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Loubrie S, Zou J, Rodriguez-Soto AE, Lim J, Andreassen MMS, Cheng Y, Batasin SJ, Ebrahimi S, Fang LK, Conlin CC, Seibert TM, Hahn ME, Dialani V, Wei CJ, Karimi Z, Kuperman J, Dale AM, Ojeda-Fournier H, Pisano E, Rakow-Penner R. Discrimination Between Benign and Malignant Lesions With Restriction Spectrum Imaging MRI in an Enriched Breast Cancer Screening Cohort. J Magn Reson Imaging 2024. [PMID: 39291552 DOI: 10.1002/jmri.29599] [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: 11/14/2023] [Revised: 08/16/2024] [Accepted: 08/20/2024] [Indexed: 09/19/2024] Open
Abstract
BACKGROUND Breast cancer screening with dynamic contrast-enhanced MRI (DCE-MRI) is recommended for high-risk women but has limitations, including variable specificity and difficulty in distinguishing cancerous (CL) and high-risk benign lesions (HRBL) from average-risk benign lesions (ARBL). Complementary non-invasive imaging techniques would be useful to improve specificity. PURPOSE To evaluate the performance of a previously-developed breast-specific diffusion-weighted MRI (DW-MRI) model (BS-RSI3C) to improve discrimination between CL, HRBL, and ARBL in an enriched screening population. STUDY TYPE Prospective. SUBJECTS Exactly 187 women, either with mammography screening recommending additional imaging (N = 49) or high-risk individuals undergoing routine breast MRI (N = 138), before the biopsy. FIELD STRENGTH/SEQUENCE Multishell DW-MRI echo planar imaging sequence with a reduced field of view at 3.0 T. ASSESSMENT A total of 72 women had at least one biopsied lesion, with 89 lesions categorized into ARBL, HRBL, CL, and combined CLs and HRBLs (CHRLs). DW-MRI data were processed to produce apparent diffusion coefficient (ADC) maps, and estimate signal contributions (C1, C2, and C3-restricted, hindered, and free diffusion, respectively) from the BS-RSI3C model. Lesion regions of interest (ROIs) were delineated on DW images based on suspicious DCE-MRI findings by two radiologists; control ROIs were drawn in the contralateral breast. STATISTICAL TESTS One-way ANOVA and two-sided t-tests were used to assess differences in signal contributions and ADC values among groups. P-values were adjusted using the Bonferroni method for multiple testing, P = 0.05 was used for the significance level. Receiver operating characteristics (ROC) curves and intra-class correlations (ICC) were also evaluated. RESULTS C1, √C1C2, andlog C 1 C 2 C 3 $$ \log \left(\frac{{\mathrm{C}}_1{\mathrm{C}}_2}{{\mathrm{C}}_3}\right) $$ were significantly different in HRBLs compared with ARBLs (P-values < 0.05). Thelog C 1 C 2 C 3 $$ \log \left(\frac{{\mathrm{C}}_1{\mathrm{C}}_2}{{\mathrm{C}}_3}\right) $$ had the highest AUC (0.821) in differentiating CHRLs from ARBLs, performing better than ADC (0.696), especially in non-mass enhancement (0.776 vs. 0.517). DATA CONCLUSION This study demonstrated the BS-RSI3C could differentiate HRBLs from ARBLs in a screening population, and separate CHRLs from ARBLs better than ADC. LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY STAGE 2.
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Affiliation(s)
- Stephane Loubrie
- Department of Radiology, University of California San Diego, La Jolla, California, USA
| | - Jingjing Zou
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Ana E Rodriguez-Soto
- Department of Radiology, University of California San Diego, La Jolla, California, USA
| | - Jihe Lim
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Gyeonggi-do, Republic of Korea
| | - Maren M S Andreassen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Research and Innovation, Vestre Viken, Drammen, Norway
| | - Yuwei Cheng
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Summer J Batasin
- Department of Radiology, University of California San Diego, La Jolla, California, USA
| | - Sheida Ebrahimi
- Department of Radiology, University of California San Diego, La Jolla, California, USA
| | - Lauren K Fang
- Department of Radiology, University of California San Diego, La Jolla, California, USA
| | - Christopher C Conlin
- Department of Radiology, University of California San Diego, La Jolla, California, USA
| | - Tyler M Seibert
- Department of Radiology, University of California San Diego, La Jolla, California, USA
- Department of Radiation Medicine, University of California San Diego, La Jolla, California, USA
- Department of Bioengineering, University of California San Diego, La Jolla, California, USA
| | - Michael E Hahn
- Department of Radiology, University of California San Diego, La Jolla, California, USA
| | - Vandana Dialani
- Department of Radiology, Beth Israel Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Catherine J Wei
- Department of Radiology, Mass General Brigham - Salem Hospital, Salem, Massachusetts, USA
| | - Zahra Karimi
- Department of Radiology, Beth Israel Hospital, Boston, Massachusetts, USA
| | - Joshua Kuperman
- Department of Radiology, University of California San Diego, La Jolla, California, USA
| | - Anders M Dale
- Department of Radiology, University of California San Diego, La Jolla, California, USA
- Department of Neurosciences, University of California San Diego, La Jolla, California, USA
| | - Haydee Ojeda-Fournier
- Department of Radiology, University of California San Diego, La Jolla, California, USA
| | - Etta Pisano
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- American College of Radiology, Reston, Virginia, USA
| | - Rebecca Rakow-Penner
- Department of Radiology, University of California San Diego, La Jolla, California, USA
- Department of Bioengineering, University of California San Diego, La Jolla, California, USA
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Almås B, Reisæter LAR, Markhus CE, Hjelle KM, Børretzen A, Beisland C. A preoperative magnetic resonance imaging can aid in staging and treatment choice for upper tract urothelial carcinoma. BJUI COMPASS 2024; 5:476-482. [PMID: 38751955 PMCID: PMC11090765 DOI: 10.1002/bco2.337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/31/2024] [Indexed: 05/18/2024] Open
Abstract
Objectives The aim was to investigate the predictive abilities of a preoperative diffusion-weighted MRI (dwMRI) among patients with surgically treated upper tract urothelial carcinoma (UTUC). Materials and methods Written consent was obtained from all participants in this prospective and ethically approved study. Thirty-five UTUC patients treated with radical surgery were examined with a preoperative dwMRI and prospectively included during 2017-2022. Two radiologists examined the CT scans and dwMRIs for radiological stage, and the apparent diffusion coefficient (ADC) in the tumours at the dwMRI was registered. The radiologists were blinded for patient history, final histopathology and the readings of the other radiologist. The radiological variables were analysed regarding their abilities to predict muscle-invasive disease (MID, T2-T4) and tumour grade at final pathology after radical surgery. The predictive abilities were assessed using chi-square tests, Student's t-test and calculating the area under the curve in a receiver operating characteristic (ROC) curve. Correlation between the two radiologists was quantified calculating the intra-class correlation coefficient. P-values <0.05 were considered statistically significant. Results Mean age was 72 years, 20 had high-grade tumour, and 13 patients had MID. The ADC values at the dwMRI were significantly lower among patients with MID compared to patients with non-muscle-invasive disease (930 vs 1189, p = <0.001). The area under the ROC curve (AUC) in an ROC curve to predict MID was 0.88 (CI 0.77-0.99, p = <0.001). The ADC values were significantly lower among patients with high-grade tumours compared to low-grade tumours (1005 vs 1210, p = 0.002). The correlation of the ADC measurements between the two radiologists was of 0.93 (CI 0.85-0.96, p < 0.001). Conclusion Tumour ADC at the MRI emerges as a potential biomarker for aggressive disease. The results are promising but should be validated in a larger, multicentre study.
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Affiliation(s)
- Bjarte Almås
- Department of UrologyHaukeland University HospitalBergenNorway
- Department of Clinical MedicineUniversity of BergenBergenNorway
| | | | | | - Karin Margrethe Hjelle
- Department of UrologyHaukeland University HospitalBergenNorway
- Department of Clinical MedicineUniversity of BergenBergenNorway
| | - Astrid Børretzen
- Department of PathologyHaukeland University HospitalBergenNorway
| | - Christian Beisland
- Department of UrologyHaukeland University HospitalBergenNorway
- Department of Clinical MedicineUniversity of BergenBergenNorway
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He L, Qin Y, Hu Q, Liu Z, Zhang Y, Ai T. Quantitative characterization of breast lesions and normal fibroglandular tissue using compartmentalized diffusion-weighted model: comparison of intravoxel incoherent motion and restriction spectrum imaging. Breast Cancer Res 2024; 26:71. [PMID: 38658999 PMCID: PMC11044413 DOI: 10.1186/s13058-024-01828-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/15/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND To compare the compartmentalized diffusion-weighted models, intravoxel incoherent motion (IVIM) and restriction spectrum imaging (RSI), in characterizing breast lesions and normal fibroglandular tissue. METHODS This prospective study enrolled 152 patients with 157 histopathologically verified breast lesions (41 benign and 116 malignant). All patients underwent a full-protocol preoperative breast MRI, including a multi-b-value DWI sequence. The diffusion parameters derived from the mono-exponential model (ADC), IVIM model (Dt, Dp, f), and RSI model (C1, C2, C3, C1C2, F1, F2, F3, F1F2) were quantitatively measured and then compared among malignant lesions, benign lesions and normal fibroglandular tissues using Kruskal-Wallis test. The Mann-Whitney U-test was used for the pairwise comparisons. Diagnostic models were built by logistic regression analysis. The ROC analysis was performed using five-fold cross-validation and the mean AUC values were calculated and compared to evaluate the discriminative ability of each parameter or model. RESULTS Almost all quantitative diffusion parameters showed significant differences in distinguishing malignant breast lesions from both benign lesions (other than C2) and normal fibroglandular tissue (all parameters) (all P < 0.0167). In terms of the comparisons of benign lesions and normal fibroglandular tissues, the parameters derived from IVIM (Dp, f) and RSI (C1, C2, C1C2, F1, F2, F3) showed significant differences (all P < 0.005). When using individual parameters, RSI-derived parameters-F1, C1C2, and C2 values yielded the highest AUCs for the comparisons of malignant vs. benign, malignant vs. normal tissue and benign vs. normal tissue (AUCs = 0.871, 0.982, and 0.863, respectively). Furthermore, the combined diagnostic model (IVIM + RSI) exhibited the highest diagnostic efficacy for the pairwise discriminations (AUCs = 0.893, 0.991, and 0.928, respectively). CONCLUSIONS Quantitative parameters derived from the three-compartment RSI model have great promise as imaging indicators for the differential diagnosis of breast lesions compared with the bi-exponential IVIM model. Additionally, the combined model of IVIM and RSI achieves superior diagnostic performance in characterizing breast lesions.
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Affiliation(s)
- Litong He
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, NO. 1095 Jiefang Avenue, Qiaokou District, Wuhan, 430030, China
| | - Yanjin Qin
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58th the Second Zhongshan Road, Guangzhou, 510080, China
| | - Qilan Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, NO. 1095 Jiefang Avenue, Qiaokou District, Wuhan, 430030, China
| | - Zhiqiang Liu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, NO. 1095 Jiefang Avenue, Qiaokou District, Wuhan, 430030, China
| | - Yunfei Zhang
- MR Collaboration, Central Research Institute, United Imaging Healthcare, Shanghai, China
| | - Tao Ai
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, NO. 1095 Jiefang Avenue, Qiaokou District, Wuhan, 430030, China.
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Gullo RL, Partridge SC, Shin HJ, Thakur SB, Pinker K. Update on DWI for Breast Cancer Diagnosis and Treatment Monitoring. AJR Am J Roentgenol 2024; 222:e2329933. [PMID: 37850579 PMCID: PMC11196747 DOI: 10.2214/ajr.23.29933] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
DWI is a noncontrast MRI technique that measures the diffusion of water molecules within biologic tissue. DWI is increasingly incorporated into routine breast MRI examinations. Currently, the main applications of DWI are breast cancer detection and characterization, prognostication, and prediction of treatment response to neoadjuvant chemotherapy. In addition, DWI is promising as a noncontrast MRI alternative for breast cancer screening. Problems with suboptimal resolution and image quality have restricted the mainstream use of DWI for breast imaging, but these shortcomings are being addressed through several technologic advancements. In this review, we present an up-to-date assessment of the use of DWI for breast cancer imaging, including a summary of the clinical literature and recommendations for future use.
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Affiliation(s)
- Roberto Lo Gullo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Savannah C Partridge
- Department of Radiology, University of Washington School of Medicine, University of Washington, Seattle, WA, USA 98109, USA
| | - Hee Jung Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Sunitha B Thakur
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Katja Pinker
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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Fukudome Y, Nagata Y, Yamada Y, Saeki T, Fujikawa T. Two resected cases of benign adenomyoepithelioma. Surg Case Rep 2023; 9:214. [PMID: 38123876 PMCID: PMC10733238 DOI: 10.1186/s40792-023-01793-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Adenomyoepithelioma (AME) of the breast is an uncommon tumor characterized by the proliferation of ductal epithelial and myoepithelial cells with the heterogeneity. Although benign AME is relatively easy to differentiate from breast cancer by core needle biopsy (CNB) alone, a definitive diagnosis is often difficult. The imaging findings of AME are also variable, and there are particularly few reports about radiological features, including contrast-enhanced magnetic resonance imaging (MRI) and apparent diffusion coefficient (ADC) values in AME. CASE PRESENTATION We present two cases of benign AME. Case 1 is a 30-year-old woman with a history of asthma. The cystic tumor shows smooth borders, and the intracystic solid component is irregular in shape and high vascularity. The pathological findings of the tumor were benign on CNB. The MRI scan showed a decreased ADC value. Case 2 is a 60-year-old woman with only a history of arrhythmia. The tumor shows a lobulated mass with cystic space and coarse calcifications. The pathological findings of the tumor were found to be benign by CNB. Dynamic MRI scan showed a fast washout pattern with a decreased ADC value. Both patients underwent excisional biopsy to confirm the diagnosis, and the pathological diagnosis was benign AME in both cases. CONCLUSIONS The AME of the breast has little specific imaging information, so it can be difficult to diagnose based on pathological findings of biopsy specimen. In our case, the ADC values were exceptionally low, contrary to previous reports. It is essential to carefully diagnose AME, considering the discrepancies in imaging findings observed in this case.
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Affiliation(s)
- Yurika Fukudome
- Department of Surgery, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-Ku, Kitakyushu City, Fukuoka, 802-8555, Japan
| | - Yoshika Nagata
- Department of Surgery, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-Ku, Kitakyushu City, Fukuoka, 802-8555, Japan.
| | - Yui Yamada
- Department of Pathology, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-Ku, Kitakyushu City, Fukuoka, 802-8555, Japan
| | - Toshihiro Saeki
- Department of Surgery, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-Ku, Kitakyushu City, Fukuoka, 802-8555, Japan
| | - Takahisa Fujikawa
- Department of Surgery, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-Ku, Kitakyushu City, Fukuoka, 802-8555, Japan
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van der Hoogt KJJ, Schipper RJ, Wessels R, Ter Beek LC, Beets-Tan RGH, Mann RM. Breast DWI Analyzed Before and After Gadolinium Contrast Administration-An Intrapatient Analysis on 1.5 T and 3.0 T. Invest Radiol 2023; 58:832-841. [PMID: 37389456 DOI: 10.1097/rli.0000000000000999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
OBJECTIVES Diffusion-weighted magnetic resonance imaging (MRI) is gaining popularity as an addition to standard dynamic contrast-enhanced breast MRI. Although adding diffusion-weighted imaging (DWI) to the standard protocol design would require increased scanning-time, implementation during the contrast-enhanced phase could offer a multiparametric MRI protocol without any additional scanning time. However, gadolinium within a region of interest (ROI) might affect assessments of DWI. This study aims to determine if acquiring DWI postcontrast, incorporated in an abbreviated MRI protocol, would statistically significantly affect lesion classification. In addition, the effect of postcontrast DWI on breast parenchyma was studied. MATERIALS AND METHODS Screening or preoperative MRIs (1.5 T/3 T) were included for this study. Diffusion-weighted imaging was acquired with single-shot spin echo-echo planar imaging before and at approximately 2 minutes after gadoterate meglumine injection. Apparent diffusion coefficients (ADCs) based on 2-dimensional ROIs of fibroglandular tissue, as well as benign and malignant lesions at 1.5 T/3.0 T, were compared with a Wilcoxon signed rank test. Diffusivity levels were compared between precontrast and postcontrast DWI with weighted κ. An overall P ≤ 0.05 was considered statistically significant. RESULTS No significant changes were observed in ADC mean after contrast administration in 21 patients with 37 ROI of healthy fibroglandular tissue and in the 93 patients with 93 (malignant and benign) lesions. This effect remained after stratification on B 0 . In 18% of all lesions, a diffusion level shift was observed, with an overall weighted κ of 0.75. CONCLUSIONS This study supports incorporating DWI at 2 minutes postcontrast when ADC is calculated based on b150-b800 with 15 mL 0.5 M gadoterate meglumine in an abbreviated multiparametric MRI protocol without requiring extra scan time.
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Affiliation(s)
- Kay J J van der Hoogt
- From the Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands (K.J.J.H., R.-J.S., R.W., R.G.H.B., R.M.M.); GROW School of Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands (K.J.J.H., R.G.H.B.); Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, the Netherlands (R.-J.S.); Department of Medical Physics, the Netherlands Cancer Institute, Amsterdam, the Netherlands (L.C.B.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (R.M.M.); and Danish Colorectal Cancer Unit South, Vejle University Hospital, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark (R.G.H.B.)
