 07/21/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective was to explore whether 3-T magnetic resonance imaging (MRI) can identify low-risk ductal carcinoma in situ (DCIS). METHODS Dynamic contrast-enhanced and diffusion-weighted (DWI) MRI features of 36 DCIS lesions [8 low risk, Van Nuys Pathologic Classification (VNPC) 1; 28 high risk, VNPC 2/3] were reviewed. An MRI model that best identified low-risk DCIS was determined using multivariate logistic regression. RESULTS Low-risk DCIS exhibited different DWI properties [i.e., higher contrast-to-noise ratio (P=.02) and lower normalized apparent diffusion coefficients (P=.04)] than high-risk DCIS. A model combining these DWI features provided best performance (area under receiver operating characteristic curve =0.86). CONCLUSIONS DWI may help identify DCIS lesions requiring less therapy.
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Affiliation(s)
- Habib Rahbar
- University of Washington, Seattle Cancer Care Alliance, Department of Radiology, Breast Imaging Section, 825 Eastlake Avenue East, P.O. Box 19023, Seattle, WA 98109-1023, USA.
| | - Sana Parsian
- University of Washington, Seattle Cancer Care Alliance, Department of Radiology, Breast Imaging Section, 825 Eastlake Avenue East, P.O. Box 19023, Seattle, WA 98109-1023, USA
| | - Diana L Lam
- University of Washington, Seattle Cancer Care Alliance, Department of Radiology, Breast Imaging Section, 825 Eastlake Avenue East, P.O. Box 19023, Seattle, WA 98109-1023, USA
| | - Brian N Dontchos
- University of Washington, Seattle Cancer Care Alliance, Department of Radiology, Breast Imaging Section, 825 Eastlake Avenue East, P.O. Box 19023, Seattle, WA 98109-1023, USA
| | - Nicole K Andeen
- University of Washington Department of Anatomic Pathology, 1959 NE Pacific St., Box 357470, Seattle, WA 98195, USA
| | - Mara H Rendi
- University of Washington Department of Anatomic Pathology, 1959 NE Pacific St., Box 357470, Seattle, WA 98195, USA
| | - Constance D Lehman
- University of Washington, Seattle Cancer Care Alliance, Department of Radiology, Breast Imaging Section, 825 Eastlake Avenue East, P.O. Box 19023, Seattle, WA 98109-1023, USA
| | - Savannah C Partridge
- University of Washington, Seattle Cancer Care Alliance, Department of Radiology, Breast Imaging Section, 825 Eastlake Avenue East, P.O. Box 19023, Seattle, WA 98109-1023, USA
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Diagnostic Significance of Diffusion-Weighted MRI in Renal Cancer. BIOMED RESEARCH INTERNATIONAL 2015; 2015:172165. [PMID: 26064881 PMCID: PMC4430628 DOI: 10.1155/2015/172165] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 01/16/2015] [Indexed: 12/21/2022]
Abstract
Background. This study aimed to investigate whether diffusion-weighted imaging (DWI) could contribute to the discrimination between benign and malignant renal cancer. Methods. We searched the PubMed electronic database for eligible studies. STATA 12.0 software was used for statistical analysis. The SMD and 95% CI were calculated. Results. Decreased ADC signal was seen in all renal cancer patients (cancer tissue versus normal tissue: SMD = 1.63 and 95% CI = 0.96~2.29, P < 0.001; cancer tissue versus benign tissue: SMD = 2.22 and 95% CI = 1.53~2.90 and P < 0.001, resp.). MRI machine type-stratified analysis showed that decreased ADC signal was found by all included MRI machine types in cancer tissues compared with benign cancer tissues (all P < 0.05). The ADC values of renal cancer patients were significantly lower than those of normal controls for all included P values (all P < 0.05), and there was a decreased ADC signal at b-500, b-600, b-1000, b-500, and 1000 gradients compared with benign cancer tissues (all P < 0.05). Conclusion. Our study concluded that decreased ADC signal presented in DWI may be essential for the differential diagnosis of renal cancer.
