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Skwierawska D, Laun FB, Wenkel E, Kapsner LA, Janka R, Uder M, Ohlmeyer S, Bickelhaupt S. Diffusion-Weighted Imaging for Skin Pathologies of the Breast-A Feasibility Study. Diagnostics (Basel) 2024; 14:934. [PMID: 38732348 PMCID: PMC11083106 DOI: 10.3390/diagnostics14090934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/19/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
Several breast pathologies can affect the skin, and clinical pathways might differ significantly depending on the underlying diagnosis. This study investigates the feasibility of using diffusion-weighted imaging (DWI) to differentiate skin pathologies in breast MRIs. This retrospective study included 88 female patients who underwent diagnostic breast MRI (1.5 or 3T), including DWI. Skin areas were manually segmented, and the apparent diffusion coefficients (ADCs) were compared between different pathologies: inflammatory breast cancer (IBC; n = 5), benign skin inflammation (BSI; n = 11), Paget's disease (PD; n = 3), and skin-involved breast cancer (SIBC; n = 11). Fifty-eight women had healthy skin (H; n = 58). The SIBC group had a significantly lower mean ADC than the BSI and IBC groups. These differences persisted for the first-order features of the ADC (mean, median, maximum, and minimum) only between the SIBC and BSI groups. The mean ADC did not differ significantly between the BSI and IBC groups. Quantitative DWI assessments demonstrated differences between various skin-affecting pathologies, but did not distinguish clearly between all of them. More extensive studies are needed to assess the utility of quantitative DWI in supplementing the diagnostic assessment of skin pathologies in breast imaging.
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Affiliation(s)
- Dominika Skwierawska
- Institute of Radiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany
| | - Frederik B. Laun
- Institute of Radiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany
| | - Evelyn Wenkel
- Radiologie München, Burgstraße 7, 80331 München, Germany
- Medical Faculty, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Lorenz A. Kapsner
- Institute of Radiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany
- Chair of Medical Informatics, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Wetterkreuz 15, 91058 Erlangen-Tennenlohe, Germany
| | - Rolf Janka
- Institute of Radiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany
| | - Michael Uder
- Institute of Radiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany
| | - Sabine Ohlmeyer
- Institute of Radiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany
| | - Sebastian Bickelhaupt
- Institute of Radiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany
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Kazama T, Takahara T, Endo J, Yamamuro H, Sekiguchi T, Niwa T, Niikura N, Okamura T, Kumaki N, Hashimoto J. Computed diffusion-weighted imaging with a low-apparent diffusion coefficient-pixel cut-off technique for breast cancer detection. Br J Radiol 2023; 96:20220951. [PMID: 37393536 PMCID: PMC10607411 DOI: 10.1259/bjr.20220951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 06/15/2023] [Accepted: 06/24/2023] [Indexed: 07/03/2023] Open
Abstract
OBJECTIVE This study aimed to compare the image quality and diagnostic performance of computed diffusion-weighted imaging (DWI) with low-apparent diffusion coefficient (ADC)-pixel cut-off technique (cDWI cut-off) and actual measured DWI (mDWI). METHODS Eighty-seven consecutive patients with malignant breast lesions and 72 with negative breast lesions who underwent breast MRI were retrospectively evaluated. Computed DWI with high b-values of 800, 1200, and 1500 s/mm2 and ADC cut-off thresholds of none, 0, 0.3, and 0.6 (×10-3 mm2/s) were generated from DWI with two b-values (0 and 800 s/mm2). To identify the optimal conditions, two radiologists evaluated the fat suppression and lesion reduction failure using a cut-off technique. The contrast between breast cancer and glandular tissue was evaluated using region of interest analysis. Three other board-certified radiologists independently assessed the optimised cDWI cut-off and mDWI data sets. Diagnostic performance was evaluated using receiver operating characteristic (ROC) analysis. RESULTS When an ADC cut-off threshold of 0.3 or 0.6 (× 10-3 mm2/s) was applied, fat suppression improved significantly (p < .05). The contrast of the cDWI cut-off with a b-value of 1200 or 1500 s/mm2 was better than the mDWI (p < .01). The ROC area under the curve for breast cancer detection was 0.837 for the mDWI and 0.909 for the cDWI cut-off (p < .01). CONCLUSION The cDWI cut-off provided better diagnostic performance than mDWI for breast cancer detection. ADVANCES IN KNOWLEDGE Using the low-ADC-pixel cut-off technique, computed DWI can improve diagnostic performance by increasing contrast and eliminating un-suppressed fat signals.