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Billy CA, Darmiati S, Prihartono J. Diagnostic accuracy of diffusion weighted imaging compared to magnetic resonance spectroscopy in differentiation of benign and malignant breast lesions: A systematic review and meta-analysis. Eur J Radiol 2023; 168:111124. [PMID: 37820523 DOI: 10.1016/j.ejrad.2023.111124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 07/12/2023] [Accepted: 09/28/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE To compare the sensitivity and specificity of diffusion weighted imaging (DWI) and magnetic resonance spectroscopy (MRS) in the differentiation of benign and malignant breast lesions. METHODS Scopus, PubMed, and other registries were searched up to April 2023. We included diagnostic studies with DWI and MRS as index tests and histopathologic examination as the reference standard for differentiating benign and malignant breast lesions in adult females. We excluded studies involving healthy women, only breast cancer patients, and non-comparative diagnostic accuracy studies on either index test. The sensitivity and specificity of DWI and MRS were investigated and pooled using random-effect bivariate meta-analysis. Risk of bias was assessed using QUADAS-2. Evidence quality was summarized using GRADE. RESULTS Eight eligible studies involving 632 females and 687 breast lesions were identified. The pooled sensitivity and specificity of DWI were 92% (CI 85-96%) and 88% (CI 75-94%), respectively. The pooled sensitivity and specificity of MRS were 85% (CI 66-94%) and 85% (CI 77-91%), respectively. No significant difference was noted in the sensitivity (7%, CI -8-22%) and specificity (3%, CI -9-14%) between DWI and MRS. CONCLUSIONS In low to moderate quality evidence, DWI and MRS show comparable sensitivity and specificity in differentiating benign and malignant breast lesions.
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Affiliation(s)
- Christy Amanda Billy
- Department of Radiology, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine, University of Indonesia, Jakarta 10430, Indonesia.
| | - Sawitri Darmiati
- Department of Radiology, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine, University of Indonesia, Jakarta 10430, Indonesia
| | - Joedo Prihartono
- Department of Community Medicine, Faculty of Medicine, University of Indonesia, Jakarta 10310, Indonesia
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Li X, Fan Z, Jiang H, Niu J, Bian W, Wang C, Wang Y, Zhang R, Zhang H. Synthetic MRI in breast cancer: differentiating benign from malignant lesions and predicting immunohistochemical expression status. Sci Rep 2023; 13:17978. [PMID: 37864025 PMCID: PMC10589282 DOI: 10.1038/s41598-023-45079-2] [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: 07/25/2022] [Accepted: 10/16/2023] [Indexed: 10/22/2023] Open
Abstract
To evaluate and compare the performance of synthetic magnetic resonance imaging (SyMRI) in classifying benign and malignant breast lesions and predicting the expression status of immunohistochemistry (IHC) markers. We retrospectively analysed 121 patients with breast lesions who underwent dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and SyMRI before surgery in our hospital. DCE-MRI was used to assess the lesions, and then regions of interest (ROIs) were outlined on SyMRI (before and after enhancement), and apparent diffusion coefficient (ADC) maps to obtain quantitative values. After being grouped according to benign and malignant status, the malignant lesions were divided into high and low expression groups according to the expression status of IHC markers. Logistic regression was used to analyse the differences in independent variables between groups. The performance of the modalities in classification and prediction was evaluated by receiver operating characteristic (ROC) curves. In total, 57 of 121 lesions were benign, the other 64 were malignant, and 56 malignant lesions performed immunohistochemical staining. Quantitative values from proton density-weighted imaging prior to an injection of the contrast agent (PD-Pre) and T2-weighted imaging (T2WI) after the injection (T2-Gd), as well as its standard deviation (SD of T2-Gd), were valuable SyMRI parameters for the classification of benign and malignant breast lesions, but the performance of SyMRI (area under the curve, AUC = 0.716) was not as good as that of ADC values (AUC = 0.853). However, ADC values could not predict the expression status of breast cancer markers, for which SyMRI had excellent performance. The AUCs of androgen receptor (AR), estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER-2), p53 and Ki-67 were 0.687, 0.890, 0.852, 0.746, 0.813 and 0.774, respectively. SyMRI had certain value in distinguishing between benign and malignant breast lesions, and ADC values were still the ideal method. However, to predict the expression status of IHC markers, SyMRI had an incomparable value compared with ADC values.
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Affiliation(s)
- Xiaojun Li
- Department of Medical Imaging, Shanxi Medical University, Taiyuan, Shanxi, China
- Department of Radiology, Cancer Hospital Chinese Academy of Medical Sciences, Shenzhen Center, Shenzhen, China
| | - Zhichang Fan
- Department of Medical Imaging, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Hongnan Jiang
- Department of Breast Surgery, Cancer Hospital Chinese Academy of Medical Sciences, Shenzhen Center, Shenzhen, China
| | - Jinliang Niu
- Department of Radiology, The 2nd Affiliated Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Wenjin Bian
- Department of Medical Imaging, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Chen Wang
- Department of Pathology, The 2nd Affiliated Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Ying Wang
- Department of Pathology, The 2nd Affiliated Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Runmei Zhang
- Department of Radiology, The 2nd Affiliated Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Hui Zhang
- Department of Radiology, First Hospital of Shanxi Medical University, No. 85, South Jiefang Road, Yingze District, Taiyuan, 030001, Shanxi, China.
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Fischer U. Breast MRI - The champion in the millimeter league: MIO breast MRI - The method of choice in women with dense breasts. Eur J Radiol 2023; 167:111053. [PMID: 37659208 DOI: 10.1016/j.ejrad.2023.111053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/16/2023] [Indexed: 09/04/2023]
Abstract
We perform MRI of the breast as a first pass technique. We successfully established 10-minute-protocols (including T2 images) with a fixed dosage of 5 ml 1 M CM. A high spatial resolution of 526 × 526, better 672 × 672 or maximum (1.024 × 1.024, MIO MRI) is vital to achieve best results. We use fixation tools to avoid motion artifacts. Motion correction algorithms can, however, often eliminate such artifacts when they are present. In initial breast MRI exams, morphologic features are the most important criteria for lesion evaluation. If previous exams are available for comparison, the main criteria indicating a suspicious lesion are an increase in lesion size or the depiction of new lesions. High quality HR MRI of the breast is the method of choice in women with dense or extremely dense breasts in all cases (screening, assessment, follow up). In density type A or B, MRI can be helpful in defined constellations, e.g. when MX and US are limited or contraindicated. According to our experience, 95% or more of all carcinomas of the breast are detectable on MRI. The remaining 5% of MRI-occult lesions are intraductal tumors or very small invasive carcinomas depicted with mammography due to associated microcalcifications. MRI is, however, superior to all other imaging modalities in the detection of the clinically relevant DCIS (high risk DCIS, intermediate type). Consecutive MRI examinations in intervals of 12 to 24 months allow a reliable detection of invasive breast cancer with an average size of 7-8 mm. This corresponds to a rate of metastasis-free locoregional lymph nodes in >95% of cases. The rate of interval cancers is <2%. In conclusion, this strategy may increase the overall-lifetime survival of breast cancer patients to more than 95%. Inversely, mortality may be reduced to <5%. Taking these improvements in early breast cancer detection and survival that can be achieved through the implementation of QA HR MRI of the breast into account, it should be discussed to modify oncologic guidelines for the treatment of breast cancer. MRI is the best diagnostic tool we have and according to our experience, a first pass, quality-assured high-resolution breast MRI protocol provides best diagnostic results at minimal procedural effort.
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Affiliation(s)
- Uwe Fischer
- Diagnostic Breast Care Center, Bahnhofsallee 1d, 37081 Goettingen, Germany.
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Teng X, Zhang J, Zhang X, Fan X, Zhou T, Huang YH, Wang L, Lee EYP, Yang R, Cai J. Noninvasive imaging signatures of HER2 and HR using ADC in invasive breast cancer: repeatability, reproducibility, and association with pathological complete response to neoadjuvant chemotherapy. Breast Cancer Res 2023; 25:77. [PMID: 37381020 DOI: 10.1186/s13058-023-01674-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/13/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND The immunohistochemical test (IHC) of HER2 and HR can provide prognostic information and treatment guidance for invasive breast cancer patients. We aimed to develop noninvasive image signatures ISHER2 and ISHR of HER2 and HR, respectively. We independently evaluate their repeatability, reproducibility, and association with pathological complete response (pCR) to neoadjuvant chemotherapy. METHODS Pre-treatment DWI, IHC receptor status HER2/HR, and pCR to neoadjuvant chemotherapy of 222 patients from the multi-institutional ACRIN 6698 trial were retrospectively collected. They were pre-separated for development, independent validation, and test-retest. 1316 image features were extracted from DWI-derived ADC maps within manual tumor segmentations. ISHER2 and ISHR were developed by RIDGE logistic regression using non-redundant and test-retest reproducible features relevant to IHC receptor status. We evaluated their association with pCR using area under receiver operating curve (AUC) and odds ratio (OR) after binarization. Their reproducibility was further evaluated using the test-retest set with intra-class coefficient of correlation (ICC). RESULTS A 5-feature ISHER2 targeting HER2 was developed (AUC = 0.70, 95% CI 0.59 to 0.82) and validated (AUC = 0.72, 95% CI 0.58 to 0.86) with high perturbation repeatability (ICC = 0.92) and test-retest reproducibility (ICC = 0.83). ISHR was developed using 5 features with higher association with HR during development (AUC = 0.75, 95% CI 0.66 to 0.84) and validation (AUC = 0.74, 95% CI 0.61 to 0.86) and similar repeatability (ICC = 0.91) and reproducibility (ICC = 0.82). Both image signatures showed significant associations with pCR with AUC of 0.65 (95% CI 0.50 to 0.80) for ISHER2 and 0.64 (95% CI 0.50 to 0.78) for ISHER2 in the validation cohort. Patients with high ISHER2 were more likely to achieve pCR to neoadjuvant chemotherapy with validation OR of 4.73 (95% CI 1.64 to 13.65, P value = 0.006). Low ISHR patients had higher pCR with OR = 0.29 (95% CI 0.10 to 0.81, P value = 0.021). Molecular subtypes derived from the image signatures showed comparable pCR prediction values to IHC-based molecular subtypes (P value > 0.05). CONCLUSION Robust ADC-based image signatures were developed and validated for noninvasive evaluation of IHC receptors HER2 and HR. We also confirmed their value in predicting treatment response to neoadjuvant chemotherapy. Further evaluations in treatment guidance are warranted to fully validate their potential as IHC surrogates.
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Affiliation(s)
- Xinzhi Teng
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - Jiang Zhang
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - Xinyu Zhang
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - Xinyu Fan
- Department of Applied Mathematics, The Hong Kong Polytechnic University, Hong Kong, China
| | - Ta Zhou
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - Yu-Hua Huang
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - Lu Wang
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - Elaine Yuen Phin Lee
- Department of Diagnostic Radiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Y920, Lee Shau Kee Building, Hong Kong, China
| | - Ruijie Yang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Jing Cai
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China.
- The Hong Kong Polytechnic University Shenzhen Research Institute, Hong Kong, China.
- Research Institute for Smart Aging, The Hong Kong Polytechnic University, Hong Kong, China.
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An Y. Comment on the value of multiparametric MRI in breast non-mass lesions. Eur J Radiol 2023; 163:110806. [PMID: 37015156 DOI: 10.1016/j.ejrad.2023.110806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 03/26/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023]
Affiliation(s)
- Yongyu An
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), No. 54, Youdian Road, Hangzhou 310006, Zhejiang Province, China.
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Fang LK, Keenan KE, Carl M, Ojeda-Fournier H, Rodríguez-Soto AE, Rakow-Penner RA. Apparent Diffusion Coefficient Reproducibility Across 3 T Scanners in a Breast Diffusion Phantom. J Magn Reson Imaging 2023; 57:812-823. [PMID: 36029225 DOI: 10.1002/jmri.28355] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND To date, the accuracy and variability of diffusion-weighted MRI (DW-MRI) metrics have been reported in a limited number of scanner/protocol/coil combinations. PURPOSE To evaluate the reproducibility of DW-MRI estimates across multiple scanners and DW-MRI protocols and to assess the effects of using an 8-channel vs. 16-channel breast coil in a breast phantom. STUDY TYPE Prospective. PHANTOM Breast phantom containing tubes of water and differing polyvinylpyrrolidone (PVP) concentrations with apparent diffusion coefficients (ADCs) matching breast tissue. FIELD STRENGTH/SEQUENCE 3 T (three standard and one wide bore), three DW-MRI single-shot echo planar imaging protocols of varying acquired spatial resolution. ASSESSMENT Accuracy of estimated ADCs was assessed using percent differences (PD) relative to nuclear magnetic resonance spectroscopy-derived reference values. Coefficients of variation (CV) were calculated to determine variation across scanners. CVs based on the median standard deviation (CVM ) were used to evaluate tube-specific dispersion using 8- or 16-channel coils at a single scanner. ADCs of PVP-containing tubes were additionally normalized by the median water tube ADC to account for temperature effects. STATISTICAL TESTS Two-way repeated measures analysis of variance and post hoc tests were used to evaluate differences in ADC, CV, and CVM across scanners and protocols (α = 0.05). RESULTS ADCs were within 11% (interquartile range [IQR] 7%) of reference values and significantly improved to 2% (IQR 7%) after normalization to an internal water reference. Normalization significantly reduced interscanner variability of ADC estimates from 7% to 4%. DW-MRI protocol did not affect ADC accuracy; however, the clinical and higher-resolution clinical protocols resulted in the greatest (9%) and least (6%) interscanner variability, respectively. The 8- and 16-channel receive coils yielded similar accuracy (PD: 12% vs. 16%) and precision (CVM : 2.7% vs. 2.9%). DATA CONCLUSION Normalization by an internal reference improved interscanner ADC reproducibility. High-resolution protocols yielded comparably accurate and significantly less variable ADCs compared to a clinical standard protocol. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Lauren K Fang
- Department of Radiology, University of California-San Diego, La Jolla, California, USA
| | - Kathryn E Keenan
- National Institute of Science and Technology, Boulder, Colorado, USA
| | | | - Haydee Ojeda-Fournier
- Department of Radiology, University of California-San Diego, La Jolla, California, USA
| | - Ana E Rodríguez-Soto
- Department of Radiology, University of California-San Diego, La Jolla, California, USA
| | - Rebecca A Rakow-Penner
- Department of Radiology, University of California-San Diego, La Jolla, California, USA.,Department of Bioengineering, University of California-San Diego, La Jolla, California, USA
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Lin CX, Tian Y, Li JM, Liao ST, Liu YT, Zhan RG, Du ZL, Yu XR. Diagnostic value of multiple b-value diffusion-weighted imaging in discriminating the malignant from benign breast lesions. BMC Med Imaging 2023; 23:10. [PMID: 36631781 PMCID: PMC9832757 DOI: 10.1186/s12880-022-00950-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 12/14/2022] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE The conventional breast Diffusion-weighted imaging (DWI) was subtly influenced by microcirculation owing to the insufficient selection of the b values. However, the multiparameter derived from multiple b-value exhibits more reliable image quality and maximize the diagnostic accuracy. We aim to evaluate the diagnostic performance of stand-alone parameter or in combination with multiparameter derived from multiple b-value DWI in differentiating malignant from benign breast lesions. METHODS A total of forty-one patients diagnosed with benign breast tumor and thirty-eight patients with malignant breast tumor underwent DWI using thirteen b values and other MRI functional sequence at 3.0 T magnetic resonance. Data were accepted mono-exponential, bi-exponential, stretched-exponential, aquaporins (AQP) model analysis. A receiver operating characteristic curve (ROC) was used to evaluate the diagnostic performance of quantitative parameter or multiparametric combination. The Youden index, sensitivity and specificity were used to assess the optimal diagnostic model. T-test, logistic regression analysis, and Z-test were used. P value < 0.05 was considered statistically significant. RESULT The ADCavg, ADCmax, f, and α value of the malignant group were lower than the benign group, while the ADCfast value was higher instead. The ADCmin, ADCslow, DDC and ADCAQP showed no statistical significance. The combination (ADCavg-ADCfast) yielded the largest area under curve (AUC = 0.807) with sensitivity (68.42%), specificity (87.8%) and highest Youden index, indicating that multiparametric combination (ADCavg-ADCfast) was validated to be a useful model in differentiating the benign from breast malignant lesion. CONCLUSION The current study based on the multiple b-value diffusion model demonstrated quantitatively multiparametric combination (ADCavg-ADCfast) exhibited the optimal diagnostic efficacy to differentiate malignant from benign breast lesions, suggesting that multiparameter would be a promising non-invasiveness to diagnose breast lesions.