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Quantitative Non-Gaussian Diffusion and Intravoxel Incoherent Motion Magnetic Resonance Imaging. Invest Radiol 2015; 50:205-11. [DOI: 10.1097/rli.0000000000000094] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fat suppression techniques (STIR vs. SPAIR) on diffusion-weighted imaging of breast lesions at 3.0 T: preliminary experience. Radiol Med 2015; 120:705-13. [PMID: 25665796 DOI: 10.1007/s11547-015-0508-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 05/19/2014] [Indexed: 12/24/2022]
Abstract
PURPOSE The aim of this work was to perform a qualitative and quantitative comparison of the performance of two fat suppression techniques on breast diffusion-weighted imaging (DWI). MATERIALS AND METHODS Fifty-one women underwent clinical breast magnetic resonance imaging, including DWI with short TI inversion recovery (STIR) and spectral attenuated inversion recovery (SPAIR). Four were excluded from the analysis due to image artefacts. Rating of fat suppression uniformity and lesion visibility were performed. Agreement between the two sequences was evaluated. Additionally, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and apparent diffusion coefficient (ADC) values for normal gland, benign and malignant lesions were compared. Receiver operating characteristic analysis was also performed. RESULTS From the 52 lesions found, 47 were detected by both sequences. DWI-STIR evidenced more homogeneous fat suppression (p = 0.03). Although these lesions were seen with both techniques, DWI-SPAIR evidenced higher score for lesion visibility in nine of them. SNR and CNR were comparable, except for SNR in benign lesions (p < 0.01), which was higher for DWI-SPAIR. Mean ADC values for lesions were similar. ADC for normal fibroglandular tissue was higher when using DWI-STIR (p = 0.006). Sensitivity, specificity, accuracy and area under the curve values were alike: 84.0 % for both; 77.3, 71.4 %; 80.9, 78.3 %; 82.5, 81.3 % for DWI-SPAIR and DWI-STIR, respectively. CONCLUSION DWI-STIR showed superior fat suppression homogeneity. No differences were found for SNR and CNR, except for SNR in benign lesions. ADCs for lesions were comparable. Findings in this study are consistent with previous studies at 1.5 T, meaning that both fat suppression techniques are appropriate for breast DWI at 3.0 T.
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Min Q, Shao K, Zhai L, Liu W, Zhu C, Yuan L, Yang J. Differential diagnosis of benign and malignant breast masses using diffusion-weighted magnetic resonance imaging. World J Surg Oncol 2015; 13:32. [PMID: 25889380 PMCID: PMC4328303 DOI: 10.1186/s12957-014-0431-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 12/24/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diffusion-weighted magnetic resonance imaging (DW-MRI) is different from conventional diagnostic methods and has the potential to delineate the microscopic anatomy of a target tissue or organ. The purpose of our study was to evaluate the value of DW-MRI in the diagnosis of benign and malignant breast masses, which would help the clinical surgeon to decide the scope and pattern of operation. METHODS A total of 52 female patients with palpable solid breast masses received breast MRI scans using routine sequences, dynamic contrast-enhanced imaging, and diffusion-weighted echo-planar imaging at b values of 400, 600, and 800 s/mm(2), respectively. Two regions of interest (ROIs) were plotted, with a smaller ROI for the highest signal and a larger ROI for the overall lesion. Apparent diffusion coefficient (ADC) values were calculated at three different b values for all detectable lesions and from two different ROIs. The sensitivity, specificity, positive predictive value, and positive likelihood ratio of DW-MRI were determined for comparison with histological results. RESULTS A total of 49 (49/52, 94.2%) lesions were detected using DW-MRI, including 20 benign lesions (two lesions detected in the same patient) and 29 malignant lesions. Benign lesion had a higher mean ADC value than their malignant counterparts, regardless of b value. According to the receiver operating characteristic (ROC) curve, the smaller-range ROI was more effective in differentiation between benign and malignant lesions. The area under the ROC curve was the largest at a b value of 800 s/mm(2). With a threshold ADC value at 1.23 × 10(-3) mm(2)/s, DW-MRI achieved a sensitivity of 82.8%, specificity of 90.0%, positive predictive value of 92.3%, and positive likelihood ratio of 8.3 for differentiating benign and malignant lesions. CONCLUSIONS DW-MRI is an accurate diagnostic tool for differentiation between benign and malignant breast lesions, with an optimal b value of 800 s/mm(2). A smaller-range ROI focusing on the highest signal has a better differential value.
