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Peng S, Sun P, Liu J, Tao J, Zhu W, Yang F. Imaging Microstructural Parameters of Breast Tumor in Patient Using Time-Dependent Diffusion: A Feasibility Study. Diagnostics (Basel) 2025; 15:823. [PMID: 40218173 PMCID: PMC11988359 DOI: 10.3390/diagnostics15070823] [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: 01/27/2025] [Revised: 03/12/2025] [Accepted: 03/24/2025] [Indexed: 04/14/2025] Open
Abstract
Objectives: To explore the feasibility of time-dependent diffusion in clinical applications of breast MRI, as well as the capacity of quantitative microstructural mapping for characterizing the cellular properties in malignant and benign breast tumors. Methods: 38 patients with 45 lesions were enrolled. Diffusion MRI acquisition was conducted with a combination of pulsed gradient spin-echo sequences (PGSE) and oscillating gradient spin-echo (OGSE) on a 3T MRI scanner. The microstructural parameters including cellularity extracellular diffusivity (Dex), mean cell size, intracellular volume fraction (νin), and the apparent diffusion coefficient (ADC) values were calculated. Each parameter was compared using the unpaired t-test between malignant and benign tumors. The area under the receiver operating characteristic curve (AUC) values was used to evaluate the diagnostic performance of different indices. Results: The mean diameter, Dex, ADC0Hz, ADC25Hz, and ADC50Hz were significantly lower in the malignant group than in the benign group (p < 0.001), while νin and cellularity were significantly higher in the malignant group (p < 0.001). All the microstructural parameters and time-dependent ADC values achieved high accuracy in differentiating between malignant and benign tumors of the breast. For microstructural parameters, the AUC of the cellularity was greater than others (AUC = 0.936). In an immunohistochemical subgroup comparison, the PR-positive group had significantly lower νin and cellularity, and significantly elevated Dex and ADC0Hz compared to the negative groups (p < 0.05). When combining diffusion parameters (cellularity, diameter, and ADC25Hz), the highest diagnostic performance was obtained with an AUC of 0.969. Conclusions: DWI with a short diffusion time is capable of providing additional microstructural parameters in differentiating between benign and malignant breast tumors. The time-dependent diffusion MRI parameters have the potential to serve as a non-invasive tool to probe the differences in the internal structures of breast lesions.
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Affiliation(s)
- Shuyi Peng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1277, Wuhan 430022, China; (S.P.); (J.L.); (J.T.); (W.Z.)
- Hubei Provincial Clinical Research Center for Precision Radiology & Interventional Medicine, Wuhan 430022, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Peng Sun
- Philips Healthcare, Beijing 100600, China;
| | - Jie Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1277, Wuhan 430022, China; (S.P.); (J.L.); (J.T.); (W.Z.)
- Hubei Provincial Clinical Research Center for Precision Radiology & Interventional Medicine, Wuhan 430022, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Juan Tao
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1277, Wuhan 430022, China; (S.P.); (J.L.); (J.T.); (W.Z.)
- Hubei Provincial Clinical Research Center for Precision Radiology & Interventional Medicine, Wuhan 430022, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Wenying Zhu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1277, Wuhan 430022, China; (S.P.); (J.L.); (J.T.); (W.Z.)
- Hubei Provincial Clinical Research Center for Precision Radiology & Interventional Medicine, Wuhan 430022, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Fan Yang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1277, Wuhan 430022, China; (S.P.); (J.L.); (J.T.); (W.Z.)