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Affiliation(s)
- Chu-Xin Lin
- grid.452930.90000 0004 1757 8087Department of Radiology, Zhuhai Hospital Affiliated With Jinan University (Zhuhai People’s Hospital), 79 Kangning Road, Zhuhai, 519000 People’s Republic of China
| | - Ye Tian
- grid.452930.90000 0004 1757 8087Department of Radiology, Zhuhai Hospital Affiliated With Jinan University (Zhuhai People’s Hospital), 79 Kangning Road, Zhuhai, 519000 People’s Republic of China
| | - Jia-Min Li
- grid.452930.90000 0004 1757 8087Department of Radiology, Zhuhai Hospital Affiliated With Jinan University (Zhuhai People’s Hospital), 79 Kangning Road, Zhuhai, 519000 People’s Republic of China
| | - Shu-Ting Liao
- grid.452930.90000 0004 1757 8087Department of Radiology, Zhuhai Hospital Affiliated With Jinan University (Zhuhai People’s Hospital), 79 Kangning Road, Zhuhai, 519000 People’s Republic of China
| | - Yu-Tao Liu
- grid.452930.90000 0004 1757 8087Department of Radiology, Zhuhai Hospital Affiliated With Jinan University (Zhuhai People’s Hospital), 79 Kangning Road, Zhuhai, 519000 People’s Republic of China
| | - Run-Gen Zhan
- grid.452930.90000 0004 1757 8087Department of Radiology, Zhuhai Hospital Affiliated With Jinan University (Zhuhai People’s Hospital), 79 Kangning Road, Zhuhai, 519000 People’s Republic of China
| | - Zhong-Li Du
- grid.452930.90000 0004 1757 8087Department of Radiology, Zhuhai Hospital Affiliated With Jinan University (Zhuhai People’s Hospital), 79 Kangning Road, Zhuhai, 519000 People’s Republic of China
| | - Xiang-Rong Yu
- grid.452930.90000 0004 1757 8087Department of Radiology, Zhuhai Hospital Affiliated With Jinan University (Zhuhai People’s Hospital), 79 Kangning Road, Zhuhai, 519000 People’s Republic of China
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Evaluation of pretreatment ADC values as predictors of treatment response to neoadjuvant chemotherapy in patients with breast cancer - a multicenter study. Cancer Imaging 2022; 22:68. [PMID: 36494872 PMCID: PMC9733082 DOI: 10.1186/s40644-022-00501-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/25/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) can be used to diagnose breast cancer. Diffusion weighted imaging (DWI) and the apparent diffusion coefficient (ADC) can reflect tumor microstructure in a non-invasive manner. The correct prediction of response of neoadjuvant chemotherapy (NAC) is crucial for clinical routine. Our aim was to compare ADC values between patients with pathological complete response (pCR) and non-responders based upon a multi-center design to improve the correct patient selection, which patient would more benefit from NAC and which patient would not. METHODS For this study, data from 4 centers (from Japan, Brazil, Spain and United Kingdom) were retrospectively acquired. The time period was overall 2003-2019. The patient sample comprises 250 patients (all female; median age, 50.5). In every case, pretreatment breast MRI with DWI was performed. pCR was assessed by experienced pathologists in every center using the surgical specimen in the clinical routine work up. pCR was defined as no residual invasive disease in either breast or axillary lymph nodes after NAC. ADC values between the group with pCR and those with no pCR were compared using the Mann-Whitney U test (two-group comparisons). Univariable and multivariabe logistic regression analysis was performed to predict pCR status. RESULTS Overall, 83 patients (33.2%) achieved pCR. The ADC values of the patient group with pCR were lower compared with patients without pCR (0.98 ± 0.23 × 10- 3 mm2/s versus 1.07 ± 0.24 × 10- 3 mm2/s, p = 0.02). The ADC value achieved an odds ratio of 4.65 (95% CI 1.40-15.49) in univariable analysis and of 3.0 (95% CI 0.85-10.63) in multivariable analysis (overall sample) to be associated with pCR status. The odds ratios differed in the subgroup analyses in accordance with the molecular subtype. CONCLUSIONS The pretreatment ADC-value is associated with pathological complete response after NAC in breast cancer patients. This could aid in clinical routine to reduce treatment toxicity for patients, who would not benefit from NAC. However, this must be tested in further studies, as the overlap of the ADC values in both groups is too high for clinical prediction.
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Orguc S, Açar ÇR. Correlation of Shear-Wave Elastography and Apparent Diffusion Coefficient Values in Breast Cancer and Their Relationship with the Prognostic Factors. Diagnostics (Basel) 2022; 12:diagnostics12123021. [PMID: 36553027 PMCID: PMC9776617 DOI: 10.3390/diagnostics12123021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/26/2022] [Accepted: 11/30/2022] [Indexed: 12/03/2022] Open
Abstract
Background: Diffusion-weighted imaging and elastography are widely accepted methods in the evaluation of breast masses, however, there is very limited data comparing the two methods. The apparent diffusion coefficient is a measure of the diffusion of water molecules obtained by diffusion-weighted imaging as a part of breast MRI. Breast elastography is an adjunct to conventional ultrasonography, which provides a noninvasive evaluation of the stiffness of the lesion. Theoretically, increased tissue density and stiffness are related to each other. The purpose of this study is to compare MRI ADC values of the breast masses with quantitative elastography based on ultrasound shear wave measurements and to investigate their possible relation with the prognostic factors and molecular subtypes. Methods: We retrospectively evaluated histopathologically proven 147 breast lesions. The molecular classification of malignant lesions was made according to the prognostic factors. Shear wave elastography was measured in kiloPascal (kPa) units which is a quantitative measure of tissue stiffness. DWI was obtained using a 1.5-T MRI system. Results: ADC values were strongly inversely correlated with elasticity (r = −0.662, p < 0.01) according to Pearson Correlation. In our study, the cut-off value of ADC was 1.00 × 10−3 cm2/s to achieve a sensitivity of 84.6% and specificity of 75.4%, and the cut-off value of elasticity was 105.5 kPa to achieve the sensitivity of 96.3% and specificity 76.9% to discriminate between the malignant and benign breast lesions. The status of prognostic factors was not correlated with the ADC values and elasticity. Conclusions: Elasticity and ADC values are correlated. Both cannot predict the status of prognostic factors and differentiate between molecular subtypes.
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Penn A, Medved M, Abe H, Dialani V, Karczmar GS, Brousseau D. Safely reducing unnecessary benign breast biopsies by applying non-mass and DWI directional variance filters to ADC thresholding. BMC Med Imaging 2022; 22:171. [PMID: 36175878 PMCID: PMC9524062 DOI: 10.1186/s12880-022-00897-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 09/15/2022] [Indexed: 11/10/2022] Open
Abstract
Background Thresholding apparent diffusion coefficient (ADC) maps obtained from Diffusion-Weighted-Imaging (DWI) has been proposed for identifying benign lesions that can safely avoid biopsy. The presence of malignancies with high ADC values leads to high thresholds, limiting numbers of avoidable biopsies.
Purpose We evaluate two previously reported methods for identifying avoidable biopsies: using case-set dependent ADC thresholds that assure 100% sensitivity and using negative likelihood ratio (LR-) with a fixed ADC threshold of 1.50 × 10–3 mm2/s. We evaluated improvements in efficacy obtained by excluding non-mass lesions and lesions with anisotropic intra-lesion morphologic characteristics. Study type Prospective. Population 55 adult females with dense breasts with 69 BI-RADS 4 or 5 lesions (38 malignant, 31 benign) identified on ultrasound and mammography and imaged with MRI prior to biopsy. Field strength/sequence 1.5 T and 3.0 T. DWI. Assessment Analysis of DWI, including directional images was done on an ROI basis. ROIs were drawn on DWI images acquired prior to biopsy, referencing all available images including DCE, and mean ADC was measured. Anisotropy was quantified via variation in ADC values in the lesion core across directional DWI images. Statistical tests Improvement in specificity at 100% sensitivity was evaluated with exact McNemar test with 1-sided p-value < 0.05 indicating statistical significance. Results Using ADC thresholding that assures 100% sensitivity, non-mass and directional variance filtering improved the percent of avoidable biopsies to 42% from baseline of 10% achieved with ADC thresholding alone. Using LR-, filtering improved outcome to 0.06 from baseline 0.25 with ADC thresholding alone. ADC thresholding showed a lower percentage of avoidable biopsies in our cohort than reported in prior studies. When ADC thresholding was supplemented with filtering, the percentage of avoidable biopsies exceeded those of prior studies. Data conclusion Supplementing ADC thresholding with filters excluding non-mass lesions and lesions with anisotropic characteristics on DWI can result in an increased number of avoidable biopsies.
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Affiliation(s)
- Alan Penn
- Alan Penn and Associates, Inc., Rockville, MD, 20850, USA.
| | | | | | - Vandana Dialani
- Beth Israel Deaconess Medical Center, Boston, MA, 02467, USA
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Fang S, Zhu J, Wang Y, Zhou J, Wang G, Xu W, Zhang W. The value of whole-lesion histogram analysis based on field‑of‑view optimized and constrained undistorted single shot (FOCUS) DWI for predicting axillary lymph node status in early-stage breast cancer. BMC Med Imaging 2022; 22:163. [PMID: 36088299 PMCID: PMC9464403 DOI: 10.1186/s12880-022-00891-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/31/2022] [Indexed: 12/28/2022] Open
Abstract
Abstract
Background
This study aims to estimate the amount of axillary lymph node (ALN) involvement in early-stage breast cancer utilizing a field of view (FOV) optimized and constrained undistorted single-shot (FOCUS) diffusion-weighted imaging (DWI) approach, as well as a whole-lesion histogram analysis.
Methods
This retrospective analysis involved 81 individuals with invasive breast cancer. The patients were divided into three groups: N0 (negative ALN metastasis), N1–2 (low metastatic burden with 1–2 ALNs), and N≥3 (heavy metastatic burden with ≥ 3 ALNs) based on their sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND). Histogram parameters of apparent diffusion coefficient (ADC) depending basically on FOCUS DWI were performed using 3D-Slicer software for whole lesions. The typical histogram characteristics for N0, N1–2, and N≥ 3 were compared to identify the significantly different parameters. To determine the diagnostic efficacy of significantly different factors, the area under their receiver operating characteristic (ROC) curves was examined.
Results
There were significant differences in the energy, maximum, 90 percentile, range, and lesion size among N0, N1–2, and N≥ 3 groups (P < 0.05). The energy differed significantly between N0 and N1–2 groups (P < 0.05), and some certain ADC histogram parameters and lesion sizes differed significantly between N0 and N≥3, or N1–2 and N≥3 groups. For ROC analysis, the energy yielded the best diagnostic performance in distinguishing N0 and N1–2 groups from N≥3 group with an AUC value of0.853. All parameters revealed excellent inter-observer agreement with inter-reader consistencies data ranging from0.919 to 0.982.
Conclusion
By employing FOCUS DWI method, the analysis of whole-lesion ADC histogram quantitatively provides a non-invasive way to evaluate the degree of ALN metastatic spread in early-stage breast cancer.
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Armani M, Lissavarid É, Dyien B, Manceau J, Bereby Kahane M, Malhaire C, Tardivon A. Lésions classées ACR3 en IRM mammaire. IMAGERIE DE LA FEMME 2022. [DOI: 10.1016/j.femme.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Galati F, Rizzo V, Moffa G, Caramanico C, Kripa E, Cerbelli B, D’Amati G, Pediconi F. Radiologic-pathologic correlation in breast cancer: do MRI biomarkers correlate with pathologic features and molecular subtypes? Eur Radiol Exp 2022; 6:39. [PMID: 35934721 PMCID: PMC9357588 DOI: 10.1186/s41747-022-00289-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/03/2022] [Indexed: 11/21/2022] Open
Abstract
Background Breast cancer (BC) includes different pathological and molecular subtypes. This study aimed to investigate whether multiparametric magnetic resonance imaging (mpMRI) could reliably predict the molecular status of BC, comparing mpMRI features with pathological and immunohistochemical results. Methods This retrospective study included 156 patients with an ultrasound-guided biopsy-proven BC, who underwent breast mpMRI (including diffusion-weighted imaging) on a 3-T scanner from 2017 to 2020. Histopathological analyses were performed on the surgical specimens. Kolmogorov–Smirnov Z, χ2, and univariate and multivariate logistic regression analyses were performed. Results Fifteen patients were affected with ductal carcinoma in situ, 122 by invasive carcinoma of no special type, and 19 with invasive lobular carcinoma. Out of a total of 141 invasive cancers, 45 were luminal A-like, 54 luminal B-like, 5 human epidermal growth factor receptor 2 (HER2) positive, and 37 triple negative. The regression analyses showed that size < 2 cm predicted luminal A-like status (p = 0.025), while rim enhancement (p < 0.001), intralesional necrosis (p = 0.001), peritumoural oedema (p < 0.001), and axillary adenopathies (p = 0.012) were negative predictors. Oppositely, round shape (p = 0.001), rim enhancement (p < 0.001), intralesional necrosis (p < 0.001), and peritumoural oedema (p < 0.001) predicted triple-negative status. Conclusions mpMRI has been confirmed to be a valid noninvasive predictor of BC subtypes, especially luminal A and triple negative. Considering the central role of pathology in BC diagnosis and immunohistochemical profiling in the current precision medicine era, a detailed radiologic-pathologic correlation seems vital to properly evaluate BC.
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Mendez AM, Fang LK, Meriwether CH, Batasin SJ, Loubrie S, Rodríguez-Soto AE, Rakow-Penner RA. Diffusion Breast MRI: Current Standard and Emerging Techniques. Front Oncol 2022; 12:844790. [PMID: 35880168 PMCID: PMC9307963 DOI: 10.3389/fonc.2022.844790] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
The role of diffusion weighted imaging (DWI) as a biomarker has been the subject of active investigation in the field of breast radiology. By quantifying the random motion of water within a voxel of tissue, DWI provides indirect metrics that reveal cellularity and architectural features. Studies show that data obtained from DWI may provide information related to the characterization, prognosis, and treatment response of breast cancer. The incorporation of DWI in breast imaging demonstrates its potential to serve as a non-invasive tool to help guide diagnosis and treatment. In this review, current technical literature of diffusion-weighted breast imaging will be discussed, in addition to clinical applications, advanced techniques, and emerging use in the field of radiomics.
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Affiliation(s)
- Ashley M. Mendez
- Department of Radiology, University of California San Diego, La Jolla, CA, United States
| | - Lauren K. Fang
- Department of Radiology, University of California San Diego, La Jolla, CA, United States
| | - Claire H. Meriwether
- Department of Radiology, University of California San Diego, La Jolla, CA, United States
| | - Summer J. Batasin
- Department of Radiology, University of California San Diego, La Jolla, CA, United States
| | - Stéphane Loubrie
- Department of Radiology, University of California San Diego, La Jolla, CA, United States
| | - Ana E. Rodríguez-Soto
- Department of Radiology, University of California San Diego, La Jolla, CA, United States
| | - Rebecca A. Rakow-Penner
- Department of Radiology, University of California San Diego, La Jolla, CA, United States,Department of Bioengineering, University of California San Diego, La Jolla, CA, United States,*Correspondence: Rebecca A. Rakow-Penner,
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James AD, Leslie TK, Kaggie JD, Wiggins L, Patten L, Murphy O'Duinn J, Langer S, Labarthe MC, Riemer F, Baxter G, McLean MA, Gilbert FJ, Kennerley AJ, Brackenbury WJ. Sodium accumulation in breast cancer predicts malignancy and treatment response. Br J Cancer 2022; 127:337-349. [PMID: 35462561 PMCID: PMC9296657 DOI: 10.1038/s41416-022-01802-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 03/10/2022] [Accepted: 03/22/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Breast cancer remains a leading cause of death in women and novel imaging biomarkers are urgently required. Here, we demonstrate the diagnostic and treatment-monitoring potential of non-invasive sodium (23Na) MRI in preclinical models of breast cancer. METHODS Female Rag2-/- Il2rg-/- and Balb/c mice bearing orthotopic breast tumours (MDA-MB-231, EMT6 and 4T1) underwent MRI as part of a randomised, controlled, interventional study. Tumour biology was probed using ex vivo fluorescence microscopy and electrophysiology. RESULTS 23Na MRI revealed elevated sodium concentration ([Na+]) in tumours vs non-tumour regions. Complementary proton-based diffusion-weighted imaging (DWI) linked elevated tumour [Na+] to increased cellularity. Combining 23Na MRI and DWI measurements enabled superior classification accuracy of tumour vs non-tumour regions compared with either parameter alone. Ex vivo assessment of isolated tumour slices confirmed elevated intracellular [Na+] ([Na+]i); extracellular [Na+] ([Na+]e) remained unchanged. Treatment with specific inward Na+ conductance inhibitors (cariporide, eslicarbazepine acetate) did not affect tumour [Na+]. Nonetheless, effective treatment with docetaxel reduced tumour [Na+], whereas DWI measures were unchanged. CONCLUSIONS Orthotopic breast cancer models exhibit elevated tumour [Na+] that is driven by aberrantly elevated [Na+]i. Moreover, 23Na MRI enhances the diagnostic capability of DWI and represents a novel, non-invasive biomarker of treatment response with superior sensitivity compared to DWI alone.
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Affiliation(s)
- Andrew D James
- Department of Biology, University of York, York, UK
- York Biomedical Research Institute, University of York, York, UK
| | | | - Joshua D Kaggie
- Department of Radiology & NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | | | - Lewis Patten
- Department of Mathematics, University of York, York, UK
| | | | - Swen Langer
- Bioscience Technology Facility, Department of Biology, University of York, York, UK
| | | | - Frank Riemer
- Mohn Medical Imaging and Visualization Centre, Haukeland University Hospital Bergen, Bergen, Norway
| | - Gabrielle Baxter
- Department of Radiology & NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Mary A McLean
- Department of Radiology & NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Fiona J Gilbert
- Department of Radiology & NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Aneurin J Kennerley
- York Biomedical Research Institute, University of York, York, UK
- Department of Chemistry, University of York, York, UK
| | - William J Brackenbury
- Department of Biology, University of York, York, UK.
- York Biomedical Research Institute, University of York, York, UK.
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22
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Lv W, Zheng D, Guan W, Wu P. Contribution of Diffusion-Weighted Imaging and ADC Values to Papillary Breast Lesions. Front Oncol 2022; 12:911790. [PMID: 35847891 PMCID: PMC9279724 DOI: 10.3389/fonc.2022.911790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
This study aimed to evaluate the role of apparent diffusion coefficient (ADC) values obtained from diffusion-weighted imaging (DWI) in the differentiation of malignant from benign papillary breast lesions. The magnetic resonance imaging (MRI) data of 94 breast papillary lesions confirmed by pathology were retrospectively analyzed. The differences in ADC values of papillary lesions under different enhancements in MRI and different pathological types were investigated, and the ADC threshold was determined by the receiver operating characteristic curve for its potential diagnostic value. The mean ADC values in borderline and malignant lesions (1.01 ± 0.20 × 10-3 mm2/s) were significantly lower compared to benign lesions (1.21 ± 0.27 × 10-3 mm2/s) (P < 0.05). The optimal threshold of the ADC value could be 1.00 × 10-3 mm2/s. The ADC values were statistically significant in differentiating between benign and malignant papillary lesions whether in mass or non-mass enhancement (P < 0.05). However, there were no statistical differences in the ADC values among borderline or any other histological subtypes of malignant lesions (P > 0.05). Measuring ADC values from DWI can be used to identify benign and malignant breast papillary lesions. The diagnostic performance of the ADC value in identifying benign and malignant breast lesions is not affected by the way of lesion enhancement. However, it shows no use for differential diagnosis among malignant lesion subtypes for now. The ADC value of 1.00 × 10-3 mm2/s can be used as the most appropriate threshold for distinguishing between benign and malignant breast papillary lesions.
