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Weng C, Yang Y, Yang L, Hu C, Ma X, Li G. Evaluations of the diagnostic performance of ZOOMit diffusion-weighted imaging and conventional diffusion-weighted imaging for breast lesions. Quant Imaging Med Surg 2023; 13:8478-8488. [PMID: 38106248 PMCID: PMC10722069 DOI: 10.21037/qims-23-415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 10/07/2023] [Indexed: 12/19/2023]
Abstract
Background Diffusion-weighted imaging (DWI) is valuable in the screening, diagnosis, and grading of breast lesions. However, conventional DWI (C-DWI) is prone to chemical shift and distortion. ZOOMit DWI (Z-DWI), as an advanced magnetic resonance imaging (MRI) technique, applies two spatially selective parallel excitation pulses to focus sampling in the hope of obtaining more valuable information. This study aimed to evaluate and compare the image quality and feasibility of Z-DWI with those of C-DWI in breast lesions. Methods The study included 51 patients with breast lesions who underwent breast MRI from May 2021 to February 2022. All patients received Z-DWI and C-DWI sequences, with b values selected as 50 and 800 s/mm2 (Z-DWIb50, Z-DWIb800, C-DWIb50, and C-DWIb800). Apparent diffusion coefficient (ADC) values based on Z-DWI and C-DWI were calculated. For qualitative analysis, four image quality parameters were selected and assessed on a 4-point Likert scale (1 = poor and 4 = excellent). For quantitative analysis, ADC, relative ADC (rADC), signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and tumor-to-parenchymal contrast (TPC) values were selected for comparison. Results Z-DWI had higher scores compared to C-DWI in terms of lesion conspicuity, anatomical details, distortion and artifacts, and overall image quality (P<0.05). Meanwhile, the agreement between the two readers was reasonably good [intraclass correlation coefficient (ICC) range, 0.360-0.881]. The SNR of Z-DWIb800 was better than that of C-DWIb800 (P<0.001). The Z-DWI ADC and rADC values of breast lesions were statistically significantly lower than those of C-DWI (mean ADC: P<0.001; rADC; P=0.005). Conclusions Z-DWI sequences were shown to have superior image quality. The ADC map of Z-DWI is more conducive to the imaging evaluation of breast lesions.
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Affiliation(s)
- Chunjiao Weng
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yiwen Yang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ling Yang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chunhong Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xinxing Ma
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Guangzheng Li
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
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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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Computed diffusion-weighted magnetic resonance imaging with high b-values in the diagnosis of gallbladder lesions. Abdom Radiol (NY) 2022; 47:3278-3289. [PMID: 35767024 DOI: 10.1007/s00261-022-03586-2] [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: 03/20/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE The diagnosis of gallbladder lesions remains challenging. The efficacy of computed diffusion-weighted imaging (DWI) with high b-values and apparent diffusion coefficient (ADC) for the diagnosis of gallbladder cancer remains unknown. We aimed to investigate the usefulness of computed DWI with high b-values and the combination of computed DWI and ADC in differentiating malignant and benign gallbladder lesions. METHODS Sixty patients (comprising 30 malignant and 30 benign lesions) who underwent magnetic resonance imaging for gallbladder lesions were included in this retrospective study. Qualitative evaluations were performed using conventional DWI with b1000, computed DWI with b1500, b1000 DWI/ADC, and computed b1500 DWI/ADC, and their diagnostic performances were compared. RESULTS The sensitivity, specificity, and accuracy of computed b1500 DWI/ADC were 90% (27/30), 80% (24/30), and 85% (51/60), respectively. The accuracy of computed b1500 DWI/ADC was higher than that of conventional b1000 DWI (52%, 31/60, p < 0.001), computed b1500 DWI (72%, 43/60, p = 0.008), and b1000 DWI/ADC (78%, 47/60, p = 0.125). The specificity of computed b1500 DWI/ADC was also higher than that of conventional b1000 DWI (7%, 2/30, p < 0.001), computed b1500 DWI (47%, 14/30, p = 0.002), and b1000 DWI/ADC (67%, 20/30, p = 0.125). No significant difference was observed in the sensitivity between the groups. CONCLUSION This study shows that computed DWI with high b-values combined with ADC can improve diagnostic performance when differentiating malignant and benign gallbladder lesions. Computed diffusion-weighted magnetic resonance imaging with high b-values in the diagnosis of gallbladder lesions. *Computed DWI with b1500 combined with ADC can improve diagnostic performance when differentiating gallbladder lesions compared with conventional methods (b1000 DWI).