- Hubei Provincial Clinical Research Center for Precision Radiology & Interventional Medicine, Wuhan 430022, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan 430022, China
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Zhou J, Liu H, Miao H, Ye S, He Y, Zhao Y, Chen Z, Zhang Y, Liu YL, Pan Z, Su MY, Wang M. Breast lesions on MRI in mass and non-mass enhancement: Kaiser score and modified Kaiser score + for readers of variable experience. Eur Radiol 2025; 35:140-150. [PMID: 38990324 PMCID: PMC11631689 DOI: 10.1007/s00330-024-10922-1] [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: 03/23/2024] [Revised: 03/23/2024] [Accepted: 05/28/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVES To compare the diagnostic performance of three readers using BI-RADS and Kaiser score (KS) based on mass and non-mass enhancement (NME) lesions. METHODS A total of 630 lesions, 393 malignant and 237 benign, 458 mass and 172 NME, were analyzed. Three radiologists with 3 years, 6 years, and 13 years of experience made diagnoses. 596 cases had diffusion-weighted imaging, and the apparent diffusion coefficient (ADC) was measured. For lesions with ADC > 1.4 × 10-3 mm2/s, the KS was reduced by 4 as the modified KS +, and the benefit was assessed. RESULTS When using BI-RADS, AUC was 0.878, 0.915, and 0.941 for mass, and 0.771, 0.838, 0.902 for NME for Reader-1, 2, and 3, respectively, better for mass than for NME. The diagnostic accuracy of KS was improved compared to BI-RADS for less experienced readers. For Reader-1, AUC was increased from 0.878 to 0.916 for mass (p = 0.005) and from 0.771 to 0.822 for NME (p = 0.124). Based on the cut-off value of BI-RADS ≥ 4B and KS ≥ 5 as malignant, the sensitivity of KS by Readers-1 and -2 was significantly higher for both Mass and NME. When ADC was considered to change to modified KS +, the AUC and the accuracy for all three readers were improved, showing higher specificity with slightly degraded sensitivity. CONCLUSION The benefit of KS compared to BI-RADS was most noticeable for the less experienced readers in improving sensitivity. Compared to KS, KS + can improve specificity for all three readers. For NME, the KS and KS + criteria need to be further improved. CLINICAL RELEVANCE STATEMENT KS provides an intuitive method for diagnosing lesions on breast MRI. BI-RADS and KS face greater difficulties in evaluating NME compared to mass lesions. Adding ADC to the KS can improve specificity with slightly degraded sensitivity. KEY POINTS KS provides an intuitive method for interpreting breast lesions on MRI, most helpful for novice readers. KS, compared to BI-RADS, improved sensitivity in both mass and NME groups for less experienced readers. NME lesions were considered during the development of the KS flowchart, but may need to be better defined.
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Affiliation(s)
- Jiejie Zhou
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Department of Radiological Sciences, University of California, Irvine, CA, US
| | - Huiru Liu
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Haiwei Miao
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shuxin Ye
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yun He
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Youfan Zhao
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhongwei Chen
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yang Zhang
- Department of Radiological Sciences, University of California, Irvine, CA, US
| | - Yan-Lin Liu
- Department of Radiological Sciences, University of California, Irvine, CA, US
| | - Zhifang Pan
- First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Min-Ying Su
- Department of Radiological Sciences, University of California, Irvine, CA, US.
- Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Meihao Wang
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
- Key Laboratory of Intelligent Medical Imaging of Wenzhou, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
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Ulu Öztürk F, Tezcan Ş, Uslu N. How to manage type 2 curve dilemma in dynamic contrast-enhanced magnetic resonance imaging of the breast: diffusion-weighted imaging or early phase enhancement kinetics? Acta Radiol 2024; 65:341-349. [PMID: 38193154 DOI: 10.1177/02841851231219675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
BACKGROUND Type 2 time-intensity curves can indicate both malignant and benign breast lesions in dynamic contrast enhanced magnetic resonance imaging (DCE-MRI). PURPOSE To investigate whether diffusion-weighted imaging (DWI) or early phase kinetics of DCE-MRI is practical to discriminate breast masses that depict type 2 curve in DCE-MRI. MATERIAL AND METHODS We retrospectively included 107 lesions in 97 patients with type 2 curves in DCE-MRI. Morphological characteristics, early phase dynamic parameters on DCE-MRI, and apparent diffusion coefficient (ADC) values on DWI were evaluated. Diagnostic thresholds of ADC and early phase maximum enhancement ratio (EPMER) to distinguish between benign and malignant masses were calculated. Strongest predictors of malignancy were determined to build the most effective diagnostic model. RESULTS DWI, EPMER, and all morphological features were found statistically significant to discriminate malignancy (P <0.05). The thresholds of ADC and EPMER were assigned as 1.0 ×10-3 mm2/s and 72%, respectively. The sensitivity and specificity were 80% and 97% for ADC, and 93% and 60% for EPMER, respectively. Two models were established. Model 1 comprised ADC and the lesion margin. Model 2 consisted of ADC, margin, and EPMER with a high specificity (99%) and positive predictive value (97%). CONCLUSION When combined with DWI, early phase wash-in data provide diagnostic improvement of breast masses presenting type 2 curve in the late phase of DCE-MRI, especially for specificity. Future studies are required to support our findings for the need of a cross-validation.