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Affiliation(s)
- Wenjie Lv
- Department of Breast Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dawen Zheng
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenbin Guan
- Department of Pathology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ping Wu
- Department of Breast Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Ping Wu,
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23
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Besser AH, Fang LK, Tong MW, Sjaastad Andreassen MM, Ojeda-Fournier H, Conlin CC, Loubrie S, Seibert TM, Hahn ME, Kuperman JM, Wallace AM, Dale AM, Rodríguez-Soto AE, Rakow-Penner RA. Tri-Compartmental Restriction Spectrum Imaging Breast Model Distinguishes Malignant Lesions from Benign Lesions and Healthy Tissue on Diffusion-Weighted Imaging. Cancers (Basel) 2022; 14:cancers14133200. [PMID: 35804972 PMCID: PMC9264763 DOI: 10.3390/cancers14133200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/25/2022] [Accepted: 06/27/2022] [Indexed: 02/02/2023] Open
Abstract
Diffusion-weighted MRI (DW-MRI) offers a potential adjunct to dynamic contrast-enhanced MRI to discriminate benign from malignant breast lesions by yielding quantitative information about tissue microstructure. Multi-component modeling of the DW-MRI signal over an extended b-value range (up to 3000 s/mm2) theoretically isolates the slowly diffusing (restricted) water component in tissues. Previously, a three-component restriction spectrum imaging (RSI) model demonstrated the ability to distinguish malignant lesions from healthy breast tissue. We further evaluated the utility of this three-component model to differentiate malignant from benign lesions and healthy tissue in 12 patients with known malignancy and synchronous pathology-proven benign lesions. The signal contributions from three distinct diffusion compartments were measured to generate parametric maps corresponding to diffusivity on a voxel-wise basis. The three-component model discriminated malignant from benign and healthy tissue, particularly using the restricted diffusion C1 compartment and product of the restricted and intermediate diffusion compartments (C1 and C2). However, benign lesions and healthy tissue did not significantly differ in diffusion characteristics. Quantitative discrimination of these three tissue types (malignant, benign, and healthy) in non-pre-defined lesions may enhance the clinical utility of DW-MRI in reducing excessive biopsies and aiding in surveillance and surgical evaluation without repeated exposure to gadolinium contrast.
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Affiliation(s)
- Alexandra H. Besser
- Department of Radiology, University of California-San Diego, La Jolla, CA 92093, USA; (A.H.B.); (L.K.F.); (M.W.T.); (H.O.-F.); (C.C.C.); (S.L.); (T.M.S.); (M.E.H.); (J.M.K.); (A.M.D.); (A.E.R.-S.)
| | - Lauren K. Fang
- Department of Radiology, University of California-San Diego, La Jolla, CA 92093, USA; (A.H.B.); (L.K.F.); (M.W.T.); (H.O.-F.); (C.C.C.); (S.L.); (T.M.S.); (M.E.H.); (J.M.K.); (A.M.D.); (A.E.R.-S.)
| | - Michelle W. Tong
- Department of Radiology, University of California-San Diego, La Jolla, CA 92093, USA; (A.H.B.); (L.K.F.); (M.W.T.); (H.O.-F.); (C.C.C.); (S.L.); (T.M.S.); (M.E.H.); (J.M.K.); (A.M.D.); (A.E.R.-S.)
| | - Maren M. Sjaastad Andreassen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Postboks 8905, 7491 Trondheim, Norway;
| | - Haydee Ojeda-Fournier
- Department of Radiology, University of California-San Diego, La Jolla, CA 92093, USA; (A.H.B.); (L.K.F.); (M.W.T.); (H.O.-F.); (C.C.C.); (S.L.); (T.M.S.); (M.E.H.); (J.M.K.); (A.M.D.); (A.E.R.-S.)
| | - Christopher C. Conlin
- Department of Radiology, University of California-San Diego, La Jolla, CA 92093, USA; (A.H.B.); (L.K.F.); (M.W.T.); (H.O.-F.); (C.C.C.); (S.L.); (T.M.S.); (M.E.H.); (J.M.K.); (A.M.D.); (A.E.R.-S.)
| | - Stéphane Loubrie
- Department of Radiology, University of California-San Diego, La Jolla, CA 92093, USA; (A.H.B.); (L.K.F.); (M.W.T.); (H.O.-F.); (C.C.C.); (S.L.); (T.M.S.); (M.E.H.); (J.M.K.); (A.M.D.); (A.E.R.-S.)
| | - Tyler M. Seibert
- Department of Radiology, University of California-San Diego, La Jolla, CA 92093, USA; (A.H.B.); (L.K.F.); (M.W.T.); (H.O.-F.); (C.C.C.); (S.L.); (T.M.S.); (M.E.H.); (J.M.K.); (A.M.D.); (A.E.R.-S.)
- Department of Radiation Medicine and Applied Sciences, University of California-San Diego, La Jolla, CA 92093, USA
- Department of Bioengineering, University of California-San Diego, La Jolla, CA 92093, USA
| | - Michael E. Hahn
- Department of Radiology, University of California-San Diego, La Jolla, CA 92093, USA; (A.H.B.); (L.K.F.); (M.W.T.); (H.O.-F.); (C.C.C.); (S.L.); (T.M.S.); (M.E.H.); (J.M.K.); (A.M.D.); (A.E.R.-S.)
| | - Joshua M. Kuperman
- Department of Radiology, University of California-San Diego, La Jolla, CA 92093, USA; (A.H.B.); (L.K.F.); (M.W.T.); (H.O.-F.); (C.C.C.); (S.L.); (T.M.S.); (M.E.H.); (J.M.K.); (A.M.D.); (A.E.R.-S.)
| | - Anne M. Wallace
- Department of Surgery, University of California-San Diego, La Jolla, CA 92093, USA;
| | - Anders M. Dale
- Department of Radiology, University of California-San Diego, La Jolla, CA 92093, USA; (A.H.B.); (L.K.F.); (M.W.T.); (H.O.-F.); (C.C.C.); (S.L.); (T.M.S.); (M.E.H.); (J.M.K.); (A.M.D.); (A.E.R.-S.)
- Department of Neuroscience, University of California-San Diego, La Jolla, CA 92093, USA
| | - Ana E. Rodríguez-Soto
- Department of Radiology, University of California-San Diego, La Jolla, CA 92093, USA; (A.H.B.); (L.K.F.); (M.W.T.); (H.O.-F.); (C.C.C.); (S.L.); (T.M.S.); (M.E.H.); (J.M.K.); (A.M.D.); (A.E.R.-S.)
| | - Rebecca A. Rakow-Penner
- Department of Radiology, University of California-San Diego, La Jolla, CA 92093, USA; (A.H.B.); (L.K.F.); (M.W.T.); (H.O.-F.); (C.C.C.); (S.L.); (T.M.S.); (M.E.H.); (J.M.K.); (A.M.D.); (A.E.R.-S.)
- Department of Bioengineering, University of California-San Diego, La Jolla, CA 92093, USA
- Correspondence:
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24
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Meyer HJ, Martin M, Denecke T. DWI of the Breast - Possibilities and Limitations. ROFO-FORTSCHR RONTG 2022; 194:966-974. [PMID: 35439830 DOI: 10.1055/a-1775-8572] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The MRI of the breast is of great importance in the diagnosis of disorders of the breast. This can be stated for the primary diagnosis as well as the follow up. Of special interest is diffusion weighted imaging (DWI), which has an increasingly important role. The present review provides results regarding the diagnostic and prognostic relevance of DWI for disorders of the breast. METHODS Under consideration of the recently published literature, the clinical value of DWI of the breast is discussed. Several diagnostic applications are shown, especially for the primary diagnosis of unclear tumors of the breast, the prediction of the axillary lymph node status and the possibility of a native screening. Moreover, correlations between DWI and histopathology features and treatment prediction with DWI are provided. RESULTS Many studies have shown the diagnostic value of DWI for the primary diagnosis of intramammary lesions. Benign lesions of the breast have significantly higher apparent diffusion coefficients (ADC values) compared to malignant tumors. This can be clinically used to reduce unnecessary biopsies in clinical routine. However, there are inconclusive results for the prediction of the histological subtype of the breast cancer. DWI can aid in the prediction of treatment to neoadjuvant chemotherapy. CONCLUSION DWI is a very promising imaging modality, which should be included in the standard protocol of the MRI of the breast. DWI can provide clinically value in the diagnosis as well as for prognosis in breast cancer. KEY POINTS · DWI can aid in the discrimination between benign and malignant tumors of the breast and therefore avoiding unnecessary biopsies.. · The ADC value cannot discriminate between immunhistochemical subtypes of the breast cancer. · The ADC value of breast cancer increases under neoadjuvant chemotherapy and can by this aid in treatment prediction.. · There is definite need of standardisation for clinical translation. CITATION FORMAT · Meyer HJ, Martin M, Denecke T. DWI of the Breast - Possibilities and Limitations. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1775-8572.
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Affiliation(s)
- Hans Jonas Meyer
- Diagnostic and Interventional Radiology, University of Leipzig Faculty of Medicine, Leipzig, Germany
| | - Mireille Martin
- Diagnostic and Interventional Radiology, University of Leipzig Faculty of Medicine, Leipzig, Germany
| | - Timm Denecke
- Diagnostic and Interventional Radiology, University of Leipzig Faculty of Medicine, Leipzig, Germany
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25
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Aybar MD, Turna O. Evaluation of Different Types of Breast Lesions With Apparent Diffusion Coefficient and Shear Wave Elastography Values: Comparison of Shear Wave Elastography and Apparent Diffusion Coefficient in Breast Lesions. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2022. [DOI: 10.1177/87564793221091245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The aim of this study was to compare the stiffness of different histological types of breast lesions by obtaining shear wave elastography (SWE) and apparent diffusion coefficient (ADC) values, and to determine the contribution of these two methods to the diagnosis. Materials and Methods: In total, 70 patients with biopsy-proven breast lesions were included in the study. The mean SWE values of breast lesions were recorded and ADC values of these lesions were calculated. Receiver operating characteristic (ROC) curve analyses and the diagnostic accuracies of SWE-ADC values were determined. Results: The mean SWE values were 45.47 ± 25.11 kPa and 3.51 ± 1.04 m/s in benign group, and 161.11 ± 219.34 kPa and 5.96 ± 1.06 m/s in malignant group, respectively. The mean ADC values were 1.38 ± 0.32 (×10–3 mm2/s) in benign group and 0.96 ± 0.22 (×10–3 mm2/s) in malignant group, respectively. When the diagnostic performances of both imaging modalities on mass stiffness are evaluated, statistically significant negative correlations were found between SWE lesion values and ADC lesion values. Conclusion: Evaluation of tissue elasticity has recently been used frequently in the diagnosis of breast diseases. SWE-ADC values, which are negatively correlated in the diagnosis of breast masses, may prove to be a powerful alternative diagnostic tool that can be used interchangeably, as appropriate.
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Affiliation(s)
- M. Devran Aybar
- Medical Imaging Techniques, Istanbul Gelişim University, Istanbul, Turkey
| | - Onder Turna
- Mehmet Akif Ersoy Training and Research Hospital Radiology Department, Istanbul, Turkey
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26
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Keenan KE, Delfino JG, Jordanova KV, Poorman ME, Chirra P, Chaudhari AS, Baessler B, Winfield J, Viswanath SE, deSouza NM. Challenges in ensuring the generalizability of image quantitation methods for MRI. Med Phys 2022; 49:2820-2835. [PMID: 34455593 PMCID: PMC8882689 DOI: 10.1002/mp.15195] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 08/17/2021] [Accepted: 08/17/2021] [Indexed: 01/31/2023] Open
Abstract
Image quantitation methods including quantitative MRI, multiparametric MRI, and radiomics offer great promise for clinical use. However, many of these methods have limited clinical adoption, in part due to issues of generalizability, that is, the ability to translate methods and models across institutions. Researchers can assess generalizability through measurement of repeatability and reproducibility, thus quantifying different aspects of measurement variance. In this article, we review the challenges to ensuring repeatability and reproducibility of image quantitation methods as well as present strategies to minimize their variance to enable wider clinical implementation. We present possible solutions for achieving clinically acceptable performance of image quantitation methods and briefly discuss the impact of minimizing variance and achieving generalizability towards clinical implementation and adoption.
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Affiliation(s)
- Kathryn E. Keenan
- Physical Measurement Laboratory, National Institute of Standards and Technology, 325 Broadway, Boulder, CO 80305, USA
| | - Jana G. Delfino
- Center for Devices and Radiological Health, US Food and Drug Administration, 10993 New Hampshire Ave, Silver Spring, MD 20993, USA
| | - Kalina V. Jordanova
- Physical Measurement Laboratory, National Institute of Standards and Technology, 325 Broadway, Boulder, CO 80305, USA
| | - Megan E. Poorman
- Physical Measurement Laboratory, National Institute of Standards and Technology, 325 Broadway, Boulder, CO 80305, USA
| | - Prathyush Chirra
- Dept of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, USA
| | - Akshay S. Chaudhari
- Department of Radiology, Stanford University, 450 Serra Mall, Stanford, CA 94305, USA
- Department of Biomedical Data Science, Stanford University, 450 Serra Mall, Stanford, CA 94305, USA
| | - Bettina Baessler
- University Hospital of Zurich and University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Jessica Winfield
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
- MRI Unit, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
| | - Satish E. Viswanath
- Dept of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, USA
| | - Nandita M. deSouza
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
- MRI Unit, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
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27
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Gültekina MA, Yabul FÇ, Temur HO, Sari L, Yilmaz TF, Toprak H, Yildiz S. Papillary Lesions of the Breast: Addition of DWI and TIRM Sequences to Routine Breast MRI Could Help in Differentiation Benign from Malignant. Curr Med Imaging 2022; 18:962-969. [PMID: 35184715 DOI: 10.2174/1573405618666220218101931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 11/17/2021] [Accepted: 12/20/2021] [Indexed: 11/22/2022]
Abstract
AIM We aimed to investigate the magnetic resonance imaging (MRI) features of benign, atypical or malignant papillary breast lesions and to assess additional value of diffusion-weighted imaging (DWI) and turbo inversion recovery magnitude (TIRM) sequences to routine breast MRI. BACKGROUND Differentiation between benign and malignant papillary breast lesions is essential for patient management. However, morphologic features and enhancement patterns of malignant papillary lesions may overlap with those of benign papilloma. METHODS Seventy two papillary breast lesions (50 benign, 22 atypical or malignant) were included in the current study, retrospectively. We divided the patients into two groups as benign papillary breast lesions and atypical or malignant papillary breast lesions. Morphologic, dynamic, turbo inversion recovery magnitude (TIRM) values and diffusion features of the papillary lesions were compared between two groups. RESULTS Benign papillary lesions were smaller in size (p=0.006 and p=0.005, for radiologist 1 and 2 respectively), closer to areola (p=0.045 and 0.049 for radiologist 1 and 2 respectively) and had higher ADC values (p=0.001 for two radiologists) than atypical or malignant group. ROC curves showed diagnostic accuracy for ADC (AUC=0.770 and 0.762, p<0.0001 for two radiologists) and showed a cut-off value of ≤957 x 10-6 mm2/s (radiologist 1) and ≤ 910 x 10-6 mm2/s (radiologist 2). CONCLUSION MRI is a useful method for differentiation between benign and malignant papillary breast lesions. Centrally located, lesser in size and higher ADC values should be considered benign, whereas peripherally located, larger in size and lower ADC values should be considered malignant.
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Affiliation(s)
- Mehmet Ali Gültekina
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Fatma Çelik Yabul
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Hafize Otçu Temur
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Lutfullah Sari
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Temel Fatih Yilmaz
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Hüseyin Toprak
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Seyma Yildiz
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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28
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Meyer HJ, Wienke A, Surov A. Diffusion-Weighted Imaging of Different Breast Cancer Molecular Subtypes: A Systematic Review and Meta-Analysis. Breast Care (Basel) 2022; 17:47-54. [PMID: 35355697 PMCID: PMC8914237 DOI: 10.1159/000514407] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 01/08/2021] [Indexed: 02/03/2023] Open
Abstract
Background Magnetic resonance imaging can be used to diagnose breast cancer (BC). Diffusion-weighted imaging (DWI) and the apparent diffusion coefficient (ADC) can be used to reflect tumor microstructure. Objectives This analysis aimed to compare ADC values between molecular subtypes of BC based on a large sample of patients. Method The MEDLINE library and Scopus database were screened for the associations between ADC and molecular subtypes of BC up to April 2020. The primary end point of the systematic review was the ADC value in different BC subtypes. Overall, 28 studies were included. Results The included studies comprised a total of 2,990 tumors. Luminal A type was diagnosed in 865 cases (28.9%), luminal B in 899 (30.1%), human epidermal growth factor receptor (Her2)-enriched in 597 (20.0%), and triple-negative in 629 (21.0%). The mean ADC values of the subtypes were as follows: luminal A: 0.99 × 10-3 mm2/s (95% CI 0.94-1.04), luminal B: 0.97 × 10-3 mm2/s (95% CI 0.89-1.05), Her2-enriched: 1.02 × 10-3 mm2/s (95% CI 0.95-1.08), and triple-negative: 0.99 × 10-3 mm2/s (95% CI 0.91-1.07). Conclusions ADC values cannot be used to discriminate between molecular subtypes of BC.
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Affiliation(s)
- Hans-Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Alexey Surov
- Department of Radiology and Nuclear Medicine, University of Magdeburg, Magdeburg, Germany
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29
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Differentiation of Benign and Malignant Breast Lesions Using ADC Values and ADC Ratio in Breast MRI. Diagnostics (Basel) 2022; 12:diagnostics12020332. [PMID: 35204423 PMCID: PMC8871288 DOI: 10.3390/diagnostics12020332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/23/2022] [Accepted: 01/26/2022] [Indexed: 11/16/2022] Open
Abstract
Magnetic resonance imaging (MRI) of the breast has been increasingly used for the detailed evaluation of breast lesions. Diffusion-weighted imaging (DWI) gives additional information for the lesions based on tissue cellularity. The aim of our study was to evaluate the possibilities of DWI, apparent diffusion coefficient (ADC) value and ADC ratio (the ratio between the ADC of the lesion and the ADC of normal glandular tissue) to differentiate benign from malignant breast lesions. Materials and methods: Eighty-seven patients with solid breast lesions (52 malignant and 35 benign) were examined on a 1.5 T MR scanner before histopathological evaluation. ADC values and ADC ratios were calculated. Results: The ADC values in the group with malignant tumors were significantly lower (mean 0.88 ± 0.15 × 10−3 mm2/s) in comparison with the group with benign lesions (mean 1.52 ± 0.23 × 10−3 mm2/s). A significantly lower ADC ratio was observed in the patients with malignant tumors (mean 0.66 ± 0.13) versus the patients with benign lesions (mean 1.12 ± 0.23). The cut-off point of the ADC value for differentiating malignant from benign breast tumors was 1.11 × 10−3 mm2/s with a sensitivity of 94.23%, specificity of 94.29%, and diagnostic accuracy of 98%, and an ADC ratio of ≤0.87 with a sensitivity of 94.23%, specificity of 91.43%, and a diagnostic accuracy of 95%. Conclusion: According to the results from our study DWI, ADC values and ADC ratio proved to be valuable additional techniques with high sensitivity and specificity for distinguishing benign from malignant breast lesions.