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Affiliation(s)
- Toshiki Kazama
- Department of Diagnostic Radiology, Tokai University School of Medicine, Isehara, Japan
| | - Taro Takahara
- Department of Biomedical Engineering, Tokai University School of Engineering, Hiratsuka, Japan
| | - Jun Endo
- Department of Diagnostic Radiology, Tokai University School of Medicine, Isehara, Japan
| | - Hiroshi Yamamuro
- Department of Diagnostic Radiology, Tokai University School of Medicine, Isehara, Japan
| | - Tatsuya Sekiguchi
- Department of Diagnostic Radiology, Tokai University School of Medicine, Isehara, Japan
| | - Tetsu Niwa
- Department of Diagnostic Radiology, Tokai University School of Medicine, Isehara, Japan
| | - Naoki Niikura
- Department of Breast Oncology, Tokai University School of Medicine, Isehara, Japan
| | - Takuho Okamura
- Department of Breast Oncology, Tokai University School of Medicine, Isehara, Japan
| | - Nobue Kumaki
- Department of Pathology, Tokai University School of Medicine, Isehara, Japan
| | - Jun Hashimoto
- Department of Diagnostic Radiology, Tokai University School of Medicine, Isehara, Japan
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Sauer ST, Christner SA, Schlaiß T, Metz C, Schmid A, Kunz AS, Pabst T, Weiland E, Benkert T, Bley TA, Grunz JP. Diffusion-weighted Breast MRI at 3 Tesla: Improved Lesion Visibility and Image Quality with a Combination of Water-excitation and Spectral Fat Saturation. Acad Radiol 2023; 30:1773-1783. [PMID: 36764882 DOI: 10.1016/j.acra.2023.01.014] [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: 11/16/2022] [Revised: 01/05/2023] [Accepted: 01/12/2023] [Indexed: 02/10/2023]
Abstract
RATIONALE AND OBJECTIVES In breast MRI with diffusion-weighted imaging (DWI), fat suppression is essential for eliminating the dominant lipid signal. This investigation evaluates a combined water-excitation-spectral-fatsat method (WEXfs) versus standard spectral attenuated inversion recovery (SPAIR) in high-resolution 3-Tesla breast MRI. MATERIALS AND METHODS Multiparametric breast MRI with 2 echo-planar DWI sequences was performed in 83 patients (50.1 ± 12.6 years) employing either WEXfs or SPAIR for fat signal suppression. Three radiologists assessed overall DWI quality and delineability of 88 focal lesions (28 malignant, 60 benign) on images with b values of 800 and 1600 s/mm2, as well as apparent diffusion coefficient (ADC) maps. For each fat suppression method and b value, the longest lesion diameter was determined in addition to measuring the signal intensity in DWI and ADC value in standardized regions of interest. RESULTS Regardless of b values, image quality (all p < 0.001) and lesion delineability (all p ≤ 0.003) with WEXfs-DWI were deemed superior compared to SPAIR-DWI in benign and malignant lesions. Irrespective of lesion characterization, WEXfs-DWI provided superior signal-to-noise, contrast-to-noise and signal-intensity ratios with 1600 s/mm2 (all p ≤ 0.05). The lesion size difference between contrast-enhanced T1 subtraction images and DWI was smaller for WEXfs compared to SPAIR fat suppression (all p ≤ 0.007). The mean ADC value in malignant lesions was lower for WEXfs-DWI (p < 0.001), while no significant ADC difference was ascertained between both techniques in benign lesions (p = 0.947). CONCLUSION WEXfs-DWI provides better subjective and objective image quality than standard SPAIR-DWI, resulting in a more accurate estimation of benign and malignant lesion size.
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Affiliation(s)
- Stephanie Tina Sauer
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Sara Aniki Christner
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Tanja Schlaiß
- Department of Obstetrics and Gynecology, University Hospital Würzburg, Würzburg, Germany
| | - Corona Metz
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Pediatric Radiology, Berlin, Germany
| | - Andrea Schmid
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Pediatric Radiology, Berlin, Germany
| | - Andreas Steven Kunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Thomas Pabst
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Elisabeth Weiland
- MRI Application Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | - Thomas Benkert
- MRI Application Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | - Thorsten Alexander Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany.
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Evaluation of apparent diffusion coefficient of two-dimensional BLADE turbo gradient- and spin-echo diffusion-weighted imaging with a breast phantom. Radiol Phys Technol 2023; 16:118-126. [PMID: 36596917 DOI: 10.1007/s12194-022-00694-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 01/05/2023]
Abstract
This study aimed to evaluate the reliability of apparent diffusion coefficient (ADC) values generated with two-dimensional turbo gradient- and spin-echo with BLADE trajectory diffusion-weighted imaging (TGSE-BLADE-DWI) sequence using a breast diffusion phantom. TGSE-BLADE-DWI and single-shot spin-echo echo-planar imaging (SS-EPI-DWI) were performed using a 3.0 T magnetic resonance imaging scanner. Concordance rates of ADC values and the signal-to-noise ratio (SNR) were compared between TGSE-BLADE-DWI and SS-EPI-DWI. TGSE-BLADE-DWI provided a higher concordance rate for ADC values than SS-EPI-DWI when b-values > 2000s/mm2 and a slice thickness of 1 mm were used. TGSE-BLADE-DWI showed less image distortion than SS-EPI-DWI. The SNR of TGSE-BLADE-DWI was higher than that of SS-EPI-DWI, except at a number of excitations of 7 and a slice thickness of 1 mm. In conclusion, TGSE-BLADE-DWI can offer a better SNR, less distortion, and more reliable ADC measurements than SS-EPI-DWI in a breast phantom.