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Affiliation(s)
- Funda Ulu Öztürk
- Department of Radiology, Başkent University Medical Faculty, Ankara, Turkey
| | - Şehnaz Tezcan
- Department of Radiology, Başkent University Medical Faculty, Ankara, Turkey
| | - Nihal Uslu
- Department of Radiology, Başkent University Medical Faculty, Ankara, Turkey
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Shahbazi-Gahrouei D, Aminolroayaei F, Nematollahi H, Ghaderian M, Gahrouei SS. Advanced Magnetic Resonance Imaging Modalities for Breast Cancer Diagnosis: An Overview of Recent Findings and Perspectives. Diagnostics (Basel) 2022; 12:2741. [PMID: 36359584 PMCID: PMC9689118 DOI: 10.3390/diagnostics12112741] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 10/26/2022] [Accepted: 11/07/2022] [Indexed: 08/28/2023] Open
Abstract
Breast cancer is the most prevalent cancer among women and the leading cause of death. Diffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI) are advanced magnetic resonance imaging (MRI) procedures that are widely used in the diagnostic and treatment evaluation of breast cancer. This review article describes the characteristics of new MRI methods and reviews recent findings on breast cancer diagnosis. This review study was performed on the literature sourced from scientific citation websites such as Google Scholar, PubMed, and Web of Science until July 2021. All relevant works published on the mentioned scientific citation websites were investigated. Because of the propensity of malignancies to limit diffusion, DWI can improve MRI diagnostic specificity. Diffusion tensor imaging gives additional information about diffusion directionality and anisotropy over traditional DWI. Recent findings showed that DWI and DTI and their characteristics may facilitate earlier and more accurate diagnosis, followed by better treatment. Overall, with the development of instruments and novel MRI modalities, it may be possible to diagnose breast cancer more effectively in the early stages.
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Affiliation(s)
- Daryoush Shahbazi-Gahrouei
- Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran
| | - Fahimeh Aminolroayaei
- Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran
| | - Hamide Nematollahi
- Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran
| | - Mohammad Ghaderian
- Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran
| | - Sogand Shahbazi Gahrouei
- Department of Management, School of Humanities, Najafabad Branch, Islamic Azad University, Najafabad 8514143131, Iran
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Zhang H, Zhang XY, Wang Y. Value of magnetic resonance diffusion combined with perfusion imaging techniques for diagnosing potentially malignant breast lesions. World J Clin Cases 2022; 10:6021-6031. [PMID: 35949832 PMCID: PMC9254209 DOI: 10.12998/wjcc.v10.i18.6021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/23/2022] [Accepted: 04/21/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Lesions of breast imaging reporting and data system (BI-RADS) 4 at mammography vary from benign to malignant, leading to difficulties for clinicians to distinguish between them. The specificity of magnetic resonance imaging (MRI) in detecting breast is relatively low, leading to many false-positive results and high rates of re-examination or biopsy. Diffusion-weighted imaging (DWI), combined with perfusion-weighted imaging (PWI), might help to distinguish between benign and malignant BI-RADS 4 breast lesions at mammography.
AIM To evaluate the value of DWI and PWI in diagnosing BI-RADS 4 breast lesions.
METHODS This is a retrospective study which included patients who underwent breast MRI between May 2017 and May 2019 in the hospital. The lesions were divided into benign and malignant groups according to the classification of histopathological results. The diagnostic efficacy of DWI and PWI were analyzed respectively and combinedly. The 95 lesions were divided according to histopathological diagnosis, with 46 benign and 49 malignant. The main statistical methods used included the Student t-test, the Mann-Whitney U-test, the chi-square test or Fisher’s exact test.
RESULTS The mean apparent diffusion coefficient (ADC) values in the parenchyma and lesion area of the normal mammary gland were 1.82 ± 0.22 × 10-3 mm2/s and 1.24 ± 0.16 × 10-3 mm2/s, respectively (P = 0.021). The mean ADC value of the malignant group was 1.09 ± 0.23 × 10-3 mm2/s, which was lower than that of the benign group (1.42 ± 0.68 × 10-3 mm2/s) (P = 0.016). The volume transfer constant (Ktrans) and rate constant (Kep) values were higher in malignant lesions than in benign ones (all P < 0.001), but there were no significant statistical differences regarding volume fraction (Ve) (P = 0.866). The sensitivity and specificity of PWI combined with DWI (91.7% and 89.3%, respectively) were higher than that of PWI or DWI alone. The accuracy of PWI combined with DWI in predicting pathological results was significantly higher than that predicted by PWI or DWI alone.