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Ohlmeyer S, Laun FB, Bickelhaupt S, Palm T, Janka R, Weiland E, Uder M, Wenkel E. Ultra-High b-Value Diffusion-Weighted Imaging-Based Abbreviated Protocols for Breast Cancer Detection. Invest Radiol 2021; 56:629-636. [PMID: 34494995 DOI: 10.1097/rli.0000000000000784] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Contrast-enhanced (CE) magnetic resonance imaging (MRI) is the most effective imaging modality for breast cancer detection. A contrast agent-free examination technique would be desirable for breast MRI screening. The purpose of this study was to evaluate the capability to detect and characterize suspicious breast lesions with an abbreviated, non-contrast-enhanced MRI protocol featuring ultra-high b-value diffusion-weighted imaging (DWI) compared with CE images. MATERIALS AND METHODS The institutional review board-approved prospective study included 127 female subjects with different clinical indications for breast MRI. Magnetic resonance imaging examinations included DWI sequences with b-values of 1500 s/mm2 (b1500) and 2500 s/mm2 (b2500), native T1- and T2-weighted images, and CE sequences at 1.5 T and 3 T scanners. Two reading rounds were performed, including either the b1500 or the b2500 DWI in consecutive assessment steps: (A) maximum intensity projections (MIPs) of DWI, (B) DWI and apparent diffusion coefficient maps, (C) as (B) but with additional native T1- and T2-weighted images, and (D) as (C) but with additional CE images (full-length protocol). Two readers independently determined the presence of a suspicious lesion. Histological confirmation was obtained for conspicuous lesions, whereas the full MRI data set was obtained for inconspicuous and clearly benign lesions. Statistical analysis included calculation of diagnostic accuracy and interrater agreement via the intraclass correlation coefficient. RESULTS The cohort comprised 116 cases with BI-RADS 1 findings and 138 cases with BI-RADS ≥2 findings, including 38 histologically confirmed malignancies. For (A), breasts without pathological findings could be recognized with high diagnostic accuracy (negative predictive value, ≥97.0%; sensitivity, ≥92.1% for both readers), but with a limited specificity (≥58.3%; positive predictive value, ≥28.6%). Within the native readings, approach (C) with b2500 performed best (negative predictive value, 99.5%; sensitivity, 97.4%; specificity, 88.4%). The intraclass correlation coefficient was between 0.683 (MIP b1500) and 0.996 (full protocol). CONCLUSIONS A native abbreviated breast MRI protocol with advanced high b-value DWI might allow nearly equivalent diagnostic accuracy as CE breast MRI and seems to be well suited for lesion detection purposes.