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Sanderink WBG, Teuwen J, Appelman L, Moy L, Heacock L, Weiland E, Sechopoulos I, Mann RM. Diffusion weighted imaging for evaluation of breast lesions: Comparison between high b-value single-shot and routine readout-segmented sequences at 3 T. Magn Reson Imaging 2021; 84:35-40. [PMID: 34560230 DOI: 10.1016/j.mri.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/10/2021] [Accepted: 09/16/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE In this study, we compare readout-segmented echo-planar imaging (rs-EPI) Diffusion Weighted Imaging (DWI) to a work-in-progress single-shot EPI with modified Inversion Recovery Background Suppression (ss-EPI-mIRBS) sequence at 3 T using a b-value of 2000 s/mm2 on image quality, lesion visibility and evaluation time. METHOD From September 2017 to December 2018, 23 women (one case used for training) with known breast cancer were included in this study, after providing signed informed consent. Women were scanned with the conventional rs-EPI sequence and the work-in-progress ss-EPI-mIRBS during the same examination. Four breast radiologists (4-13 years of experience) independently scored both series for overall image quality (1: extremely poor to 9: excellent). All lesions (47 in total, 36 malignant, and 11 benign and high-risk) were evaluated for visibility (1: not visible, 2: visible if location is given, 3: visible) and probability of malignancy (BI-RADS 1 to 5). ADC values were determined by measuring signal intensity in the lesions using dynamic contrast-enhanced (DCE) images for reference. Evaluation times for all assessments were automatically recorded. Results were analyzed using the visual grading characteristics (VGC) and the resulting area under the curve (AUCVGC) method. Statistical analysis was performed in SPSS, with McNemar tests, and paired t-tests used for comparison. RESULTS No significant differences were detected between the two sequences in image quality (AUCVGC: 0.398, p = 0.087) and lesion visibility (AUCVGC: 0.534, p = 0.336) scores. Lesion characteristics (e.g benign and high-risk, versus malignant; small (≤10 mm) vs. larger (>10 mm)) did not result in different image quality or lesion visibility between sequences. Sensitivity (rs-EPI: 72.2% vs. ss-EPImIRBS: 78.5%, p = 0.108) and specificity (70.5% vs. 56.8%, p = 0.210, respectively) were comparable. In both sequences the mean ADC value was higher for benign and high-risk lesions than for malignant lesions (ss-EPI-mIRBS: p = 0.022 and rs-EPI: p = 0.055). On average, ss-EPI-mIRBS resulted in decreased overall reading time by 7.7 s/case (p = 0.067); a reduction of 17%. For malignant lesions, average reading time was significantly shorter using ss-EPI-mIRBS compared to rs-EPI (64.0 s/lesion vs. 75.9 s/lesion, respectively, p = 0.039). CONCLUSION Based on this study, the ss-EPI sequence using a b-value of 2000 s/mm2 enables for a mIRBS acquisition with quality and lesion conspicuity that is comparable to conventional rs-EPI, but with a decreased reading time.
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Affiliation(s)
- Wendelien B G Sanderink
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525GA Nijmegen, the Netherlands.
| | - Jonas Teuwen
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525GA Nijmegen, the Netherlands; Department of Radiology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066, CX, Amsterdam, the Netherlands
| | - Linda Appelman
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525GA Nijmegen, the Netherlands
| | - Linda Moy
- Department of Radiology, New York University Langone Medical Center, 660 First Avenue, 4(th) floor, New York, NY 10016, United States
| | - Laura Heacock
- Department of Radiology, New York University Langone Medical Center, 660 First Avenue, 4(th) floor, New York, NY 10016, United States
| | - Elisabeth Weiland
- MR Application Predevelopment, Siemens Healthcare, Allee am Roethelheimpark 2, 91052 Erlangen, Germany
| | - Ioannis Sechopoulos
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525GA Nijmegen, the Netherlands
| | - Ritse M Mann
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525GA Nijmegen, the Netherlands; Department of Radiology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066, CX, Amsterdam, the Netherlands
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Apparent diffusion coefficient values in borderline breast lesions upgraded and not upgraded at definitive histopathological examination after surgical excision. Pol J Radiol 2021; 86:e255-e261. [PMID: 34093923 PMCID: PMC8147718 DOI: 10.5114/pjr.2021.105857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 05/13/2020] [Indexed: 01/04/2023] Open
Abstract
Purpose The study aims were to evaluate if the apparent diffusion coefficient (ADC) value could distinguish between breast lesions classified as B3 at core needle biopsy (CNB) that show or do not show atypia or malignancy at definitive histopathological examination (DHE) after surgical excision. Material and methods From January 2013 to December 2017, 141 patients with a B3 breast lesion underwent magnetic resonance imaging and were included in the study. The ADC value was assessed drawing a ROI outlining the entire lesion, evaluating the mean (ADCmean) and minimum ADC values (ADCmin). Results Both ADCmean and ADCmin values showed a statistically significant difference between B3 lesions without and with malignancy or, for B3a lesions, atypia at DHE. They both showed a statistically significant difference also between B3a lesions without or with atypia or malignancy at DHE, but only ADCmin (not ADCmean) showed statistically significant difference between B3b lesions without or with malignancy at DHE. Conclusions The ADC value could help distinguish between B3a lesions without or with atypia/malignancy at DHE after surgical excision and between B3b lesions without or with malignancy at DHE. Therefore, it could be used to help guide the diagnostic-therapeutic pathway of these lesions, particularly of B3a lesions.