CONCLUSION DWI, combined with PWI, might possibly distinguish between benign and malignant BI-RADS 4 breast lesions at mammography.
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Affiliation(s)
- Hui Zhang
- Department of Radiology, Hebei General Hospital, Shijiazhuang 050000, Hebei Province, China
| | - Xin-Yi Zhang
- Department of Radiology, the First Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Yong Wang
- Department of Radiology, the First Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
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Hashem LMB, Sawy YAE, Kamal RM, Ahmed SM, elmesidy DS. The additive role of dynamic contrast-enhanced and diffusion-weighted MR imaging in preoperative staging of breast cancer. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00411-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
In women with diagnosed breast cancer, accurate loco-regional staging and preoperative examination are of utmost importance for optimal patient management decisions. MRI may be warranted for correct preoperative staging as recommended from international guidelines. DWI-MRI can be combined with CE-MRI to assess more functional data. So we aimed to evaluate the performance of CE-MRI and qualitative DWI-MRI in preoperative loco-regional staging of malignant breast lesions as regards the local extension of the disease and axillary lymph node status, beyond standard assessment with mammography and ultrasound. This prospective study included 50 female patients with pathologically proven malignant breast lesions (BIRADS VI) coming for preoperative staging. Full-field digital mammography (FFDM) and ultrasound, CE-MRI, and DWI-MRI findings were compared for all patients, and the findings were evaluated independently. Results were then correlated to postoperative histopathology.
Results
Fifty women with pathologically proven malignant breast lesions (BIRADS VI) were enrolled in this study; the mean age of this study population was 43.25 years. The 50 patients were divided into 2 groups: 37/50 (74%) underwent upfront surgery and 13/50 (26%) received neoadjuvant therapy before surgery. All patients performed DCE and DWI-MRI breast. Among patients who underwent upfront surgery, DCE-MRI showed the highest correlation with the postoperative pathology size and the overall sensitivity regarding multiplicity. Regarding patients who received neoadjuvant therapy, DCE-MRI was found to have the highest correlation with the postoperative pathology concerning lesion size and multiplicity after completion of the neoadjuvant chemotherapy cycles.
Conclusion
CE-MRI can accurately map lesion extension and detect multifocality/multicentricity, thus tailor surgical management options (either conservative surgery or mastectomy). Qualitative DWI can be combined with ultrasonography for better evaluation of the axillary nodal status.
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Breast cancer in dense breasts: comparative diagnostic merits of contrast-enhanced mammography and diffusion-weighted breast MRI. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00442-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Abstract
Background
The study was done to compare the value of contrast-enhanced mammography and diffusion-weighted breast MRI in dense breast screening and accurate detection of the breast cancer with correlation of the findings to the histopathological results.
The study included 32 female patients having suspicious breast lesions and underwent digital mammography then scheduled for CESM and MRI DW imaging technique. The imaging findings were correlated to the histopathological findings.
Results
The study was conducted on 40 breast lesions in 32 female patients having dense breasts; they were classified by the digital mammography into ACR C (59.4%) and ACR D (40.6%). By CESM, there were twenty three lesions (57.5%) as mass lesions and thirteen lesions (32.5%) as non-mass lesions. Four lesions (10%) showed no contrast enhancement. According to the lesion characteristics in diffusion-weighted imaging, the breast lesions were classified into thirty three lesions (82.5%) with restricted diffusion and seven lesions (17.5%) with non-restricted diffusion. The study showed a cutoff ADC value to detect the malignant lesions in the dense breasts ≤ 1.1 × 10-3 s/mm2 at b value of 1000 s/mm2 with a sensitivity of 96.77%, specificity of 66.67%, PPV of 96.77%, NPV of 55.55%, and an overall total accuracy of 92.5%.
On comparing the diagnostic accuracy of the CESM to that of the DW MRI, the sensitivity of DW MRI (96.77%) was higher than that of CESM (90.32%). The specificity of DW MRI (66.67%) was higher than that of CESM (33.33%). Total accuracy of DW MRI was higher than that of CESM; they were 90% and 77.5%, respectively. Also, PPV and NPV of DW MRI were 90.91 and 85.71% as compared with 82.35 and 50.00% in CESM, respectively. When comparing the sensitivity of CESM to DW MRI in the detection of multiple breast lesions, they were 88.8 and 100%, respectively.