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30
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Song H, Bak S, Kim I, Woo JY, Cho EJ, Choi YJ, Rha SE, Oh SA, Youn SY, Lee SJ. An Application of Machine Learning That Uses the Magnetic Resonance Imaging Metric, Mean Apparent Diffusion Coefficient, to Differentiate between the Histological Types of Ovarian Cancer. J Clin Med 2021; 11:jcm11010229. [PMID: 35011970 PMCID: PMC8745699 DOI: 10.3390/jcm11010229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/21/2021] [Accepted: 12/29/2021] [Indexed: 12/13/2022] Open
Abstract
This retrospective single-center study included patients diagnosed with epithelial ovarian cancer (EOC) using preoperative pelvic magnetic resonance imaging (MRI). The apparent diffusion coefficient (ADC) of the axial MRI maps that included the largest solid portion of the ovarian mass was analysed. The mean ADC values (ADCmean) were derived from the regions of interest (ROIs) of each largest solid portion. Logistic regression and three types of machine learning (ML) applications were used to analyse the ADCs and clinical factors. Of the 200 patients, 103 had high-grade serous ovarian cancer (HGSOC), and 97 had non-HGSOC (endometrioid carcinoma, clear cell carcinoma, mucinous carcinoma, and low-grade serous ovarian cancer). The median ADCmean of patients with HGSOC was significantly lower than that of patients without HGSOCs. Low ADCmean and CA 19-9 levels were independent predictors for HGSOC over non-HGSOC. Compared to stage I disease, stage III disease was associated with HGSOC. Gradient boosting machine and extreme gradient boosting machine showed the highest accuracy in distinguishing between the histological findings of HGSOC versus non-HGSOC and between the five histological types of EOC. In conclusion, ADCmean, disease stage at diagnosis, and CA 19-9 level were significant factors for differentiating between EOC histological types.
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Affiliation(s)
- Heekyoung Song
- Department of Obstetrics and Gynecology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Korea; (H.S.); (S.B.); (I.K.); (J.Y.W.); (E.J.C.); (Y.J.C.)
| | - Seongeun Bak
- Department of Obstetrics and Gynecology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Korea; (H.S.); (S.B.); (I.K.); (J.Y.W.); (E.J.C.); (Y.J.C.)
| | - Imhyeon Kim
- Department of Obstetrics and Gynecology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Korea; (H.S.); (S.B.); (I.K.); (J.Y.W.); (E.J.C.); (Y.J.C.)
| | - Jae Yeon Woo
- Department of Obstetrics and Gynecology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Korea; (H.S.); (S.B.); (I.K.); (J.Y.W.); (E.J.C.); (Y.J.C.)
| | - Eui Jin Cho
- Department of Obstetrics and Gynecology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Korea; (H.S.); (S.B.); (I.K.); (J.Y.W.); (E.J.C.); (Y.J.C.)
| | - Youn Jin Choi
- Department of Obstetrics and Gynecology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Korea; (H.S.); (S.B.); (I.K.); (J.Y.W.); (E.J.C.); (Y.J.C.)
| | - Sung Eun Rha
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Korea;
| | - Shin Ah Oh
- NAVER Clova, 246, Hwangsaeul-ro, Bundang-gu, Seongnam-si 13595, Korea;
| | - Seo Yeon Youn
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Korea;
- Correspondence: (S.Y.Y.); (S.J.L.)
| | - Sung Jong Lee
- Department of Obstetrics and Gynecology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Korea; (H.S.); (S.B.); (I.K.); (J.Y.W.); (E.J.C.); (Y.J.C.)
- Correspondence: (S.Y.Y.); (S.J.L.)
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MRI of the Lactating Breast: Computer-Aided Diagnosis False Positive Rates and Background Parenchymal Enhancement Kinetic Features. Acad Radiol 2021; 29:1332-1341. [PMID: 34857455 DOI: 10.1016/j.acra.2021.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 11/01/2021] [Accepted: 11/01/2021] [Indexed: 12/28/2022]
Abstract
RATIONALE AND OBJECTIVES To investigate the application of computer-added diagnosis (CAD) in dynamic contrast-enhanced (DCE) MRI of the healthy lactating breast, focusing on false-positive rates and background parenchymal enhancement (BPE) coloring patterns in comparison with breast cancer features in non-lactating patients. MATERIALS AND METHODS The study population was composed of 58 healthy lactating patients and control groups of 113 healthy premenopausal non-lactating patients and 55 premenopausal non-lactating patients with newly-diagnosed breast cancer. Patients were scanned on 1.5-T MRI using conventional DCE protocol. A retrospective analysis of DCE-derived CAD properties was conducted using a commercial software that is regularly utilized in our routine radiological work-up. Qualitative morphological characterization and automatically-obtained quantitative parametric measurements of the BPE-induced CAD coloring were categorized and subgroups' trends and differences between the lactating and cancer cohorts were statistically assessed. RESULTS CAD false-positive coloring was found in the majority of lactating cases (87%). Lactation BPE coloring was characteristically non-mass enhancement (NME)-like shaped (87%), bilateral (79%) and symmetric (64%), whereas, unilateral coloring was associated with prior irradiation (p <0.0001). Inter-individual variability in CAD appearance of both scoring-grade and kinetic-curve dominance was found among the lactating cohort. When compared with healthy non-lactating controls, CAD false positive probability was significantly increased [Odds ratio 40.2, p <0001], while in comparison with the breast cancer cohort, CAD features were mostly inconclusive, even though increased size parameters were significantly associated with lactation-BPE (p <0.00001). CONCLUSION BPE was identified as a common source for false-positive CAD coloring on breast DCE-MRI among lactating population. Despite several typical characteristics, overlapping features with breast malignancy warrant a careful evaluation and clinical correlation in all cases with suspected lactation induced CAD coloring.
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Drewes R, Pech M, Powerski M, Omari J, Heinze C, Damm R, Wienke A, Surov A. Apparent Diffusion Coefficient Can Predict Response to Chemotherapy of Liver Metastases in Colorectal Cancer. Acad Radiol 2021; 28 Suppl 1:S73-S80. [PMID: 33008734 DOI: 10.1016/j.acra.2020.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/07/2020] [Accepted: 09/12/2020] [Indexed: 02/06/2023]
Abstract
RATIONALE AND OBJECTIVES The aim of this meta-analysis was to evaluate the suitability of apparent diffusion coefficient (ADC) as a predictor of response to systemic chemotherapy in patients with metastatic colorectal carcinoma (CRC). MATERIALS AND METHODS MEDLINE library, SCOPUS database, and EMBASE database were screened for relationships between pretreatment ADC values of hepatic CRC metastases and response to systemic chemotherapy. Overall, five eligible studies were identified. The following data were extracted: authors, year of publication, study design, number of patients, mean value ADC and standard-deviation, measure method, b-values, and Tesla-strength. The methodological quality of every study was checked according to the Quality Assessment of Diagnostic Studies-2 instrument. The meta-analysis was undertaken by employing RevMan 5.3 software. DerSimonian and Laird random-effects models with inverse-variance weights were used to account for heterogeneity. Mean ADC values including 95% confidence intervals were calculated. RESULTS Five studies (n = 114 patients) were included. The pretreatment mean ADC in the responder group was 1.15 × 10-3 mm2/s (1.03, 1.28) and 1.37 × 10-3 mm2/s (1.3, 1.44) in the nonresponder group. An ADC baseline threshold of 1.2 × 10-3 mm2/s, below which no nonresponder was found, can distinguish both groups. CONCLUSION The results indicate ADC can serve as a predictor of response to chemotherapy for CRC patients.
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Xue M, Che S, Tian Y, Xie L, Huang L, Zhao L, Guo N, Li J. Nomogram Based on Breast MRI and Clinicopathologic Features for Predicting Axillary Lymph Node Metastasis in Patients with Early-Stage Invasive Breast Cancer: A Retrospective Study. Clin Breast Cancer 2021; 22:e428-e437. [PMID: 34865995 DOI: 10.1016/j.clbc.2021.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 01/01/2023]
Abstract
INTRODUCTION To establish a nomogram for predicting axillary lymph node (ALN) involvement in patients with early-stage invasive breast cancer (BC) based on magnetic resonance imaging (MRI) features and clinicopathological characteristics. MATERIALS AND METHODS Patients with confirmed early-stage invasive BC between 03/2016 and 05/2017 were retrospectively reviewed at the National Cancer Center/Cancer Hospital. Risk factors for ALN metastasis (ALNM) were identified by univariable and multivariable logistic regression analysis. The independent risk factors were used to create a nomogram. RESULTS This study included 214 early-stage invasive BC patients, including 57 (26.6%) with positive ALNs. Tumor location (OR = 4.019, 95% CI: 1.304 -12.383, P = .015), tumor size (OR = 3.702, 95%CI: 1.517 -9.034, P = .004), multifocality (OR = 3.534, 95%CI: 1.249 -9.995, P = .017), MR-reported suspicious ALN (OR = 9.829, 95%CI: 4.132 -23.384, P <0.001), apparent diffusion coefficient (ADC) value (OR = 0.367, 95%CI: 0.158 -0.852, P = .020), and lymphovascular invasion (LVI) (OR = 3.530, 95%CI: 1.483 -8.400, P = .004) were identified as independent risk factors associated with ALNM. A nomogram was created for predicting the probability of ALNM by using these risk factors. The calibration curve of the nomogram showed that the nomogram predictions are consistent with the actual ALNM rate. The area under the curve was 0.88 (95% CI: 0.83 -0.93). The nomogram had a bootstrapped-concordance index of 0.88 and was well-calibrated. CONCLUSION The nomogram based on MRI and clinicopathologic features might be a useful tool for predicting ALNM in early-stage invasive BC and could help clinical decision-making.
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Affiliation(s)
- Mei Xue
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shunan Che
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan Tian
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | - Liling Huang
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liyun Zhao
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning Guo
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Li
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Zhu CR, Chen KY, Li P, Xia ZY, Wang B. Accuracy of multiparametric MRI in distinguishing the breast malignant lesions from benign lesions: a meta-analysis. Acta Radiol 2021; 62:1290-1297. [PMID: 33059458 DOI: 10.1177/0284185120963900] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The sensitivity of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for detecting breast cancer was high and the specificity was relatively low. However, diffusion-weighted imaging (DWI) has a high specificity in the diagnosis of malignant lesions. PURPOSE To evaluate the accuracy of the multiparametric MRI (mp-MRI) in distinguishing the breast malignant lesions from the benign lesions. MATERIAL AND METHODS A comprehensive search of the PubMed, Embase, and Cochrane Library electronic databases was conducted up to March 2020. Data were analyzed for the following indexes: pooled sensitivity and specificity; positive likelihood ratio; negative likelihood ratio; diagnostic odds ratio; and the area under the curve. RESULTS A total of 2356 patients with 1604 malignant and 967 benign breast lesions were included from 22 studies. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and area under the curve for mp-MRI were 0.93, 0.85, 6.3, 0.08, 81, and 0.96, respectively. The pooled sensitivity, specificity, and area under the curve for DCE-MRI alone were 0.95, 0.71, and 0.92, respectively. The pooled sensitivity, specificity, and area under the curve for DWI alone were 0.88, 0.84, and 0.93, respectively. CONCLUSION The mp-MRI did not improve the sensitivity but increased the specificity for the diagnosis of breast malignant lesions.
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Affiliation(s)
- Chun-Rong Zhu
- North Sichuan Medical College, Nanchong, Sichuan, PR China
| | - Ke-Yu Chen
- North Sichuan Medical College, Nanchong, Sichuan, PR China
| | - Pan Li
- North Sichuan Medical College, Nanchong, Sichuan, PR China
| | - Zhi-Yang Xia
- North Sichuan Medical College, Nanchong, Sichuan, PR China
| | - Bin Wang
- Department of Breast and Thyroid Surgery, The Third People’s Hospital of Chengdu, Chengdu, Sichuan, PR China
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Meyer HJ, Wienke A, Surov A. Discrimination between malignant and benign thyroid tumors by diffusion-weighted imaging - A systematic review and meta analysis. Magn Reson Imaging 2021; 84:41-57. [PMID: 34560233 DOI: 10.1016/j.mri.2021.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 08/19/2021] [Accepted: 09/05/2021] [Indexed: 01/01/2023]
Abstract
PURPOSE Magnetic resonance imaging is used to stage thyroid tumors. Diffusion weighted imaging (DWI) and apparent diffusion coefficient (ADC) can be used to reflect tumor microstructure. Our aim was to compare ADC values of malignant and benign thyroid lesions based on a large sample. METHODS MEDLINE library, EMBASE and SCOPUS databases were screened for the associations between ADC values and thyroid lesions up to August 2021. The primary endpoint of the systematic review were ADC values of benign and malignant thyroid lesions. In total, 29 studies were suitable for the analysis and were included into the present study. RESULTS The included studies comprised a total of 2137 lesions, 1118 (52.3%) benign and 1019 (47.7%) malignant lesions. The pooled mean ADC value of the benign thyroid lesions was 1.88 × 10-3 mm2/s [95% CI 1.77-2.0] and the pooled mean ADC value of malignant thyroid lesions was 1.15 × 10-3 mm2/s [95% CI 1.04-1.25]. CONCLUSIONS ADC can well discriminate benign and malignant thyroid tumors. Therefore, DWI should be implemented into the presurgical diagnostic work-up in clinical routine.
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Affiliation(s)
- Hans-Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany.
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Alexey Surov
- Department of Radiology and Nuclear Medicine, University of Magdeburg, Magdeburg, Germany
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He M, Ruan H, Ma M, Zhang Z. Application of Diffusion Weighted Imaging Techniques for Differentiating Benign and Malignant Breast Lesions. Front Oncol 2021; 11:694634. [PMID: 34235084 PMCID: PMC8255916 DOI: 10.3389/fonc.2021.694634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/07/2021] [Indexed: 12/25/2022] Open
Abstract
To explore the value of apparent diffusion coefficient (ADC), intravoxel incoherent motion (IVIM), and diffusional kurtosis imaging (DKI) based on diffusion weighted magnetic resonance imaging (DW-MRI) in differentiating benign and malignant breast lesions. A total of 215 patients with breast lesions were prospectively collected for breast MR examination. Single exponential, IVIM, and DKI models were calculated using a series of b values. Parameters including ADC, perfusion fraction (f), tissue diffusion coefficient (D), perfusion-related incoherent microcirculation (D*), average kurtosis (MK), and average diffusivity (MD) were compared between benign and malignant lesions. ROC curves were used to analyze the optimal diagnostic threshold of each parameter, and to evaluate the diagnostic efficacy of single and combined parameters. ADC, D, MK, and MD values were significantly different between benign and malignant breast lesions (P<0.001). Among the single parameters, ADC had the highest diagnostic efficiency (sensitivity 91.45%, specificity 82.54%, accuracy 88.84%, AUC 0.915) and the best diagnostic threshold (0.983 μm2/ms). The combination of ADC and MK offered high diagnostic performance (sensitivity 90.79%, specificity 85.71%, accuracy 89.30%, AUC 0.923), but no statistically significant difference in diagnostic performance as compared with single-parameter ADC (P=0.268). The ADC, D, MK, and MD parameters have high diagnostic value in differentiating benign and malignant breast lesions, and of these individual parameters the ADC has the best diagnostic performance. Therefore, our study revealed that the use of ADC alone should be useful for differentiating between benign and malignant breast lesions, whereas the combination of MK and ADC might improve the diagnostic performance to some extent.
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Affiliation(s)
- Muzhen He
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.,Department of Radiology, Fujian Provincial Hospital, Fuzhou, China
| | - Huiping Ruan
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.,Department of Radiology, Fujian Provincial Hospital, Fuzhou, China
| | - Mingping Ma
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.,Department of Radiology, Fujian Provincial Hospital, Fuzhou, China
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Mao H, Zhang B, Zou M, Huang Y, Yang L, Wang C, Pang P, Zhao Z. MRI-Based Radiomics Models for Predicting Risk Classification of Gastrointestinal Stromal Tumors. Front Oncol 2021; 11:631927. [PMID: 34041017 PMCID: PMC8141866 DOI: 10.3389/fonc.2021.631927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 04/13/2021] [Indexed: 01/04/2023] Open
Abstract
Background We conduct a study in developing and validating four MRI-based radiomics models to preoperatively predict the risk classification of gastrointestinal stromal tumors (GISTs). Methods Forty-one patients (low-risk = 17, intermediate-risk = 13, high-risk = 11) underwent MRI before surgery between September 2013 and March 2019 in this retrospective study. The Kruskal–Wallis test with Bonferonni correction and variance threshold was used to select appropriate features, and the Random Forest model (three classification model) was used to select features among the high-risk, intermediate-risk, and low-risk of GISTs. The predictive performance of the models built by the Random Forest was estimated by a 5-fold cross validation (5FCV). Their performance was estimated using the receiver operating characteristic (ROC) curve, summarized as the area under the ROC curve (AUC). Area under the curve (AUC), accuracy, sensitivity, and specificity for risk classification were reported. Linear discriminant analysis (LDA) was used to assess the discriminative ability of these radiomics models. Results The high-risk, intermediate-risk, and low-risk of GISTs were well classified by radiomics models, the micro-average of ROC curves was 0.85, 0.81, 0.87 and 0.94 for T1WI, T2WI, ADC and combined three MR sequences. And ROC curves achieved excellent AUCs for T1WI (0.85, 0.75 and 0.82), T2WI (0.69, 0.78 and 0.78), ADC (0.85, 0.77 and 0.80) and combined three MR sequences (0.96, 0.92, 0.81) for the diagnosis of high-risk, intermediate-risk, and low-risk of GISTs, respectively. In addition, LDA demonstrated the different risk of GISTs were correctly classified by radiomics analysis (61.0% for T1WI, 70.7% for T2WI, 83.3% for ADC, and 78.9% for the combined three MR sequences). Conclusions Radiomics models based on a single sequence and combined three MR sequences can be a noninvasive method to evaluate the risk classification of GISTs, which may help the treatment of GISTs patients in the future.