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Mansour TMM, El-Barody MM, Tammam H, Okasha A. Role of diffusion-weighted MRI in differentiating between benign and malignant bone lesions: a prospective study. Clin Radiol 2021; 76:576-584. [PMID: 33865551 DOI: 10.1016/j.crad.2021.02.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 02/11/2021] [Indexed: 01/12/2023]
Abstract
AIM To evaluate the ability of diffusion-weighted magnetic resonance imaging (DW-MRI) to differentiate between benign and malignant bony tumours. MATERIALS AND METHODS This prospective study was conducted from October, 2018 to December, 2019. The study included 62 patients (37 male and 25 female) with clinically suspected bony lesions referred to the Radiology Department. Patients underwent clinical examination, radiography, computed tomography (CT), and ultrasonography examinations. MRI studies were conducted using a 1.5-T MRI machine, and post-processing analysis was done using a Philips Extended MRI workspace workstation. RESULTS The mean apparent diffusion coefficient (ADC) value of benign lesions ranged between 0.85 × 10-3 and 2.44 × 10-3 mm2/s. The lowest ADC values were measured in a giant cell tumour and in an inclusion epidermoid cyst (0.85 × 10-3 and 0.93 × 10-3 mm2/s, respectively). The highest measurement was in bony cysts (2.44 × 10-3 mm2/s) followed by osteoid osteoma (2.2 × 10-3 mm2/s) and osteochondroma (1.85 × 10-3 mm2/s). Amongst malignant lesions, ADC values ranged from 0.42 × 10-3 to 2.4 × 10-3 mm2/s. The lowest value was measured in malignant round cell tumour Ewing's/primitive neuroectodermal tumour (PNET), and the highest was measured in conventional chondrosarcoma. Metastatic lesions were observed in 11 patients with a mean ADC value of 0.71 × 10-3 mm2/s, followed by osteosarcoma in six patients with a mean ADC value of 0.74 × 10-3 mm2/s. CONCLUSION There was a significant difference between the mean, minimum, and maximum ADC values of benign and malignant tumours. The present findings indicate that the best cut-off ADC range to predict malignancy is 0.78-0.86 × 10-3 mm2/s, with a sensitivity of 89.47%, specificity of 97.22%, and accuracy of 94.55%.
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Affiliation(s)
- T M M Mansour
- Radio-diagnosis Department, Faculty of Medicine, Al-Azhar University, Assuit, Egypt.
| | - M M El-Barody
- Radio-diagnosis Department, South Egypt Cancer Institute, Assuit University, Assuit, Egypt
| | - H Tammam
- Orthopedic Department, Faculty of Medicine, South Valley University, Qena, Egypt
| | - A Okasha
- Radio-diagnosis Department, Faculty of Medicine, South Valley University, Qena, Egypt
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Xu F, Liang YY, Guo Y, Liang ZP, Wu M, Chen S, Zeng XW. Diagnostic performance of whole-lesion apparent diffusion coefficient histogram analysis metrics for differentiating benign and malignant breast lesions: a systematic review and diagnostic meta-analysis. Acta Radiol 2020; 61:1165-1175. [PMID: 31924104 DOI: 10.1177/0284185119896520] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Although whole-lesion apparent diffusion coefficient (ADC) histogram has been increasingly used for breast lesions, it has not been routinely used in clinical practice as an emergent promising imaging tool. PURPOSE To evaluate the performance of whole-lesion ADC histogram analysis metrics for differentiating benign and malignant breast lesions. MATERIAL AND METHODS A systematic PubMed/EMBASE/Cochrane electronic database search was performed for original diagnostic studies from 1 January 1970 to 2 January 2019. Summary estimates of diagnostic accuracy were generated and meta-regression was performed to explore sources of heterogeneity according to study and magnetic resonance imaging characteristics. RESULTS Five original articles involving 493 patients were included in the meta-analysis. The pooled sensitivity and specificity of whole-lesion ADC histogram analysis were 0.85 (95% confidence interval [CI] = 0.81-0.89) and 0.79 (95% CI = 0.72-0.84) for distinguishing benign and malignant breast lesions, respectively. The area under the curve (AUC) was 0.9178. No publication bias was detected (P = 0.51). In subgroup analysis, the summary sensitivity and specificity of 50th percentile ADC value were 0.81 (95% CI = 0.71-0.88) and 0.86 (95% CI = 0.74-0.94), respectively. Meta-regression analysis indicated no covariates were sources of heterogeneity (P > 0.05). CONCLUSION Whole-lesion ADC histogram analysis demonstrated good diagnostic performance for differentiating between benign and malignant breast lesions, with 50th percentile ADC value showing higher diagnostic accuracy than other histogram parameters. Given the limited number of studies included in the analysis, the findings from our meta-analysis will need further confirmation in future research.