Conclusion
CESM is a useful technique in identification of hidden lesions in mammographically dense breasts. DW MRI is a fast, unenhanced modality that can be used as a breast cancer screening modality. CESM and DWI demonstrated good overall diagnostic accuracy in dense breast patients; however, DW MRI has a higher diagnostic accuracy than CESM for the detection of malignant breast lesions and their multiplicity.
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Dkhar W, Kadavigere R, Mustaffa SP. Quantitative Evaluation for Differential Diagnosis of Breast Lesions in Diffusion-Weighted MR Imaging. HEALTH AND TECHNOLOGY 2021. [DOI: 10.1007/s12553-021-00604-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractDiffusion-weighted MR Imaging is a rapidly emerging technique, that allows in-vivo mapping processes of the water diffusion in tissues. It has the potential capabilities for clinical application in breast imaging. The aim of this study was to find out the optimal b-value for calculation of ADC value for differential diagnosis of breast lesions. A total of 124 subjects (mean age 46 years) with 141 lesions were included. The protocol consists of axial T2 sequence for lesion localization and measurement and DW sequence with three sets of b-values of 0, 300, 600, and 1000 s/mm2. The mean ADC values of the breast lesions for b-values (0, 300, 600, and 1000) were 1.75 ± 0.18 × 10−3mm2/sec, 1.66 ± 0.12 × 10−3mm2/sec and 1.57 ± 0.15 × 10−3mm2/sec for the benign lesions and 1.26 ± 0.048 × 10−3mm2/sec, 1.14 ± 0.11 × 10−3mm2/sec and 0.93 ± 0.14 × 10−3mm2/sec for malignant lesions respectively. Statistical significant differences were noted on the ADC value of benign and malignant lesions among the three sets of b values (p = 0.001). ADC values of malignant lesion was significantly lower compared to benign lesions. The AUC (0.998) was substantially large for b-value of 0,600 s/mm2 with a threshold ADC cut off value of 1.28 × 10−3mm2/sec with 98.4% sensitivity, 93.2% specificity and 98.5% positive predictive value(PPV). In conclusion, diffusion weighted imaging has the ability for differential diagnosis of breast lesions with the optimal b value of 0,600 s/ mm2. DWI is a reliable tool for characterising breast lesions and may increase the overall specificity of breast MRI.
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Roknsharifi S, Fishman MDC, Agarwal MD, Brook A, Kharbanda V, Dialani V. The role of diffusion weighted imaging as supplement to dynamic contrast enhanced breast MRI: Can it help predict malignancy, histologic grade and recurrence? Acad Radiol 2019; 26:923-929. [PMID: 30293819 DOI: 10.1016/j.acra.2018.09.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 08/29/2018] [Accepted: 09/06/2018] [Indexed: 12/18/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the value of adding Diffusion Weighted Imaging (DWI) with Apparent Diffusion Coefficient (ADC) mapping to dynamic contrast enhanced (DCE-MRI) to distinguish benign from malignant pathology subtypes and tumor recurrence. METHOD AND MATERIALS In this retrospective IRB approved study, 956 consecutive patients underwent bilateral breast MRI between 1/2015 and 12/2015, with 156 BIRADS 4, 5, or 6 lesions detected in 111 patients. DWI imaging at B0, B100, B600, B1000 was performed with DCE-MRI. Values for diffusion and ADC images were recorded by two fellowship-trained breast radiologists. Mean ADC and signal intensity (SI) values were correlated with histology, tumor grade, hormone receptors (ER, PR, and HER-2)and Oncotype DX scores, when available. p ≤ 0.05 was considered significant. RESULTS Of 156 lesions, there were 59 (38%) benign lesions, 24 (15%) Ductal Carcinoma In-Situ, 47 (30%) Invasive Ductal Carcinoma (IDC), 15 (10%) Invasive Lobular Carcinoma (ILC) and 2 (2%) Mucinous carcinoma (MC), five (5%) mixed IDC and ILC, and four (4%) other, including tubular and rare types of malignancy. Mean ADC values for malignancy were significantly lower than for benign lesions (1085 ± 343 × 10-6 vs 1481 ± 276 × 10-6 mm2/s), which is highly predictive (area under curve = 0.82). In addition, tumors with PR negativity and Oncotype score ≥18 (intermediate to high risk for recurrence) demonstrated significantly lower ADC values. SI at B100 and B600 was helpful in distinguishing benign versus IDC. There was no significant correlation between ADC values and tumor grade or ER/HER2 status. CONCLUSION ADC value is important factor in distinguishing malignancy, differentiating tumors with higher Oncotype score, and PR negativity. Therefore, it can be used as an important tool to assist appropriate treatment selection.