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Affiliation(s)
- Haijia Mao
- Department of Radiology, Shaoxing People's Hospital, Shaoxing Hospital, Zhejiang University School of Medicine, Shaoxing, China
| | - Bingqian Zhang
- Department of Radiology, Shaoxing People's Hospital, Shaoxing Hospital, Zhejiang University School of Medicine, Shaoxing, China
| | - Mingyue Zou
- Department of Radiology, Shaoxing People's Hospital, Shaoxing Hospital, Zhejiang University School of Medicine, Shaoxing, China
| | - Yanan Huang
- Department of Radiology, Shaoxing People's Hospital, Shaoxing Hospital, Zhejiang University School of Medicine, Shaoxing, China
| | - Liming Yang
- Department of Radiology, Shaoxing People's Hospital, Shaoxing Hospital, Zhejiang University School of Medicine, Shaoxing, China
| | - Cheng Wang
- Department of Pathology, Shaoxing People's Hospital, Shaoxing Hospital, Zhejiang University School of Medicine, Shaoxing, China
| | - PeiPei Pang
- Department of Pharmaceuticals Diagnosis, GE Healthcare, Hangzhou, China
| | - Zhenhua Zhao
- Department of Radiology, Shaoxing People's Hospital, Shaoxing Hospital, Zhejiang University School of Medicine, Shaoxing, China
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Xu M, Tang Q, Li M, Liu Y, Li F. An analysis of Ki-67 expression in stage 1 invasive ductal breast carcinoma using apparent diffusion coefficient histograms. Quant Imaging Med Surg 2021; 11:1518-1531. [PMID: 33816188 DOI: 10.21037/qims-20-615] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background To investigate the value of apparent diffusion coefficient (ADC) histograms in differentiating Ki-67 expression in T1 stage invasive ductal breast carcinoma (IDC). Methods The records of 111 patients with pathologically confirmed T1 stage IDC who underwent magnetic resonance imaging prior to surgery were retrospectively reviewed. The expression of Ki-67 in tumor tissue samples from the patients was assessed using immunohistochemical (IHC) staining, with a cut-off value of 25% for high Ki-67 labeling index (LI). ADC images of the maximum lay of tumors were selected, and the region of interest (ROI) of each lay was delineated using the MaZda software and analyzed by histogram. The correlations between the histogram characteristic parameters and the Ki-67 LI were investigated. Additionally, the histogram characteristic parameters of the high Ki-67 group (n=54) and the low Ki-67 group (n=57) were statistically analyzed to determine the characteristic parameters with significant difference. Receiver operator characteristic (ROC) analyses were further performed for the significant parameters. Results The mean value, and the 1st, 10th, 50th, 90th, and 99th percentiles were found to be negatively correlated with the expression of Ki-67 (all P values <0.001), with a correlation coefficient of -0.624, -0.749, -0.717, -0.621, -0.500, and -0.410, respectively. In the high Ki-67 group, the mean value, and the 1st, 10th, 50th, 90th, and 99th percentiles extracted by the histogram were significantly lower (all P values <0.05) than that of the low Ki-67 group, with areas under the ROC curves ranging from 0.717-0.856. However, the variance, skewness, and kurtosis did not differ between the two groups (all P values >0.05). Conclusions Histogram-derived parameters for ADC images can serve as a reliable tool in the prediction of Ki-67 proliferation status in patients with T1 stage IDC. Among the significant ADC histogram values, the 1st and 10th percentiles showed the best predictive values.
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Affiliation(s)
- Maolin Xu
- Department of Radiology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qi Tang
- Department of Radiology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Manxiu Li
- Department of Breast Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yulin Liu
- Department of Radiology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fang Li
- Department of Ultrasound, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Naranjo ID, Reymbaut A, Brynolfsson P, Lo Gullo R, Bryskhe K, Topgaard D, Giri DD, Reiner JS, Thakur SB, Pinker-Domenig K. Multidimensional Diffusion Magnetic Resonance Imaging for Characterization of Tissue Microstructure in Breast Cancer Patients: A Prospective Pilot Study. Cancers (Basel) 2021; 13:1606. [PMID: 33807205 PMCID: PMC8037718 DOI: 10.3390/cancers13071606] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 03/29/2021] [Indexed: 12/19/2022] Open
Abstract
Diffusion-weighted imaging is a non-invasive functional imaging modality for breast tumor characterization through apparent diffusion coefficients. Yet, it has so far been unable to intuitively inform on tissue microstructure. In this IRB-approved prospective study, we applied novel multidimensional diffusion (MDD) encoding across 16 patients with suspected breast cancer to evaluate its potential for tissue characterization in the clinical setting. Data acquired via custom MDD sequences was processed using an algorithm estimating non-parametric diffusion tensor distributions. The statistical descriptors of these distributions allow us to quantify tissue composition in terms of metrics informing on cell densities, shapes, and orientations. Additionally, signal fractions from specific cell types, such as elongated cells (bin1), isotropic cells (bin2), and free water (bin3), were teased apart. Histogram analysis in cancers and healthy breast tissue showed that cancers exhibited lower mean values of "size" (1.43 ± 0.54 × 10-3 mm2/s) and higher mean values of "shape" (0.47 ± 0.15) corresponding to bin1, while FGT (fibroglandular breast tissue) presented higher mean values of "size" (2.33 ± 0.22 × 10-3 mm2/s) and lower mean values of "shape" (0.27 ± 0.11) corresponding to bin3 (p < 0.001). Invasive carcinomas showed significant differences in mean signal fractions from bin1 (0.64 ± 0.13 vs. 0.4 ± 0.25) and bin3 (0.18 ± 0.08 vs. 0.42 ± 0.21) compared to ductal carcinomas in situ (DCIS) and invasive carcinomas with associated DCIS (p = 0.03). MDD enabled qualitative and quantitative evaluation of the composition of breast cancers and healthy glands.
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Affiliation(s)
- Isaac Daimiel Naranjo
- Memorial Sloan Kettering Cancer Center, Department of Radiology, Breast Imaging Service, 300 E 66th Street, New York, NY 10065, USA; (I.D.N.); (R.L.G.); (J.S.R.); (S.B.T.)
- Department of Radiology, Breast Imaging Service, Guy’s and St. Thomas’ NHS Trust, Great Maze Pond, London SE1 9RT, UK
| | - Alexis Reymbaut
- Random Walk Imaging AB, SE-22002 Lund, Sweden; (A.R.); (P.B.); (K.B.)
| | - Patrik Brynolfsson
- Random Walk Imaging AB, SE-22002 Lund, Sweden; (A.R.); (P.B.); (K.B.)
- NONPI Medical AB, SE-90738 Umeå, Sweden
| | - Roberto Lo Gullo
- Memorial Sloan Kettering Cancer Center, Department of Radiology, Breast Imaging Service, 300 E 66th Street, New York, NY 10065, USA; (I.D.N.); (R.L.G.); (J.S.R.); (S.B.T.)
| | - Karin Bryskhe
- Random Walk Imaging AB, SE-22002 Lund, Sweden; (A.R.); (P.B.); (K.B.)
| | - Daniel Topgaard
- Department of Chemistry, Lund University, SE-22100 Lund, Sweden;
| | - Dilip D. Giri
- Memorial Sloan Kettering Cancer Center, Department of Pathology, 1275 York Ave, New York, NY 10065, USA;
| | - Jeffrey S. Reiner
- Memorial Sloan Kettering Cancer Center, Department of Radiology, Breast Imaging Service, 300 E 66th Street, New York, NY 10065, USA; (I.D.N.); (R.L.G.); (J.S.R.); (S.B.T.)
| | - Sunitha B. Thakur
- Memorial Sloan Kettering Cancer Center, Department of Radiology, Breast Imaging Service, 300 E 66th Street, New York, NY 10065, USA; (I.D.N.); (R.L.G.); (J.S.R.); (S.B.T.)
- Memorial Sloan Kettering Cancer Center, Department of Medical Physics, 1275 York Ave, New York, NY 10065, USA
| | - Katja Pinker-Domenig
- Memorial Sloan Kettering Cancer Center, Department of Radiology, Breast Imaging Service, 300 E 66th Street, New York, NY 10065, USA; (I.D.N.); (R.L.G.); (J.S.R.); (S.B.T.)
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Meyer HJ, Wienke A, Surov A. Diffusion weighted imaging to predict nodal status in breast cancer: A systematic review and meta-analysis. Breast J 2021; 27:495-498. [PMID: 33615603 DOI: 10.1111/tbj.14200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Hans-Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale, Germany
| | - Alexey Surov
- Department of Radiology and Nuclear Medicine, University of Magdeburg, Magdeburg, Germany
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Surov A, Pech M, Omari J, Fischbach F, Damm R, Fischbach K, Powerski M, Relja B, Wienke A. Diffusion-Weighted Imaging Reflects Tumor Grading and Microvascular Invasion in Hepatocellular Carcinoma. Liver Cancer 2021; 10:10-24. [PMID: 33708636 PMCID: PMC7923880 DOI: 10.1159/000511384] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 09/06/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND To date, there are inconsistent data about relationships between diffusion-weighted imaging (DWI) and tumor grading/microvascular invasion (MVI) in hepatocellular carcinoma (HCC). Our purpose was to systematize the reported results regarding the role of DWI in prediction of tumor grading/MVI in HCC. METHOD MEDLINE library, Scopus, and Embase data bases were screened up to December 2019. Overall, 29 studies with 2,715 tumors were included into the analysis. There were 20 studies regarding DWI and tumor grading, 8 studies about DWI and MVI, and 1 study investigated DWI, tumor grading, and MVI in HCC. RESULTS In 21 studies (1,799 tumors), mean apparent diffusion coefficient (ADC) values (ADCmean) were used for distinguishing HCCs. ADCmean of G1-3 lesions overlapped significantly. In 4 studies (461 lesions), minimum ADC (ADCmin) was used. ADCmin values in G1/2 lesions were over 0.80 × 10-3 mm2/s and in G3 tumors below 0.80 × 10-3 mm2/s. In 4 studies (241 tumors), true diffusion (D) was reported. A significant overlapping of D values between G1, G2, and G3 groups was found. ADCmean and MVI were analyzed in 9 studies (1,059 HCCs). ADCmean values of MIV+/MVI- lesions overlapped significantly. ADCmin was used in 4 studies (672 lesions). ADCmin values of MVI+ tumors were in the area under 1.00 × 10-3 mm2/s. In 3 studies (227 tumors), D was used. Also, D values of MVI+ lesions were predominantly in the area under 1.00 × 10-3 mm2/s. CONCLUSION ADCmin reflects tumor grading, and ADCmin and D predict MVI in HCC. Therefore, these DWI parameters should be estimated for every HCC lesion for pretreatment tumor stratification. ADCmean cannot predict tumor grading/MVI in HCC.
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Affiliation(s)
- Alexey Surov
- Department of Radiology and Nuclear Medicine University of Magdeburg, Magdeburg, Germany,*Alexey Surov, Department of Radiology and Nuclear Medicine, Ott-Von-Guericke University Magdeburg, Leipziger St., 44, DE–39112 Magdeburg (Germany),
| | - Maciej Pech
- Department of Radiology and Nuclear Medicine University of Magdeburg, Magdeburg, Germany
| | - Jazan Omari
- Department of Radiology and Nuclear Medicine University of Magdeburg, Magdeburg, Germany
| | - Frank Fischbach
- Department of Radiology and Nuclear Medicine University of Magdeburg, Magdeburg, Germany
| | - Robert Damm
- Department of Radiology and Nuclear Medicine University of Magdeburg, Magdeburg, Germany
| | - Katharina Fischbach
- Department of Radiology and Nuclear Medicine University of Magdeburg, Magdeburg, Germany
| | - Maciej Powerski
- Department of Radiology and Nuclear Medicine University of Magdeburg, Magdeburg, Germany
| | - Borna Relja
- Department of Radiology and Nuclear Medicine University of Magdeburg, Magdeburg, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
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Surov A, Meyer HJ, Pech M, Powerski M, Omari J, Wienke A. Apparent diffusion coefficient cannot discriminate metastatic and non-metastatic lymph nodes in rectal cancer: a meta-analysis. Int J Colorectal Dis 2021; 36:2189-2197. [PMID: 34184127 PMCID: PMC8426255 DOI: 10.1007/s00384-021-03986-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Our aim was to provide data regarding use of diffusion-weighted imaging (DWI) for distinguishing metastatic and non-metastatic lymph nodes (LN) in rectal cancer. METHODS MEDLINE library, EMBASE, and SCOPUS database were screened for associations between DWI and metastatic and non-metastatic LN in rectal cancer up to February 2021. Overall, 9 studies were included into the analysis. Number, mean value, and standard deviation of DWI parameters including apparent diffusion coefficient (ADC) values of metastatic and non-metastatic LN were extracted from the literature. The methodological quality of the studies was investigated according to the QUADAS-2 assessment. The meta-analysis was undertaken by using RevMan 5.3 software. DerSimonian, and Laird random-effects models with inverse-variance weights were used to account the heterogeneity between the studies. Mean DWI values including 95% confidence intervals were calculated for metastatic and non-metastatic LN. RESULTS ADC values were reported for 1376 LN, 623 (45.3%) metastatic LN, and 754 (54.7%) non-metastatic LN. The calculated mean ADC value (× 10-3 mm2/s) of metastatic LN was 1.05, 95%CI (0.94, 1.15). The calculated mean ADC value of the non-metastatic LN was 1.17, 95%CI (1.01, 1.33). The calculated sensitivity and specificity were 0.81, 95%CI (0.74, 0.89) and 0.67, 95%CI (0.54, 0.79). CONCLUSION No reliable ADC threshold can be recommended for distinguishing of metastatic and non-metastatic LN in rectal cancer.
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Affiliation(s)
- Alexey Surov
- grid.5807.a0000 0001 1018 4307Department of Radiology and Nuclear Medicine, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Hans-Jonas Meyer
- grid.9647.c0000 0004 7669 9786Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
| | - Maciej Pech
- grid.5807.a0000 0001 1018 4307Department of Radiology and Nuclear Medicine, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Maciej Powerski
- grid.5807.a0000 0001 1018 4307Department of Radiology and Nuclear Medicine, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Jasan Omari
- grid.5807.a0000 0001 1018 4307Department of Radiology and Nuclear Medicine, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Andreas Wienke
- grid.9018.00000 0001 0679 2801Institute of Medical Epidemiology, Martin-Luther-University Halle-Wittenberg, Biostatistics, and Informatics, Halle (Saale), Germany
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McDonald ES, Romanoff J, Rahbar H, Kitsch AE, Harvey SM, Whisenant JG, Yankeelov TE, Moy L, DeMartini WB, Dogan BE, Yang WT, Wang LC, Joe BN, Wilmes LJ, Hylton NM, Oh KY, Tudorica LA, Neal CH, Malyarenko DI, Comstock CE, Schnall MD, Chenevert TL, Partridge SC. Mean Apparent Diffusion Coefficient Is a Sufficient Conventional Diffusion-weighted MRI Metric to Improve Breast MRI Diagnostic Performance: Results from the ECOG-ACRIN Cancer Research Group A6702 Diffusion Imaging Trial. Radiology 2020; 298:60-70. [PMID: 33201788 DOI: 10.1148/radiol.2020202465] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background The Eastern Cooperative Oncology Group and American College of Radiology Imaging Network Cancer Research Group A6702 multicenter trial helped confirm the potential of diffusion-weighted MRI for improving differential diagnosis of suspicious breast abnormalities and reducing unnecessary biopsies. A prespecified secondary objective was to explore the relative value of different approaches for quantitative assessment of lesions at diffusion-weighted MRI. Purpose To determine whether alternate calculations of apparent diffusion coefficient (ADC) can help further improve diagnostic performance versus mean ADC values alone for analysis of suspicious breast lesions at MRI. Materials and Methods This prospective trial (ClinicalTrials.gov identifier: NCT02022579) enrolled consecutive women (from March 2014 to April 2015) with a Breast Imaging Reporting and Data System category of 3, 4, or 5 at breast MRI. All study participants underwent standardized diffusion-weighted MRI (b = 0, 100, 600, and 800 sec/mm2). Centralized ADC measures were performed, including manually drawn whole-lesion and hotspot regions of interest, histogram metrics, normalized ADC, and variable b-value combinations. Diagnostic performance was estimated by using the area under the receiver operating characteristic curve (AUC). Reduction in biopsy rate (maintaining 100% sensitivity) was estimated according to thresholds for each ADC metric. Results Among 107 enrolled women, 81 lesions with outcomes (28 malignant and 53 benign) in 67 women (median age, 49 years; interquartile range, 41-60 years) were analyzed. Among ADC metrics tested, none improved diagnostic performance versus standard mean ADC (AUC, 0.59-0.79 vs AUC, 0.75; P = .02-.84), and maximum ADC had worse performance (AUC, 0.52; P < .001). The 25th-percentile ADC metric provided the best performance (AUC, 0.79; 95% CI: 0.70, 0.88), and a threshold using median ADC provided the greatest reduction in biopsy rate of 23.9% (95% CI: 14.8, 32.9; 16 of 67 BI-RADS category 4 and 5 lesions). Nonzero minimum b value (100, 600, and 800 sec/mm2) did not improve the AUC (0.74; P = .28), and several combinations of two b values (0 and 600, 100 and 600, 0 and 800, and 100 and 800 sec/mm2; AUC, 0.73-0.76) provided results similar to those seen with calculations of four b values (AUC, 0.75; P = .17-.87). Conclusion Mean apparent diffusion coefficient calculated with a two-b-value acquisition is a simple and sufficient diffusion-weighted MRI metric to augment diagnostic performance of breast MRI compared with more complex approaches to apparent diffusion coefficient measurement. © RSNA, 2020 Online supplemental material is available for this article.