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Affiliation(s)
- Fan Xu
- Department of Radiology, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, Guangdong Province, PR China
| | - Ying-ying Liang
- Department of Radiology, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong Province, PR China
| | - Yuan Guo
- Department of Radiology, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong Province, PR China
| | - Zhi-ping Liang
- Department of Radiology, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, Guangdong Province, PR China
| | - Mei Wu
- Department of Radiology, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong Province, PR China
| | - Song Chen
- Department of Radiology, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, Guangdong Province, PR China
| | - Xu-wen Zeng
- Department of Radiology, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, Guangdong Province, PR China
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Wielema M, Dorrius MD, Pijnappel RM, De Bock GH, Baltzer PAT, Oudkerk M, Sijens PE. Diagnostic performance of breast tumor tissue selection in diffusion weighted imaging: A systematic review and meta-analysis. PLoS One 2020; 15:e0232856. [PMID: 32374781 PMCID: PMC7202642 DOI: 10.1371/journal.pone.0232856] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 04/22/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Several methods for tumor delineation are used in literature on breast diffusion weighted imaging (DWI) to measure the apparent diffusion coefficient (ADC). However, in the process of reaching consensus on breast DWI scanning protocol, image analysis and interpretation, still no standardized optimal breast tumor tissue selection (BTTS) method exists. Therefore, the purpose of this study is to assess the impact of BTTS methods on ADC in the discrimination of benign from malignant breast lesions in DWI in terms of sensitivity, specificity and area under the curve (AUC). METHODS AND FINDINGS In this systematic review and meta-analysis, adhering to the PRISMA statement, 61 studies, with 65 study subsets, in females with benign or malignant primary breast lesions (6291 lesions) were assessed. Studies on DWI, quantified by ADC, scanned on 1.5 and 3.0 Tesla and using b-values 0/50 and ≥ 800 s/mm2 were included. PubMed and EMBASE were searched for studies up to 23-10-2019 (n = 2897). Data were pooled based on four BTTS methods (by definition of measured region of interest, ROI): BTTS1: whole breast tumor tissue selection, BTTS2: subtracted whole breast tumor tissue selection, BTTS3: circular breast tumor tissue selection and BTTS4: lowest diffusion breast tumor tissue selection. BTTS methods 2 and 3 excluded necrotic, cystic and hemorrhagic areas. Pooled sensitivity, specificity and AUC of the BTTS methods were calculated. Heterogeneity was explored using the inconsistency index (I2) and considering covariables: field strength, lowest b-value, image of BTTS selection, pre-or post-contrast DWI, slice thickness and ADC threshold. Pooled sensitivity, specificity and AUC were: 0.82 (0.72-0.89), 0.79 (0.65-0.89), 0.88 (0.85-0.90) for BTTS1; 0.91 (0.89-0.93), 0.84 (0.80-0.87), 0.94 (0.91-0.96) for BTTS2; 0.89 (0.86-0.92), 0.90 (0.85-0.93), 0.95 (0.93-0.96) for BTTS3 and 0.90 (0.86-0.93), 0.84 (0.81-0.87), 0.86 (0.82-0.88) for BTTS4, respectively. Significant heterogeneity was found between studies (I2 = 95). CONCLUSIONS None of the breast tissue selection (BTTS) methodologies outperformed in differentiating benign from malignant breast lesions. The high heterogeneity of ADC data acquisition demands further standardization, such as DWI acquisition parameters and tumor tissue selection to substantially increase the reliability of DWI of the breast.
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Affiliation(s)
- M. Wielema
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M. D. Dorrius
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - R. M. Pijnappel
- Department of Radiology, Utrecht University, University Medical Center Utrecht, Utrecht, The Netherlands
| | - G. H. De Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - P. A. T. Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - M. Oudkerk
- University of Groningen, Groningen, The Netherlands
- Institute for Diagnostic Accuracy, Groningen, The Netherlands
| | - P. E. Sijens
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Surov A, Meyer HJ, Wienke A. Can apparent diffusion coefficient (ADC) distinguish breast cancer from benign breast findings? A meta-analysis based on 13 847 lesions. BMC Cancer 2019; 19:955. [PMID: 31615463 PMCID: PMC6794799 DOI: 10.1186/s12885-019-6201-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 09/24/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The purpose of the present meta-analysis was to provide evident data about use of Apparent Diffusion Coefficient (ADC) values for distinguishing malignant and benign breast lesions. METHODS MEDLINE library and SCOPUS database were screened for associations between ADC and malignancy/benignancy of breast lesions up to December 2018. Overall, 123 items were identified. The following data were extracted from the literature: authors, year of publication, study design, number of patients/lesions, lesion type, mean value and standard deviation of ADC, measure method, b values, and Tesla strength. The methodological quality of the 123 studies was checked according to the QUADAS-2 instrument. The meta-analysis was undertaken by using RevMan 5.3 software. DerSimonian and Laird random-effects models with inverse-variance weights were used without any further correction to account for the heterogeneity between the studies. Mean ADC values including 95% confidence intervals were calculated separately for benign and malign lesions. RESULTS The acquired 123 studies comprised 13,847 breast lesions. Malignant lesions were diagnosed in 10,622 cases (76.7%) and benign lesions in 3225 cases (23.3%). The mean ADC value of the malignant lesions was 1.03 × 10- 3 mm2/s and the mean value of the benign lesions was 1.5 × 10- 3 mm2/s. The calculated ADC values of benign lesions were over the value of 1.00 × 10- 3 mm2/s. This result was independent on Tesla strength, choice of b values, and measure methods (whole lesion measure vs estimation of ADC in a single area). CONCLUSION An ADC threshold of 1.00 × 10- 3 mm2/s can be recommended for distinguishing breast cancers from benign lesions.