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Affiliation(s)
- Sabine Ohlmeyer
- From the Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg
| | - Frederik Bernd Laun
- From the Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg
| | - Sebastian Bickelhaupt
- From the Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg
| | - Theresa Palm
- From the Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg
| | - Rolf Janka
- From the Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg
| | | | - Michael Uder
- From the Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg
| | - Evelyn Wenkel
- From the Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg
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DelPriore MR, Biswas D, Hippe DS, Zecevic M, Parsian S, Scheel JR, Rahbar H, Partridge SC. Breast Cancer Conspicuity on Computed Versus Acquired High b-Value Diffusion-Weighted MRI. Acad Radiol 2021; 28:1108-1117. [PMID: 32307271 DOI: 10.1016/j.acra.2020.03.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/07/2020] [Accepted: 03/08/2020] [Indexed: 12/30/2022]
Abstract
RATIONALE AND OBJECTIVES On unenhanced diffusion-weighted imaging (DWI), computing or synthesizing high b-value images from lower b-value acquisitions can enhance breast cancer visibility. This study aimed to evaluate relative lesion conspicuity on computed versus acquired diffusion-weighted images and investigate clinical characteristics influencing optimal b-values. MATERIALS AND METHODS Women with newly diagnosed breast cancer were prospectively enrolled and underwent 3T breast MRI with DWI. Lesion contrast-to-noise ratio (CNR) was measured across a range of b-values (0-2500 s/mm2) for computed and acquired DWI. Three readers independently compared lesion visibility between computed and acquired DWI and selected the optimal b-value. Computed versus acquired DWI was compared quantitatively based on CNR by paired t-test and qualitatively based on reader preference using a sign test. Optimal b-values by qualitative and quantitative assessment were compared by paired t-test, and associations with clinical characteristics were assessed by Wilcoxon rank sum test. RESULTS The study included 30 women (median age, 48 years); 28 with invasive carcinoma, 2 DCIS. Lesion CNR was higher on acquired versus computed images (p = 0.018), while lesion visibility by reader assessment was not different (p = 0.36). Optimal b-values selected by readers (mean, b = 1411 ± 383 s/mm2) were slightly higher than those based on peak CNR (b = 1233 ± 463 s/mm2, p = 0.023), and were higher for younger (≤50 years) versus older women (p = 0.002) and dense versus nondense breasts (p = 0.015). CONCLUSION Lesion CNR on computed high b-value images was slightly reduced versus acquired images, but our study suggests that this did not significantly impact lesion visibility. Computing high b-value images offers extra flexibility to adjust b-value during interpretation.
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Sartoretti T, Sartoretti E, Wyss M, Mannil M, van Smoorenburg L, Eichenberger B, Reischauer C, Alfieri A, Binkert C, Sartoretti-Schefer S. Diffusion-weighted MRI of ischemic stroke at 3T: Value of synthetic b-values. Br J Radiol 2021; 94:20200869. [PMID: 33596102 DOI: 10.1259/bjr.20200869] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Diffusion-weighted imaging (DWI) plays a crucial role in the diagnosis of ischemic stroke. We assessed the value of computed and acquired high b-value DWI in comparison with conventional b = 1000 s mm-2 DWI for ischemic stroke at 3T. METHODS We included 36 patients with acute ischemic stroke who presented with diffusion abnormalities on DWI performed within 24 h of symptom onset. B-values of 0, 500, 1000 and 2000 s mm-2 were acquired. Synthetic images with b-values of 1000, 1500, 2000 and 2500 s mm-2 were computed. Two readers compared synthetic (syn) and acquired (acq) b = 2000 s mm-2 images with acquired b = 1000 s mm-2 images in terms of lesion detection rate, image quality, presence of uncertain hyperintensities and lesion conspicuity. Readers also selected their preferred b-value. Contrast ratio (CR) measurements were performed. Non-parametrical statistical tests and weighted Cohens' κ tests were computed. RESULTS Syn1000 and syn1500 matched acq1000 images in terms of lesion detection rate, image quality and presence of uncertain hyperintensities but presented with significantly improved lesion conspicuity (p < 0.01) and were frequently selected as preferred b-values. Acq2000 images exhibited a similar lesion detection rate and improved lesion conspicuity (p < 0.01) but worse image quality (p < 0.01) than acq1000 images. Syn2000 and syn2500 images performed significantly worse (p < 0.01) than acq1000 images in most or all categories. CR significantly increased with increasing b-values. CONCLUSION Synthetic images at b = 1000 and 1500 s mm-2 and acquired DWI images at b = 2000 s mm-2 may be of clinical value due to improved lesion conspicuity. ADVANCES IN KNOWLEDGE Synthetic b-values enable improved lesion conspicuity for DWI of ischemic stroke.