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Affiliation(s)
- Elizabeth S McDonald
- From the Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (E.S.M., M.D.S.); Center for Statistical Sciences, Brown University, Providence, RI (J.R.); Department of Radiology, University of Washington, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109 (H.R., A.E.K., S.C.P.); Departments of Radiology and Radiological Sciences (S.M.H.) and Medicine (J.G.W.), Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt-Ingram Cancer Center, Nashville, Tenn (J.G.W.); Department of Biomedical Engineering, University of Texas, Austin, Tex (T.E.Y.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (W.B.D.); Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.E.D.); Department of Breast Imaging, MD Anderson Cancer Center, Houston, Tex (W.T.Y.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.W.); Department of Radiology and Biomedical Imaging, University of California, San Francisco School of Medicine, San Francisco, Calif (B.N.J., L.J.W., N.M.H.); Department of Radiology, Oregon Health and Science University, Portland, Ore (K.Y.O., L.A.T.); Department of Radiology/MRI, University of Michigan, Ann Arbor, Mich (C.H.N., D.I.M., T.L.C.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (C.E.C.)
| | - Justin Romanoff
- From the Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (E.S.M., M.D.S.); Center for Statistical Sciences, Brown University, Providence, RI (J.R.); Department of Radiology, University of Washington, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109 (H.R., A.E.K., S.C.P.); Departments of Radiology and Radiological Sciences (S.M.H.) and Medicine (J.G.W.), Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt-Ingram Cancer Center, Nashville, Tenn (J.G.W.); Department of Biomedical Engineering, University of Texas, Austin, Tex (T.E.Y.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (W.B.D.); Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.E.D.); Department of Breast Imaging, MD Anderson Cancer Center, Houston, Tex (W.T.Y.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.W.); Department of Radiology and Biomedical Imaging, University of California, San Francisco School of Medicine, San Francisco, Calif (B.N.J., L.J.W., N.M.H.); Department of Radiology, Oregon Health and Science University, Portland, Ore (K.Y.O., L.A.T.); Department of Radiology/MRI, University of Michigan, Ann Arbor, Mich (C.H.N., D.I.M., T.L.C.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (C.E.C.)
| | - Habib Rahbar
- From the Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (E.S.M., M.D.S.); Center for Statistical Sciences, Brown University, Providence, RI (J.R.); Department of Radiology, University of Washington, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109 (H.R., A.E.K., S.C.P.); Departments of Radiology and Radiological Sciences (S.M.H.) and Medicine (J.G.W.), Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt-Ingram Cancer Center, Nashville, Tenn (J.G.W.); Department of Biomedical Engineering, University of Texas, Austin, Tex (T.E.Y.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (W.B.D.); Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.E.D.); Department of Breast Imaging, MD Anderson Cancer Center, Houston, Tex (W.T.Y.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.W.); Department of Radiology and Biomedical Imaging, University of California, San Francisco School of Medicine, San Francisco, Calif (B.N.J., L.J.W., N.M.H.); Department of Radiology, Oregon Health and Science University, Portland, Ore (K.Y.O., L.A.T.); Department of Radiology/MRI, University of Michigan, Ann Arbor, Mich (C.H.N., D.I.M., T.L.C.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (C.E.C.)
| | - Averi E Kitsch
- From the Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (E.S.M., M.D.S.); Center for Statistical Sciences, Brown University, Providence, RI (J.R.); Department of Radiology, University of Washington, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109 (H.R., A.E.K., S.C.P.); Departments of Radiology and Radiological Sciences (S.M.H.) and Medicine (J.G.W.), Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt-Ingram Cancer Center, Nashville, Tenn (J.G.W.); Department of Biomedical Engineering, University of Texas, Austin, Tex (T.E.Y.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (W.B.D.); Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.E.D.); Department of Breast Imaging, MD Anderson Cancer Center, Houston, Tex (W.T.Y.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.W.); Department of Radiology and Biomedical Imaging, University of California, San Francisco School of Medicine, San Francisco, Calif (B.N.J., L.J.W., N.M.H.); Department of Radiology, Oregon Health and Science University, Portland, Ore (K.Y.O., L.A.T.); Department of Radiology/MRI, University of Michigan, Ann Arbor, Mich (C.H.N., D.I.M., T.L.C.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (C.E.C.)
| | - Sara M Harvey
- From the Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (E.S.M., M.D.S.); Center for Statistical Sciences, Brown University, Providence, RI (J.R.); Department of Radiology, University of Washington, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109 (H.R., A.E.K., S.C.P.); Departments of Radiology and Radiological Sciences (S.M.H.) and Medicine (J.G.W.), Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt-Ingram Cancer Center, Nashville, Tenn (J.G.W.); Department of Biomedical Engineering, University of Texas, Austin, Tex (T.E.Y.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (W.B.D.); Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.E.D.); Department of Breast Imaging, MD Anderson Cancer Center, Houston, Tex (W.T.Y.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.W.); Department of Radiology and Biomedical Imaging, University of California, San Francisco School of Medicine, San Francisco, Calif (B.N.J., L.J.W., N.M.H.); Department of Radiology, Oregon Health and Science University, Portland, Ore (K.Y.O., L.A.T.); Department of Radiology/MRI, University of Michigan, Ann Arbor, Mich (C.H.N., D.I.M., T.L.C.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (C.E.C.)
| | - Jennifer G Whisenant
- From the Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (E.S.M., M.D.S.); Center for Statistical Sciences, Brown University, Providence, RI (J.R.); Department of Radiology, University of Washington, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109 (H.R., A.E.K., S.C.P.); Departments of Radiology and Radiological Sciences (S.M.H.) and Medicine (J.G.W.), Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt-Ingram Cancer Center, Nashville, Tenn (J.G.W.); Department of Biomedical Engineering, University of Texas, Austin, Tex (T.E.Y.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (W.B.D.); Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.E.D.); Department of Breast Imaging, MD Anderson Cancer Center, Houston, Tex (W.T.Y.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.W.); Department of Radiology and Biomedical Imaging, University of California, San Francisco School of Medicine, San Francisco, Calif (B.N.J., L.J.W., N.M.H.); Department of Radiology, Oregon Health and Science University, Portland, Ore (K.Y.O., L.A.T.); Department of Radiology/MRI, University of Michigan, Ann Arbor, Mich (C.H.N., D.I.M., T.L.C.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (C.E.C.)
| | - Thomas E Yankeelov
- From the Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (E.S.M., M.D.S.); Center for Statistical Sciences, Brown University, Providence, RI (J.R.); Department of Radiology, University of Washington, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109 (H.R., A.E.K., S.C.P.); Departments of Radiology and Radiological Sciences (S.M.H.) and Medicine (J.G.W.), Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt-Ingram Cancer Center, Nashville, Tenn (J.G.W.); Department of Biomedical Engineering, University of Texas, Austin, Tex (T.E.Y.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (W.B.D.); Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.E.D.); Department of Breast Imaging, MD Anderson Cancer Center, Houston, Tex (W.T.Y.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.W.); Department of Radiology and Biomedical Imaging, University of California, San Francisco School of Medicine, San Francisco, Calif (B.N.J., L.J.W., N.M.H.); Department of Radiology, Oregon Health and Science University, Portland, Ore (K.Y.O., L.A.T.); Department of Radiology/MRI, University of Michigan, Ann Arbor, Mich (C.H.N., D.I.M., T.L.C.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (C.E.C.)
| | - Linda Moy
- From the Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (E.S.M., M.D.S.); Center for Statistical Sciences, Brown University, Providence, RI (J.R.); Department of Radiology, University of Washington, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109 (H.R., A.E.K., S.C.P.); Departments of Radiology and Radiological Sciences (S.M.H.) and Medicine (J.G.W.), Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt-Ingram Cancer Center, Nashville, Tenn (J.G.W.); Department of Biomedical Engineering, University of Texas, Austin, Tex (T.E.Y.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (W.B.D.); Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.E.D.); Department of Breast Imaging, MD Anderson Cancer Center, Houston, Tex (W.T.Y.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.W.); Department of Radiology and Biomedical Imaging, University of California, San Francisco School of Medicine, San Francisco, Calif (B.N.J., L.J.W., N.M.H.); Department of Radiology, Oregon Health and Science University, Portland, Ore (K.Y.O., L.A.T.); Department of Radiology/MRI, University of Michigan, Ann Arbor, Mich (C.H.N., D.I.M., T.L.C.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (C.E.C.)
| | - Wendy B DeMartini
- From the Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (E.S.M., M.D.S.); Center for Statistical Sciences, Brown University, Providence, RI (J.R.); Department of Radiology, University of Washington, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109 (H.R., A.E.K., S.C.P.); Departments of Radiology and Radiological Sciences (S.M.H.) and Medicine (J.G.W.), Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt-Ingram Cancer Center, Nashville, Tenn (J.G.W.); Department of Biomedical Engineering, University of Texas, Austin, Tex (T.E.Y.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (W.B.D.); Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.E.D.); Department of Breast Imaging, MD Anderson Cancer Center, Houston, Tex (W.T.Y.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.W.); Department of Radiology and Biomedical Imaging, University of California, San Francisco School of Medicine, San Francisco, Calif (B.N.J., L.J.W., N.M.H.); Department of Radiology, Oregon Health and Science University, Portland, Ore (K.Y.O., L.A.T.); Department of Radiology/MRI, University of Michigan, Ann Arbor, Mich (C.H.N., D.I.M., T.L.C.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (C.E.C.)
| | - Basak E Dogan
- From the Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (E.S.M., M.D.S.); Center for Statistical Sciences, Brown University, Providence, RI (J.R.); Department of Radiology, University of Washington, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109 (H.R., A.E.K., S.C.P.); Departments of Radiology and Radiological Sciences (S.M.H.) and Medicine (J.G.W.), Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt-Ingram Cancer Center, Nashville, Tenn (J.G.W.); Department of Biomedical Engineering, University of Texas, Austin, Tex (T.E.Y.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (W.B.D.); Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.E.D.); Department of Breast Imaging, MD Anderson Cancer Center, Houston, Tex (W.T.Y.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.W.); Department of Radiology and Biomedical Imaging, University of California, San Francisco School of Medicine, San Francisco, Calif (B.N.J., L.J.W., N.M.H.); Department of Radiology, Oregon Health and Science University, Portland, Ore (K.Y.O., L.A.T.); Department of Radiology/MRI, University of Michigan, Ann Arbor, Mich (C.H.N., D.I.M., T.L.C.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (C.E.C.)
| | - Wei T Yang
- From the Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (E.S.M., M.D.S.); Center for Statistical Sciences, Brown University, Providence, RI (J.R.); Department of Radiology, University of Washington, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109 (H.R., A.E.K., S.C.P.); Departments of Radiology and Radiological Sciences (S.M.H.) and Medicine (J.G.W.), Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt-Ingram Cancer Center, Nashville, Tenn (J.G.W.); Department of Biomedical Engineering, University of Texas, Austin, Tex (T.E.Y.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (W.B.D.); Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.E.D.); Department of Breast Imaging, MD Anderson Cancer Center, Houston, Tex (W.T.Y.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.W.); Department of Radiology and Biomedical Imaging, University of California, San Francisco School of Medicine, San Francisco, Calif (B.N.J., L.J.W., N.M.H.); Department of Radiology, Oregon Health and Science University, Portland, Ore (K.Y.O., L.A.T.); Department of Radiology/MRI, University of Michigan, Ann Arbor, Mich (C.H.N., D.I.M., T.L.C.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (C.E.C.)
| | - Lilian C Wang
- From the Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (E.S.M., M.D.S.); Center for Statistical Sciences, Brown University, Providence, RI (J.R.); Department of Radiology, University of Washington, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109 (H.R., A.E.K., S.C.P.); Departments of Radiology and Radiological Sciences (S.M.H.) and Medicine (J.G.W.), Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt-Ingram Cancer Center, Nashville, Tenn (J.G.W.); Department of Biomedical Engineering, University of Texas, Austin, Tex (T.E.Y.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (W.B.D.); Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.E.D.); Department of Breast Imaging, MD Anderson Cancer Center, Houston, Tex (W.T.Y.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.W.); Department of Radiology and Biomedical Imaging, University of California, San Francisco School of Medicine, San Francisco, Calif (B.N.J., L.J.W., N.M.H.); Department of Radiology, Oregon Health and Science University, Portland, Ore (K.Y.O., L.A.T.); Department of Radiology/MRI, University of Michigan, Ann Arbor, Mich (C.H.N., D.I.M., T.L.C.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (C.E.C.)
| | - Bonnie N Joe
- From the Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (E.S.M., M.D.S.); Center for Statistical Sciences, Brown University, Providence, RI (J.R.); Department of Radiology, University of Washington, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109 (H.R., A.E.K., S.C.P.); Departments of Radiology and Radiological Sciences (S.M.H.) and Medicine (J.G.W.), Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt-Ingram Cancer Center, Nashville, Tenn (J.G.W.); Department of Biomedical Engineering, University of Texas, Austin, Tex (T.E.Y.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (W.B.D.); Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.E.D.); Department of Breast Imaging, MD Anderson Cancer Center, Houston, Tex (W.T.Y.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.W.); Department of Radiology and Biomedical Imaging, University of California, San Francisco School of Medicine, San Francisco, Calif (B.N.J., L.J.W., N.M.H.); Department of Radiology, Oregon Health and Science University, Portland, Ore (K.Y.O., L.A.T.); Department of Radiology/MRI, University of Michigan, Ann Arbor, Mich (C.H.N., D.I.M., T.L.C.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (C.E.C.)
| | - Lisa J Wilmes
- From the Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (E.S.M., M.D.S.); Center for Statistical Sciences, Brown University, Providence, RI (J.R.); Department of Radiology, University of Washington, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109 (H.R., A.E.K., S.C.P.); Departments of Radiology and Radiological Sciences (S.M.H.) and Medicine (J.G.W.), Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt-Ingram Cancer Center, Nashville, Tenn (J.G.W.); Department of Biomedical Engineering, University of Texas, Austin, Tex (T.E.Y.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (W.B.D.); Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.E.D.); Department of Breast Imaging, MD Anderson Cancer Center, Houston, Tex (W.T.Y.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.W.); Department of Radiology and Biomedical Imaging, University of California, San Francisco School of Medicine, San Francisco, Calif (B.N.J., L.J.W., N.M.H.); Department of Radiology, Oregon Health and Science University, Portland, Ore (K.Y.O., L.A.T.); Department of Radiology/MRI, University of Michigan, Ann Arbor, Mich (C.H.N., D.I.M., T.L.C.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (C.E.C.)
| | - Nola M Hylton
- From the Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (E.S.M., M.D.S.); Center for Statistical Sciences, Brown University, Providence, RI (J.R.); Department of Radiology, University of Washington, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109 (H.R., A.E.K., S.C.P.); Departments of Radiology and Radiological Sciences (S.M.H.) and Medicine (J.G.W.), Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt-Ingram Cancer Center, Nashville, Tenn (J.G.W.); Department of Biomedical Engineering, University of Texas, Austin, Tex (T.E.Y.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (W.B.D.); Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.E.D.); Department of Breast Imaging, MD Anderson Cancer Center, Houston, Tex (W.T.Y.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.W.); Department of Radiology and Biomedical Imaging, University of California, San Francisco School of Medicine, San Francisco, Calif (B.N.J., L.J.W., N.M.H.); Department of Radiology, Oregon Health and Science University, Portland, Ore (K.Y.O., L.A.T.); Department of Radiology/MRI, University of Michigan, Ann Arbor, Mich (C.H.N., D.I.M., T.L.C.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (C.E.C.)
| | - Karen Y Oh
- From the Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (E.S.M., M.D.S.); Center for Statistical Sciences, Brown University, Providence, RI (J.R.); Department of Radiology, University of Washington, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109 (H.R., A.E.K., S.C.P.); Departments of Radiology and Radiological Sciences (S.M.H.) and Medicine (J.G.W.), Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt-Ingram Cancer Center, Nashville, Tenn (J.G.W.); Department of Biomedical Engineering, University of Texas, Austin, Tex (T.E.Y.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (W.B.D.); Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.E.D.); Department of Breast Imaging, MD Anderson Cancer Center, Houston, Tex (W.T.Y.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.W.); Department of Radiology and Biomedical Imaging, University of California, San Francisco School of Medicine, San Francisco, Calif (B.N.J., L.J.W., N.M.H.); Department of Radiology, Oregon Health and Science University, Portland, Ore (K.Y.O., L.A.T.); Department of Radiology/MRI, University of Michigan, Ann Arbor, Mich (C.H.N., D.I.M., T.L.C.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (C.E.C.)
| | - Luminita A Tudorica
- From the Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (E.S.M., M.D.S.); Center for Statistical Sciences, Brown University, Providence, RI (J.R.); Department of Radiology, University of Washington, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109 (H.R., A.E.K., S.C.P.); Departments of Radiology and Radiological Sciences (S.M.H.) and Medicine (J.G.W.), Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt-Ingram Cancer Center, Nashville, Tenn (J.G.W.); Department of Biomedical Engineering, University of Texas, Austin, Tex (T.E.Y.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (W.B.D.); Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.E.D.); Department of Breast Imaging, MD Anderson Cancer Center, Houston, Tex (W.T.Y.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.W.); Department of Radiology and Biomedical Imaging, University of California, San Francisco School of Medicine, San Francisco, Calif (B.N.J., L.J.W., N.M.H.); Department of Radiology, Oregon Health and Science University, Portland, Ore (K.Y.O., L.A.T.); Department of Radiology/MRI, University of Michigan, Ann Arbor, Mich (C.H.N., D.I.M., T.L.C.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (C.E.C.)