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Affiliation(s)
- Alexey Surov
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany. .,Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
| | - Hans Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Magdeburger Str. 8, 06097, Halle, Germany
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Gity M, Moradi B, Arami R, Arabkheradmand A, Kazemi MA. Two Different Methods of Region-of-Interest Placement for Differentiation of Benign and Malignant Breast Lesions by Apparent Diffusion Coefficient Value. Asian Pac J Cancer Prev 2018; 19:2765-2770. [PMID: 30360604 PMCID: PMC6291064 DOI: 10.22034/apjcp.2018.19.10.2765] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Purpose: We aimed to investigate the influence of different methods of region-of-interest (ROI) placement on apparent diffusion coefficient (ADC) values in breast tumours and their accuracy in differentiating benign versus malignant tumors in mass and nonmass lesions. Methods and Materials: In this prospective study, 79 patients with 98 breast lesions, from 2015 until 2017, were investigated by 1.5-T breast MRI. Histopathology evaluation were done for all malignant lesions and most of the benign ones. ADC values were measured in normal breast tissue and by two ways of ROI placement in the breast lesions (mass and non-mass): 1- ROI covering the whole lesion, 2- ROI in the highest part (most restricted area) of the lesion in DWI images. The accuracy of these two approaches were compared. Results: The age range was 17-68 years with mean age 43.3 ± 9.9 years. 49% of the lesions were benign and 51% of tumors were malignant. Our results revealed that the measured ADC values in normal breast tissue were higher than breast lesions (P≤0.01). Appropriate cut off determination in non-mass was not valid by both methods, but in mass in the first way was 1.45×10-3mm2/s and in the most restricted part was 1.16×10-3 mm2/s. ADC values differed significantly between the two ways of ROI placement in mass lesions (P<.001). Most restricted part ADC showed the best diagnostic performance in mass lesions with area under curve 0.88 versus 0.82. Conclusion: ROI placement has significant impact on the meseaured ADC values of breast lesions and ROIs in most restricted parts were more accurate than whole-lesion ROIs. Cut-off values differed significantly based on the methods of measurement.
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Affiliation(s)
- Masoumeh Gity
- Department of Radiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
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Shi RY, Yao QY, Wu LM, Xu JR. Breast Lesions: Diagnosis Using Diffusion Weighted Imaging at 1.5T and 3.0T—Systematic Review and Meta-analysis. Clin Breast Cancer 2018; 18:e305-e320. [DOI: 10.1016/j.clbc.2017.06.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 05/20/2017] [Accepted: 06/24/2017] [Indexed: 12/26/2022]
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13
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Zhuang Z, Zhang Q, Zhang D, Cheng F, Suo S, Geng X, Hua J, Xu J. Utility of apparent diffusion coefficient as an imaging biomarker for assessing the proliferative potential of invasive ductal breast cancer. Clin Radiol 2017; 73:473-478. [PMID: 29273228 DOI: 10.1016/j.crad.2017.11.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 11/20/2017] [Indexed: 11/25/2022]
Abstract
AIM To determine the clinical utility of apparent diffusion coefficient (ADC) metrics for the non-invasive assessment of tumour proliferation indicated by Ki-67 labelling index (LI) in invasive ductal breast cancer. MATERIALS AND METHODS Eighty patients with 80 histopathologically proven invasive ductal breast cancers underwent diffusion-weighted imaging with b-values of 0 and 800 s/mm2 at a 3-T system. ADC metrics including ADCmean, ADCmedian, ADCmin, ADCmax, and ΔADC (ADCmax-ADCmin) were recorded from the entire tumour volume on ADC maps, and correlated with the Ki-67 LI. Ki-67 staining of ≥14% was considered to indicate high proliferation and <14% was considered to indicate low proliferation. RESULTS ADCmin, ADCmax, and ΔADC showed significant correlations with the Ki-67 LI (for all tumours, r=-0.311, 0.436, and 0.551, respectively; for luminal/human epidermal growth factor receptor 2 (HER2)-negative group, r=-0.437, 0.512, and 0.639, respectively; all p<0.01), whereas ADCmean and ADCmedian showed no significant correlation (both p>0.05). Receiver operating characteristic (ROC) curve analysis for the differentiation of high- from low-proliferation groups showed that ΔADC yielded the highest area under the ROC curve for the whole tumour population (0.825; 95% confidence interval [CI]: 0.724, 0.901), as well as for the luminal/HER2-negative group (0.844; 95% CI: 0.692, 0.940). CONCLUSION ΔADC may serve as a promising imaging biomarker for the prediction of Ki-67 proliferation status in invasive ductal breast cancer.
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Affiliation(s)
- Z Zhuang
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, PR China
| | - Q Zhang
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, PR China
| | - D Zhang
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, PR China
| | - F Cheng
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, PR China
| | - S Suo
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, PR China
| | - X Geng
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, PR China
| | - J Hua
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, PR China.
| | - J Xu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, PR China.
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14
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Wang Q, Guo Y, Zhang J, Wang Z, Huang M, Zhang Y. Contribution of IVIM to Conventional Dynamic Contrast-Enhanced and Diffusion-Weighted MRI in Differentiating Benign from Malignant Breast Masses. Breast Care (Basel) 2016; 11:254-258. [PMID: 27721712 DOI: 10.1159/000447765] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The aim of this study was to determine whether the indicators obtained from intravoxel incoherent motion (IVIM) imaging can improve the characterization of benign and malignant breast masses compared with conventional dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted magnetic resonance imaging (DW-MRI). PATIENTS AND METHODS This study included 23 benign and 31 malignant breast masses of 48 patients. Main indicators were initial enhancement ratio (IER), time-signal intensity curve (TIC), apparent diffusion coefficient (ADC), tissue diffusivity (D), pseudodiffusivity (D*), and perfusion fraction (f). The discriminative abilities of the different models were compared by means of receiver operating characteristic (ROC) curve and area under the ROC curve (AUC) analysis. RESULTS D had the highest AUC (0.980), sensitivity (93.55%), specificity (100%), and diagnostic accuracy (96.36%). Both D and TIC could provide the independent predicted features for malignant breast masses. The combination of D and TIC had an AUC of up to 0.990. CONCLUSION D of IVIM can effectively complement existing conventional DCE-MRI and DW-MRI in differentiating malignant from benign breast masses. IVIM combined with DCE-MRI is a robust means of evaluating breast masses.