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MESH Headings
- Adenocarcinoma, Mucinous/diagnostic imaging
- Adenocarcinoma, Mucinous/pathology
- Adult
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Intraductal, Noninfiltrating/diagnostic imaging
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Lobular/diagnostic imaging
- Carcinoma, Lobular/pathology
- Contrast Media
- Diffusion Magnetic Resonance Imaging/methods
- Female
- Humans
- Magnetic Resonance Imaging/methods
- Middle Aged
- Neoplasm Grading
- Neoplasm Recurrence, Local/diagnostic imaging
- Neoplasms, Complex and Mixed/diagnostic imaging
- Neoplasms, Complex and Mixed/pathology
- Predictive Value of Tests
- Receptor, ErbB-2/metabolism
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
- Retrospective Studies
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Affiliation(s)
- Shima Roknsharifi
- Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, 330 Brookline Ave, Shapiro 4, Breast Imaging, Boston, MA 02215
| | - Michael D C Fishman
- Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, 330 Brookline Ave, Shapiro 4, Breast Imaging, Boston, MA 02215
| | - Monica D Agarwal
- Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, 330 Brookline Ave, Shapiro 4, Breast Imaging, Boston, MA 02215
| | - Alexander Brook
- Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, 330 Brookline Ave, Shapiro 4, Breast Imaging, Boston, MA 02215
| | - Vritti Kharbanda
- Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, 330 Brookline Ave, Shapiro 4, Breast Imaging, Boston, MA 02215
| | - Vandana Dialani
- Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, 330 Brookline Ave, Shapiro 4, Breast Imaging, Boston, MA 02215
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Abstract
In the current era of breast imaging, magnetic resonance imaging (MRI) has an important role. To get its specificity better, some supporting or cooperative tools might be needed. The search for new methods continues and non-contrast MRI trials are seen. With the shorter and easier acquisition, no need for contrast material, diffusion-weighted (DW)-MRI could be the best collaborator. This pictorial review aims to give an overview of the DW-MRI of the breast by means of a set of specially selected cases.
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Affiliation(s)
- Irmak Durur-Subasi
- University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Clinic of Radiology, Ankara, Turkey.
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11
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Liu F, Wang M, Li H. Role of perfusion parameters on DCE-MRI and ADC values on DWMRI for invasive ductal carcinoma at 3.0 Tesla. World J Surg Oncol 2018; 16:239. [PMID: 30577820 PMCID: PMC6303963 DOI: 10.1186/s12957-018-1538-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 11/30/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The value of apparent diffusion coefficient (ADC) values and quantitative parameters (Ktrans, Kep, Ve) in detecting prognostic factor at 3.0 Tesla remains unclear, especially in predicting prognosis of breast cancer. METHODS A total of 151 patients with IDC underwent breast DCE-MRI and DWI-MRI at 3.0 Tesla following surgery. The ADC values were acquired with b values of 0 and 1000 s/mm2. The relationship between ADC values or DCE-MRI quantitative parameters and size, histologic grade (HG), lymph node metastasis (LNM), ER, PR, and Ki67 was evaluated. The predictive values of ADC, Ktrans, Kep, and Ve to prognosis of IDC were assessed. RESULTS ADC value was positively related to size (P = 0.04) and HER2 (P = 0.046) expression and negatively related to ER (P = 0.012) and PR (P < 0.001) expression. Ktrans value has positive correlation with size (P < 0.001), HG (P < 0.001), LNM (P < 0.001), HER2 (P = 0.007), and Ki67 (P < 0.001) expression and negative correlation with ER (P < 0.001) and PR (P < 0.001) expression. Kep value was positively related to size (P < 0.001) and negatively related to ER (P < 0.001) and PR (P < 0.001) expression. Ve value was negatively related to HER2 expression (P = 0.004). The Cox hazard ratio (HR) of ADC, Ktrans, Kep, and Ve values on survival was 5.26 (P = 0.093), 1.081 (P = 0.002), 1.006 (P = 0.941), and 0.883 (P = 0.926), respectively. CONCLUSIONS Ktrans value was a best predictive indicator of HG, LNM, ER, PR, and Ki67 expression, and ADC value was the best predictive indicator of HER2. Preoperative use of the 3.0 Tesla could provide important information to determine the optimal treatment plan.