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Affiliation(s)
- Thomas Sartoretti
- Institute of Radiology, Kantonsspital Winterthur, Winterthur, Switzerland.,Faculty of Medicine, University of Zürich, Zürich, Switzerland.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - Elisabeth Sartoretti
- Institute of Radiology, Kantonsspital Winterthur, Winterthur, Switzerland.,Faculty of Medicine, University of Zürich, Zürich, Switzerland
| | - Michael Wyss
- Institute of Radiology, Kantonsspital Winterthur, Winterthur, Switzerland.,Philips Healthsystems, Zürich, Switzerland
| | - Manoj Mannil
- Institute of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland
| | | | | | - Carolin Reischauer
- Department of Medicine, University of Fribourg, Fribourg, Switzerland.,Department of Radiology, HFR Fribourg-Hôpital Cantonal, Fribourg, Switzerland
| | - Alex Alfieri
- Department of Neurosurgery, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Christoph Binkert
- Institute of Radiology, Kantonsspital Winterthur, Winterthur, Switzerland
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Daimiel Naranjo I, Lo Gullo R, Saccarelli C, Thakur SB, Bitencourt A, Morris EA, Jochelson MS, Sevilimedu V, Martinez DF, Pinker-Domenig K. Diagnostic value of diffusion-weighted imaging with synthetic b-values in breast tumors: comparison with dynamic contrast-enhanced and multiparametric MRI. Eur Radiol 2020; 31:356-367. [PMID: 32780207 PMCID: PMC7755636 DOI: 10.1007/s00330-020-07094-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 05/22/2020] [Accepted: 07/21/2020] [Indexed: 12/24/2022]
Abstract
Objectives To assess DWI for tumor visibility and breast cancer detection by the addition of different synthetic b-values. Methods Eighty-four consecutive women who underwent a breast-multiparametric-MRI (mpMRI) with enhancing lesions on DCE-MRI (BI-RADS 2–5) were included in this IRB-approved retrospective study from September 2018 to March 2019. Three readers evaluated DW acquired b-800 and synthetic b-1000, b-1200, b-1500, and b-1800 s/mm2 images for lesion visibility and preferred b-value based on lesion conspicuity. Image quality (1–3 scores) and breast composition (BI-RADS) were also recorded. Diagnostic parameters for DWI were determined using a 1–5 malignancy score based on qualitative imaging parameters (acquired + preferred synthetic b-values) and ADC values. BI-RADS classification was used for DCE-MRI and quantitative ADC values + BI-RADS were used for mpMRI. Results Sixty-four malignant (average = 23 mm) and 39 benign (average = 8 mm) lesions were found in 80 women. Although b-800 achieved the best image quality score, synthetic b-values 1200–1500 s/mm2 were preferred for lesion conspicuity, especially in dense breast. b-800 and synthetic b-1000/b-1200 s/mm2 values allowed the visualization of 84–90% of cancers visible with DCE-MRI performing better than b-1500/b-1800 s/mm2. DWI was more specific (86.3% vs 65.7%, p < 0.001) but less sensitive (62.8% vs 90%, p < 0.001) and accurate (71% vs 80.7%, p = 0.003) than DCE-MRI for breast cancer detection, where mpMRI was the most accurate modality accounting for less false positive cases. Conclusion The addition of synthetic b-values enhances tumor conspicuity and could potentially improve tumor visualization particularly in dense breast. However, its supportive role for DWI breast cancer detection is still not definite. Key Points • The addition of synthetic b-values (1200–1500 s/mm2) to acquired DWI afforded a better lesion conspicuity without increasing acquisition time and was particularly useful in dense breasts. • Despite the use of synthetic b-values, DWI was less sensitive and accurate than DCE-MRI for breast cancer detection. • A multiparametric MRI modality still remains the best approach having the highest accuracy for breast cancer detection and thus reducing the number of unnecessary biopsies. Electronic supplementary material The online version of this article (10.1007/s00330-020-07094-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Isaac Daimiel Naranjo
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Roberto Lo Gullo
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA.,Department of Radiology, Breast Imaging Division, Istituto Europeo di Oncologia, Via Giuseppe Ripamonti, 435, 20141, Milano, Italy
| | - Carolina Saccarelli
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Sunitha B Thakur
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA.,Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Almir Bitencourt
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA.,Department of Imaging, A.C.Camargo Cancer Center, SP, São Paulo, Brazil
| | - Elizabeth A Morris
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Maxine S Jochelson
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Varadan Sevilimedu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Danny F Martinez
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Katja Pinker-Domenig
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA. .,Department of Biomedical Imaging and Image-guided Therapy Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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