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Affiliation(s)
- Qinghua Min
- Department of Radiology, Shanghai Tongren Hospital, No. 1111 Xianxia Road, Changning District, Shanghai, 200336, PR China.
| | - Kangwei Shao
- Department of Radiology, Shanghai Tongren Hospital, No. 1111 Xianxia Road, Changning District, Shanghai, 200336, PR China.
| | - Lulan Zhai
- Department of Radiology, Shanghai Tongren Hospital, No. 1111 Xianxia Road, Changning District, Shanghai, 200336, PR China.
| | - Wei Liu
- Department of Radiology, Shanghai Tongren Hospital, No. 1111 Xianxia Road, Changning District, Shanghai, 200336, PR China.
| | - Caisong Zhu
- Department of Radiology, Shanghai Tongren Hospital, No. 1111 Xianxia Road, Changning District, Shanghai, 200336, PR China.
| | - Lixin Yuan
- Department of Radiology, Shanghai Tongren Hospital, No. 1111 Xianxia Road, Changning District, Shanghai, 200336, PR China.
| | - Jun Yang
- Department of Radiology, Shanghai Tongren Hospital, No. 1111 Xianxia Road, Changning District, Shanghai, 200336, PR China.
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Bickel H, Pinker-Domenig K, Bogner W, Spick C, Bagó-Horváth Z, Weber M, Helbich T, Baltzer P. Quantitative Apparent Diffusion Coefficient as a Noninvasive Imaging Biomarker for the Differentiation of Invasive Breast Cancer and Ductal Carcinoma In Situ. Invest Radiol 2015; 50:95-100. [DOI: 10.1097/rli.0000000000000104] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bogner W, Pinker K, Zaric O, Baltzer P, Minarikova L, Porter D, Bago-Horvath Z, Dubsky P, Helbich TH, Trattnig S, Gruber S. Bilateral Diffusion-weighted MR Imaging of Breast Tumors with Submillimeter Resolution Using Readout-segmented Echo-planar Imaging at 7 T. Radiology 2015; 274:74-84. [DOI: 10.1148/radiol.14132340] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Wenkel E, Uder M, Janka R. [Diffusion-weighted breast imaging. Clinical implementation procedure]. Radiologe 2014; 54:224-32. [PMID: 24570109 DOI: 10.1007/s00117-013-2588-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Diffusion-weighted imaging (DWI) of the breast provides additional contrast information in breast magnetic resonance imaging (MRI). The DWI procedure can easily be implemented in the routine breast MRI protocol with little time expenditure regarding image acquisition and evaluation. Evaluation of the DW images can be performed with or without the routine breast MRI sequences (T2w and T1w with contrast material) but evaluation in combination with the routine program is highly recommended. Objective analysis of the tissue diffusion can be achieved by calculating the apparent diffusion coefficient (ADC) value with the scanner software. The choice of the DW sequence, evaluation and determination of the ADC threshold to differentiate between benign and malignant lesions should be scanner adapted. The use of DW imaging qualifies for routine use regarding the differentiation between malignant and benign breast lesions. Non-mass-like lesions and monitoring neoadjuvant chemotherapy can also be evaluated with DW sequences. The benefit of the additional information from DW-MR mammography to characterize non-mass-like lesions and in the course of neoadjuvant chemotherapy remains unclear to date.
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Affiliation(s)
- E Wenkel
- Radiologisches Institut, Universitätsklinikum Erlangen, Maximiliansplatz 1, 91054, Erlangen, Deutschland,
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