| | - Colleen H Neal
- From the Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (E.S.M., M.D.S.); Center for Statistical Sciences, Brown University, Providence, RI (J.R.); Department of Radiology, University of Washington, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109 (H.R., A.E.K., S.C.P.); Departments of Radiology and Radiological Sciences (S.M.H.) and Medicine (J.G.W.), Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt-Ingram Cancer Center, Nashville, Tenn (J.G.W.); Department of Biomedical Engineering, University of Texas, Austin, Tex (T.E.Y.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (W.B.D.); Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.E.D.); Department of Breast Imaging, MD Anderson Cancer Center, Houston, Tex (W.T.Y.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.W.); Department of Radiology and Biomedical Imaging, University of California, San Francisco School of Medicine, San Francisco, Calif (B.N.J., L.J.W., N.M.H.); Department of Radiology, Oregon Health and Science University, Portland, Ore (K.Y.O., L.A.T.); Department of Radiology/MRI, University of Michigan, Ann Arbor, Mich (C.H.N., D.I.M., T.L.C.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (C.E.C.)
| | - Dariya I Malyarenko
- From the Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (E.S.M., M.D.S.); Center for Statistical Sciences, Brown University, Providence, RI (J.R.); Department of Radiology, University of Washington, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109 (H.R., A.E.K., S.C.P.); Departments of Radiology and Radiological Sciences (S.M.H.) and Medicine (J.G.W.), Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt-Ingram Cancer Center, Nashville, Tenn (J.G.W.); Department of Biomedical Engineering, University of Texas, Austin, Tex (T.E.Y.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (W.B.D.); Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.E.D.); Department of Breast Imaging, MD Anderson Cancer Center, Houston, Tex (W.T.Y.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.W.); Department of Radiology and Biomedical Imaging, University of California, San Francisco School of Medicine, San Francisco, Calif (B.N.J., L.J.W., N.M.H.); Department of Radiology, Oregon Health and Science University, Portland, Ore (K.Y.O., L.A.T.); Department of Radiology/MRI, University of Michigan, Ann Arbor, Mich (C.H.N., D.I.M., T.L.C.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (C.E.C.)
| | - Christopher E Comstock
- From the Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (E.S.M., M.D.S.); Center for Statistical Sciences, Brown University, Providence, RI (J.R.); Department of Radiology, University of Washington, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109 (H.R., A.E.K., S.C.P.); Departments of Radiology and Radiological Sciences (S.M.H.) and Medicine (J.G.W.), Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt-Ingram Cancer Center, Nashville, Tenn (J.G.W.); Department of Biomedical Engineering, University of Texas, Austin, Tex (T.E.Y.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (W.B.D.); Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.E.D.); Department of Breast Imaging, MD Anderson Cancer Center, Houston, Tex (W.T.Y.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.W.); Department of Radiology and Biomedical Imaging, University of California, San Francisco School of Medicine, San Francisco, Calif (B.N.J., L.J.W., N.M.H.); Department of Radiology, Oregon Health and Science University, Portland, Ore (K.Y.O., L.A.T.); Department of Radiology/MRI, University of Michigan, Ann Arbor, Mich (C.H.N., D.I.M., T.L.C.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (C.E.C.)
| | - Mitchell D Schnall
- From the Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (E.S.M., M.D.S.); Center for Statistical Sciences, Brown University, Providence, RI (J.R.); Department of Radiology, University of Washington, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109 (H.R., A.E.K., S.C.P.); Departments of Radiology and Radiological Sciences (S.M.H.) and Medicine (J.G.W.), Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt-Ingram Cancer Center, Nashville, Tenn (J.G.W.); Department of Biomedical Engineering, University of Texas, Austin, Tex (T.E.Y.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (W.B.D.); Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.E.D.); Department of Breast Imaging, MD Anderson Cancer Center, Houston, Tex (W.T.Y.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.W.); Department of Radiology and Biomedical Imaging, University of California, San Francisco School of Medicine, San Francisco, Calif (B.N.J., L.J.W., N.M.H.); Department of Radiology, Oregon Health and Science University, Portland, Ore (K.Y.O., L.A.T.); Department of Radiology/MRI, University of Michigan, Ann Arbor, Mich (C.H.N., D.I.M., T.L.C.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (C.E.C.)
| | - Thomas L Chenevert
- From the Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (E.S.M., M.D.S.); Center for Statistical Sciences, Brown University, Providence, RI (J.R.); Department of Radiology, University of Washington, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109 (H.R., A.E.K., S.C.P.); Departments of Radiology and Radiological Sciences (S.M.H.) and Medicine (J.G.W.), Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt-Ingram Cancer Center, Nashville, Tenn (J.G.W.); Department of Biomedical Engineering, University of Texas, Austin, Tex (T.E.Y.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (W.B.D.); Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.E.D.); Department of Breast Imaging, MD Anderson Cancer Center, Houston, Tex (W.T.Y.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.W.); Department of Radiology and Biomedical Imaging, University of California, San Francisco School of Medicine, San Francisco, Calif (B.N.J., L.J.W., N.M.H.); Department of Radiology, Oregon Health and Science University, Portland, Ore (K.Y.O., L.A.T.); Department of Radiology/MRI, University of Michigan, Ann Arbor, Mich (C.H.N., D.I.M., T.L.C.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (C.E.C.)
| | - Savannah C Partridge
- From the Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (E.S.M., M.D.S.); Center for Statistical Sciences, Brown University, Providence, RI (J.R.); Department of Radiology, University of Washington, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109 (H.R., A.E.K., S.C.P.); Departments of Radiology and Radiological Sciences (S.M.H.) and Medicine (J.G.W.), Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt-Ingram Cancer Center, Nashville, Tenn (J.G.W.); Department of Biomedical Engineering, University of Texas, Austin, Tex (T.E.Y.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (W.B.D.); Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.E.D.); Department of Breast Imaging, MD Anderson Cancer Center, Houston, Tex (W.T.Y.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.W.); Department of Radiology and Biomedical Imaging, University of California, San Francisco School of Medicine, San Francisco, Calif (B.N.J., L.J.W., N.M.H.); Department of Radiology, Oregon Health and Science University, Portland, Ore (K.Y.O., L.A.T.); Department of Radiology/MRI, University of Michigan, Ann Arbor, Mich (C.H.N., D.I.M., T.L.C.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (C.E.C.)
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44
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Razek AAKA, El-Adalany MA, El-Metwally D. Role of diffusion-weighted imaging in prediction of nipple-areolar complex invasion by breast cancer. Clin Imaging 2020; 69:45-49. [PMID: 32652457 DOI: 10.1016/j.clinimag.2020.06.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/12/2020] [Accepted: 06/26/2020] [Indexed: 11/29/2022]
Abstract
THE AIM OF THIS WORK The aim of this work was to estimate the role of diffusion-weighted imaging (DWI) in predicting malignant invasion of the nipple-areolar complex (NAC) by underlying breast cancer. MATERIAL AND METHODS This prospective study included 70 female patients with breast cancer with a mean age of 45.8 years (range: 28-68). DWI of the breast was done for all patients. Apparent diffusion coefficient (ADC) maps were automatically constructed. The mean ADC values of NAC were independently measured by two observers who are experts in breast imaging and correlated with the results of histopathological examinations. RESULTS Both observers found a significantly lower ADC value of malignant NAC invasion (n = 18) when compared with free NAC (n = 52), with mean ADC value for malignant NAC invasion was 0.86 ± 0.35 × 10-3 mm2/s and 0.84 ± 0.08 × 10-3 mm2/s for observer one and two respectively versus mean ADC value of 1.34 ± 0.25 × 10-3 mm2/s and 1.4 ± 0.26 × 10-3 mm2/s for free NAC by observer one and two respectively (P-value =0.001). Observer one found that a cutoff ADC value of 1.05 × 0-3 mm2/s can predict malignant NAC invasion with 0.975 AUC, 92.8% accuracy, 94.4% sensitivity, and 92.3% specificity. Observer two found that a cutoff ADC value of 0.95 × 10-3 mm2/s can predict malignant NAC invasion with 0.992 AUC, 95.7% accuracy, 88.9% sensitivity, and 98.1% specificity. CONCLUSION DWI can predict malignant NAC invasion in patients with breast cancer.
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Affiliation(s)
| | | | - Dina El-Metwally
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura, Egypt
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Ogawa T, Kojima I, Wakamori S, Yoshida T, Murata T, Sakamoto M, Ohkoshi A, Nakanome A, Endo H, Endo T, Usubuchi H, Katori Y. Clinical utility of apparent diffusion coefficient and diffusion-weighted magnetic resonance imaging for resectability assessment of head and neck tumors with skull base invasion. Head Neck 2020; 42:2896-2904. [PMID: 32608548 DOI: 10.1002/hed.26336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 04/28/2020] [Accepted: 05/30/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The usefulness of apparent diffusion coefficient (ADC) and diffusion-weighted magnetic resonance imaging (DWI) in the detection of malignant tumors has been reported. The purpose of this study is to clarify the role of ADC and DWI for diagnosis of skull base tumors. METHODS A total of 27 patients with head and neck tumors with skull base invasions undergoing skull base surgery were enrolled in this study. Pathological findings of dural invasion and bone invasion were compared with the diagnostic imaging. RESULTS Advanced magnetic resonance imaging techniques revealed that ADC values in regions of pathological bone and dural invasions were significantly lower than in regions of no invasion. The area under the curve of ADC in bone invasions and dural invasions were 0.957 and 0.894, respectively. CONCLUSIONS Our findings indicate that ADC and DWI are useful tools for the diagnosis of head and neck tumors with skull base invasion.
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Affiliation(s)
- Takenori Ogawa
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Hospital, Sendai, Japan.,Head and Neck Cancer Center, Tohoku University Hospital, Sendai, Japan
| | - Ikuho Kojima
- Head and Neck Cancer Center, Tohoku University Hospital, Sendai, Japan.,Department of Oral Diagnosis, Tohoku University Hospital, Sendai, Japan
| | - Shun Wakamori
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Hospital, Sendai, Japan.,Head and Neck Cancer Center, Tohoku University Hospital, Sendai, Japan
| | - Takuya Yoshida
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Hospital, Sendai, Japan.,Head and Neck Cancer Center, Tohoku University Hospital, Sendai, Japan
| | - Takaki Murata
- Head and Neck Cancer Center, Tohoku University Hospital, Sendai, Japan.,Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Maya Sakamoto
- Head and Neck Cancer Center, Tohoku University Hospital, Sendai, Japan.,Department of Oral Diagnosis, Tohoku University Hospital, Sendai, Japan
| | - Akira Ohkoshi
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Hospital, Sendai, Japan.,Head and Neck Cancer Center, Tohoku University Hospital, Sendai, Japan
| | - Ayako Nakanome
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Hospital, Sendai, Japan.,Head and Neck Cancer Center, Tohoku University Hospital, Sendai, Japan
| | - Hidenori Endo
- Head and Neck Cancer Center, Tohoku University Hospital, Sendai, Japan.,Department of Neurosurgery, Tohoku University Hospital, Sendai, Japan
| | - Toshiki Endo
- Department of Neurosurgery, Tohoku University Hospital, Sendai, Japan
| | - Hajime Usubuchi
- Department of Pathology, Tohoku University Hospital, Sendai, Japan
| | - Yukio Katori
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Hospital, Sendai, Japan.,Head and Neck Cancer Center, Tohoku University Hospital, Sendai, Japan
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46
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Surov A, Wienke A, Meyer HJ. Pretreatment apparent diffusion coefficient does not predict therapy response to neoadjuvant chemotherapy in breast cancer. Breast 2020; 53:59-67. [PMID: 32652460 PMCID: PMC7375564 DOI: 10.1016/j.breast.2020.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/30/2020] [Accepted: 06/01/2020] [Indexed: 12/12/2022] Open
Abstract
Background Some reports indicated that apparent diffusion coefficient can predict pathologic response to treatment in breast cancer (BC). The purpose of the present meta-analysis was to provide evident data regarding use of ADC values for prediction of treatment response in BC. Methods MEDLINE library, EMBASE and SCOPUS databases were screened for associations between ADC and treatment response for neoadjuvant chemotherapy in breast cancer (BC) up to March 2020. Overall, 22 studies met the inclusion criteria. For the present analysis, the following data were extracted from the collected studies: authors, year of publication, study design, number of patients/lesions, mean and standard deviation of the pretreatment ADC values. The methodological quality of the included 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 responders and non responders. Results The acquired 22 studies comprised 1827 patients with different BC. Of the 1827 patients, 650 (35.6%) were reported as responders and 1177 (64.4%) as non-responders to the neoadjuvant chemotherapy. The pooled calculated pretreatment mean ADC value of BC in responders was 0.98 (95% CI = [0.94; 1.03]). In non-responders, it was 1.05 (95% CI = [1.00; 1.10]). The ADC values of the groups overlapped significantly. Conclusion Pretreatment ADC alone cannot predict response to neoadjuvant chemotherapy in BC.
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Affiliation(s)
- Alexey Surov
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University of Magdeburg, Germany.
| | - Andreas Wienke
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Germany.
| | - Hans Jonas Meyer
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Germany.
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Brenet E, Barbe C, Hoeffel C, Dubernard X, Merol JC, Fath L, Servagi-Vernat S, Labrousse M. Predictive Value of Early Post-Treatment Diffusion-Weighted MRI for Recurrence or Tumor Progression of Head and Neck Squamous Cell Carcinoma Treated with Chemo-Radiotherapy. Cancers (Basel) 2020; 12:cancers12051234. [PMID: 32422975 PMCID: PMC7281260 DOI: 10.3390/cancers12051234] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/04/2020] [Accepted: 05/10/2020] [Indexed: 12/14/2022] Open
Abstract
Aims: To investigate the predictive capacity of early post-treatment diffusion-weighted magnetic resonance imaging (MRI) for recurrence or tumor progression in patients with no tumor residue after chemo-radiotherapy (CRT) for head and neck squamous cell carcinoma, and, to assess the predictive capacity of pre-treatment diffusion-weighted MRI for persistent tumor residue post-CRT. Materials and Method: A single center cohort study was performed in one French hospital. All patients with squamous cell carcinoma receiving CRT (no surgical indication) were included. Two diffusion-weighted MRI were performed: one within 8 days before CRT and one 3 months after completing CRT with determination of median tumor apparent diffusion coefficient (ADC). Main outcome: The primary endpoint was progression-free survival. Results: 59 patients were included prior to CRT and 46 (78.0%) completed CRT. A post-CRT tumor residue was found in 19/46 (41.3%) patients. In univariate analysis, initial ADC was significantly lower in patients with residue post CRT (0.56 ± 0.11 versus 0.79 ± 0.13; p < 0.001). When initial ADC was dichotomized at the median, initial ADC lower than 0.7 was significantly more frequent in patients with residue post CRT (73.7% versus 11.1%, p < 0.0001). In multivariate analysis, only initial ADC lower than 0.7 was significantly associated with tumor residue (OR = 22.6; IC [4.9–103.6], p < 0.0001). Among 26 patients without tumor residue after CRT and followed up until 12 months, 6 (23.1%) presented recurrence or progression. Only univariate analysis was performed due to a small number of events. The only factor significantly associated with disease progression or early recurrence was the delta ADC (p = 0.0009). When ADC variation was dichotomized at the median, patients with ADC variation greater than 0.7 had time of disease-free survival significantly longer than patients with ADC variation lower than 0.7 (377.5 [286–402] days versus 253 [198–370], p < 0.0001). Conclusion and relevance: Diffusion-weighted MRI could be a technique that enables differentiation of patients with high potential for early recurrence for whom intensive post-CRT monitoring is mandatory. Prospective studies with more inclusions would be necessary to validate our results.
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Affiliation(s)
- Esteban Brenet
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Robert Debré University Hospital, 51100 Reims, France; (X.D.); (J.-C.M.); (M.L.)
- Correspondence:
| | - Coralie Barbe
- Clinical Research Unit, Robert Debré University Hospital, 51100 Reims, France;
| | - Christine Hoeffel
- Department of Radiology, Robert Debré University Hospital, 51100 Reims, France;
| | - Xavier Dubernard
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Robert Debré University Hospital, 51100 Reims, France; (X.D.); (J.-C.M.); (M.L.)
| | - Jean-Claude Merol
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Robert Debré University Hospital, 51100 Reims, France; (X.D.); (J.-C.M.); (M.L.)
| | - Léa Fath
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital of Strasbourg, 67000 Strasbourg, France;
| | | | - Marc Labrousse
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Robert Debré University Hospital, 51100 Reims, France; (X.D.); (J.-C.M.); (M.L.)
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48
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Surov A, Meyer HJ, Wienke A. Apparent Diffusion Coefficient for Distinguishing Between Malignant and Benign Lesions in the Head and Neck Region: A Systematic Review and Meta-Analysis. Front Oncol 2020; 9:1362. [PMID: 31970081 PMCID: PMC6960101 DOI: 10.3389/fonc.2019.01362] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 11/18/2019] [Indexed: 12/18/2022] 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 lesions in the head and neck region. Material and Methods: MEDLINE and Scopus databases were screened for associations between ADC and malignancy/benignancy of head and neck lesions up to December 2018. Overall, 22 studies met the inclusion criteria. The following data were extracted: authors, year of publication, study design, number of patients/lesions, lesion type, mean value, and standard deviation of ADC. The primary endpoint of the systematic review was the analysis of the association between lesion nature and ADC values. The methodological quality of the involved studies was checked according to the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) 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 further correction to account for the heterogeneity between the studies. Mean ADC values including 95% confidence intervals were calculated separately for benign and malignant lesions. Results: The acquired 22 studies comprised 1,227 lesions. Different malignant lesions were diagnosed in 818 cases (66.7%) and benign lesions in 409 cases (33.3%). The mean ADC value of the malignant lesions was 1.04 × 10−3 mm2/s, and the mean value of the benign lesions was 1.46 × 10−3 mm2/s. Lymphomas and sarcomas showed the lowest calculated mean ADC values, 0.7 and 0.79 × 10−3 mm2/s, respectively. Adenoid cystic carcinomas had the highest ADC values (1.5 × 10−3 mm2/s). None of the analyzed malignant tumors had mean ADC values above 1.75 × 10−3 mm2/s. Conclusion: ADC values play a limited role in distinguishing between malignant and benign lesions in the head and neck region. It may be only suggested that lesions with mean ADC values above 1.75 × 10−3 mm2/s are probably benign. Further large studies are needed for the analysis of the role of diffusion-weighted imaging (DWI)/ADC in the discrimination of benign and malignant lesions in the head and neck region.
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Affiliation(s)
- Alexey Surov
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
| | - Hans Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
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