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Affiliation(s)
- Qingjun Wang
- Department of Radiology, Chinese Navy General Hospital of PLA, Beijing, China
| | - Yong Guo
- Department of Radiology, Chinese Navy General Hospital of PLA, Beijing, China
| | - Jing Zhang
- Department of Radiology, Chinese Navy General Hospital of PLA, Beijing, China
| | - Zijun Wang
- Department of Radiology, Chinese Navy General Hospital of PLA, Beijing, China
| | - Minhua Huang
- Department of Radiology, Chinese Navy General Hospital of PLA, Beijing, China
| | - Yun Zhang
- Department of Radiology, Chinese Navy General Hospital of PLA, Beijing, China
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Durando M, Gennaro L, Cho GY, Giri DD, Gnanasigamani MM, Patil S, Sutton EJ, Deasy JO, Morris EA, Thakur SB. Quantitative apparent diffusion coefficient measurement obtained by 3.0Tesla MRI as a potential noninvasive marker of tumor aggressiveness in breast cancer. Eur J Radiol 2016; 85:1651-8. [PMID: 27501902 DOI: 10.1016/j.ejrad.2016.06.019] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 05/09/2016] [Accepted: 06/27/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE To assess the association between apparent diffusion coefficient (ADC), and histological prognostic parameters in malignant breast lesions. The ability of ADC to identify lesions with the presence of Lymphovascular invasion (LVI) in breast carcinoma was also examined. MATERIALS AND METHODS This HIPAA-compliant retrospective study consisted of 212 consecutive patients with known cancers who underwent 3.0T MRI between January 2011 and 2013. In this study, a total of 126 malignant lesions in 114 women, who had undergone DWI (b-values of 0 and 1000s/mm(2)) in addition to diagnostic MRI, were included. Patients with less than 0.8cm lesions, or those who underwent neoadjuvant chemotherapy or suboptimal DW images were excluded. Classical prognostic factors [lesion size, histopathological type and grade, lymph node (LN) status and lymphovascular invasion (LVI)], molecular prognostic markers [estrogen receptor (ER), progesterone receptor (PR) and human epidermal grow factor receptor 2 (HER2)] were reviewed and recorded. A region of interest (ROI) was drawn within the lesions to measure ADC values. Statistical analyses were performed by the Wilcoxon rank sum test (statistical significance at P<0.05). Adjusted p values from multiple comparison analysis were also calculated. RESULTS This study demonstrates an inverse correlation between ADC and LVI in malignant lesions and the ability of ADC to identify aggressiveness in lesions with positive LVI. Tumor size, grade, ER, PR, HER2 and lymph node status did not impact tumor ADC value. However, tumors with LVI showed significantly lower ADC values when compared to tumors without LVI, regardless of the enhancement type, histological grade, histological type, and LN status. CONCLUSION Our study shows that ADC could be a potential clinical adjunct in the evaluation of prognostic factors related to malignant lesion aggressiveness such as LVI.
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Affiliation(s)
- Manuela Durando
- Department of Diagnostic Imaging and Radiotherapy, A. O. U. Città della Salute e della Scienza of Turin, 10126, Italy.
| | - Lucas Gennaro
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 300 East, 66th street, NY 10065, USA.
| | - Gene Y Cho
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 300 East, 66th street, NY 10065, USA.
| | - Dilip D Giri
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, 300 East 66th street, NY 10065, USA.
| | - Merlin M Gnanasigamani
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, NY 10065, USA.
| | - Sujata Patil
- Department of Biostatistics, Memorial Sloan-Kettering Cancer Center, 485 Lexington Avenue, NY 10065, USA.
| | - Elizabeth J Sutton
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 300 East, 66th street, NY 10065, USA.
| | - Joseph O Deasy
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, NY 10065, USA.
| | - Elizabeth A Morris
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 300 East, 66th street, NY 10065, USA.
| | - Sunitha B Thakur
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 300 East, 66th street, NY 10065, USA; Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, NY 10065, USA.
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Ertas G, Onaygil C, Akin Y, Kaya H, Aribal E. Quantitative differentiation of breast lesions at 3T diffusion-weighted imaging (DWI) using the ratio of distributed diffusion coefficient (DDC). J Magn Reson Imaging 2016; 44:1633-1641. [DOI: 10.1002/jmri.25327] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 05/16/2016] [Indexed: 12/19/2022] Open
Affiliation(s)
- Gokhan Ertas
- Department of Biomedical Engineering; Yeditepe University; Istanbul Turkey
| | - Can Onaygil
- Institute of Diagnostic and Interventional Radiology; Oberlausitz-Kliniken gGmbH; Bautzen Germany
| | - Yasin Akin
- Department of Radiology; Sanliurfa Mehmet Akif Inan Education and Research Hospital; Sanliurfa Turkey
| | - Handan Kaya
- Department of Pathology; Marmara University School of Medicine; Istanbul Turkey
| | - Erkin Aribal
- Department of Radiology; Marmara University School of Medicine; Istanbul Turkey
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17
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Nogueira L, Brandão S, Matos E, Gouveia Nunes R, Ferreira HA, Loureiro J, Ramos I. Improving malignancy prediction in breast lesions with the combination of apparent diffusion coefficient and dynamic contrast-enhanced kinetic descriptors. Clin Radiol 2015; 70:1016-25. [DOI: 10.1016/j.crad.2015.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 05/08/2015] [Accepted: 05/28/2015] [Indexed: 02/03/2023]
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18
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Nogueira L, Brandão S, Nunes RG, Ferreira HA, Loureiro J, Ramos I. Breast DWI at 3 T: influence of the fat-suppression technique on image quality and diagnostic performance. Clin Radiol 2014; 70:286-94. [PMID: 25555315 DOI: 10.1016/j.crad.2014.11.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 11/12/2014] [Accepted: 11/19/2014] [Indexed: 10/24/2022]
Abstract
AIM To evaluate two fat-suppression techniques: short tau inversion recovery (STIR) and spectral adiabatic inversion recovery (SPAIR) regarding image quality and diagnostic performance in diffusion-weighted imaging (DWI) of breast lesions at 3 T. MATERIALS AND METHODS Ninety-two women (mean age 48 ± 12.1 years; range 21-78 years) underwent breast MRI. Two DWI pulse sequences, with b-values (50 and 1000 s/mm(2)) were performed with STIR and SPAIR. The signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), suppression homogeneity, and apparent diffusion coefficient (ADC) values were quantitatively assessed for each technique. Values were compared between techniques and lesion type. Receiver operating characteristics (ROC) analysis was used to evaluate lesion discrimination. RESULTS One hundred and fourteen lesions were analysed (40 benign and 74 malignant). SNR and CNR were significantly higher for DWI-SPAIR; fat-suppression uniformity was better for DWI-STIR (p < 1 × 10(-4)). ADC values for benign and malignant lesions and normal tissue were 1.92 × 10(-3), 1.18 × 10(-3), 1.86 × 10(-3) s/mm(2) for DWI-STIR and 1.80 × 10(-3), 1.11 × 10(-3), 1.79 × 10(-3) s/mm(2) for SPAIR, respectively. Comparison between fat-suppression techniques showed significant differences in mean ADC values for benign (p = 0.013) and malignant lesions (p = 0.001). DWI-STIR and -SPAIR ADC cut-offs were 1.42 × 10(-3) and 1.46 × 10(-3) s/mm(2), respectively. Diagnostic performance for DWI-STIR versus SPAIR was: accuracy (81.6 versus 83.3%), area under curve (87.7 versus 89.2%), sensitivity (79.7 versus 85.1%), and specificity (85 versus 80%). Positive predictive value was similar. CONCLUSION The fat-saturation technique used in the present study may influence image quality and ADC quantification. Nevertheless, STIR and SPAIR techniques showed similar diagnostic performances, and therefore, both are suitable for use in clinical practice.
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Affiliation(s)
- Luisa Nogueira
- Department of Radiology, School of Health Technology of Porto/Polytechnic Institute of Porto (ESTSP/IPP), Rua Valente Perfeito, 4400-330, Vila Nova de Gaia, Portugal; Department of Radiology, Hospital de São João/Faculty of Medicine of Porto University (FMUP), Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.
| | - Sofia Brandão
- MRI Unit, Department of Radiology, Hospital de São João, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal
| | - Rita G Nunes
- Institute of Biophysics and Biomedical Engineering (IBEB), Faculty of Sciences, University of Lisbon, Campo Grande, 1749-016, Lisboa, Portugal
| | - Hugo Alexandre Ferreira
- Institute of Biophysics and Biomedical Engineering (IBEB), Faculty of Sciences, University of Lisbon, Campo Grande, 1749-016, Lisboa, Portugal
| | - Joana Loureiro
- MRI Unit, Department of Radiology, Hospital de São João, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal
| | - Isabel Ramos
- Department of Radiology, Hospital de São João/Faculty of Medicine of Porto University (FMUP), Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
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Ramírez-Galván YA, Cardona-Huerta S, Ibarra-Fombona E, Elizondo-Riojas G. Apparent diffusion coefficient (ADC) value to evaluate BI-RADS 4 breast lesions: correlation with pathological findings. Clin Imaging 2014; 39:51-5. [PMID: 25457520 DOI: 10.1016/j.clinimag.2014.09.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 08/11/2014] [Accepted: 09/09/2014] [Indexed: 01/08/2023]
Abstract
Diffusion-weighted imaging and apparent diffusion coefficient (ADC) of 36 breast lesions previously categorized as 4 according to the Breast Imaging Reporting and Data System (BI-RADS) were prospectively studied. The pathological results were 21 benign lesions and 15 malignant. The ADC of malignant lesions was significantly lower than that of the benign ones (0.87 ± 0.12 × 10(-3) mm(2)/s vs. 1.41 ± 0.22 × 10(-3) mm(2)/s, respectively) (P<.001). Using a threshold ADC value of 1.08 × 10(-3) mm(2)/s, a sensitivity of 95% and specificity of 100% were obtained.
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