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Affiliation(s)
- Fei Liu
- Department of Medical Imaging, The Second Affiliated Hospital of Nanjing Medical University, No.121 Jiangjiayuan, Nanjing, 210011, Jiangsu Province, China
| | - Mei Wang
- Department of Medical Imaging, The Second Affiliated Hospital of Nanjing Medical University, No.121 Jiangjiayuan, Nanjing, 210011, Jiangsu Province, China
| | - Haige Li
- Department of Medical Imaging, The Second Affiliated Hospital of Nanjing Medical University, No.121 Jiangjiayuan, Nanjing, 210011, Jiangsu Province, China.
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12
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Cloete DJ, Minne C, Schoub PK, Becker JHR. Magnetic resonance imaging of fibroadenoma-like lesions and correlation with Breast Imaging-Reporting and Data System and Kaiser scoring system. SA J Radiol 2018; 22:1532. [PMID: 31754520 PMCID: PMC6837785 DOI: 10.4102/sajr.v22i2.1532] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 09/14/2018] [Indexed: 12/18/2022] Open
Abstract
Background Multiple breast lesions resembling fibroadenomas are a common imaging finding in patients presenting to the mammography unit at Dr George Mukhari Academic Hospital in the North-West district of Tshwane, South Africa. Patients often present with multiple lesions, up to 20 lesions per breast. These lesions often have atypical features on ultrasound and/or a clinical history of growth is commonly given. Phyllodes tumours may be indistinguishable from fibroadenomas and breast cancers may on occasion present with benign features, which can lead to misdiagnosis. Breast magnetic resonance imaging (bMRI) evaluation of lesions resembling fibroadenomas may improve accurate assessment and identification of lesions requiring biopsy. Objectives To assess the reliability of bMRI to characterise lesions resembling fibroadenomas on ultrasound, using the Breast Imaging-Reporting and Data System (BI-RADS) and Kaiser scoring systems with histopathological correlation. Method A quantitative, prospective, investigative study was performed with a sample size of 100 breast lesions among a total of 35 patients at Dr George Mukhari Academic Hospital. Patients were recruited after a breast ultrasound investigation revealed lesions resembling fibroadenomas, but with an indication for ultrasound-guided biopsy, for example, very large size, atypical features on ultrasound or a history of recent growth. The bMRI was performed prior to the ultrasound-guided breast biopsies. Three investigators independently evaluated the bMRI and applied BI-RADS descriptors to each lesion. The Kaiser score was then calculated for each lesion. Statistics were calculated using Pearson’s and Spearman’s coefficients for inter-reader variability, kappa scores for BI-RADS and Kaiser score correlation with histology. Results Evaluation with bMRI, BI-RADS and the Kaiser scoring system showed statistically significant correlation with each other and with histopathology results for each lesion. There was statistically significant agreement among the investigators regarding the interpretation of the lesions and allocation of appropriate BI-RADS scores. Conclusion Multiple lesions resembling fibroadenomas can be evaluated with bMRI when multiple breast biopsies would not be feasible. With a good imaging protocol and technique, adequate interpretation skills by the radiologist and the use of the Kaiser scoring system, an accurate diagnosis can be achieved.
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Affiliation(s)
- Daniel J Cloete
- Dr George Mukhari Academic Hospital, Ga-Rankuwa, South Africa.,Department of Diagnostic Radiology, Sefako Makgatho Health Sciences University, South Africa
| | - Cornelia Minne
- Dr George Mukhari Academic Hospital, Ga-Rankuwa, South Africa.,Department of Diagnostic Radiology, Sefako Makgatho Health Sciences University, South Africa
| | - Peter K Schoub
- Department of Radiology, Parklane Radiology, Johannesburg, South Africa
| | - Jan H R Becker
- Dr George Mukhari Academic Hospital, Ga-Rankuwa, South Africa.,Department of General Surgery, Sefako Makgatho Health Sciences University, South Africa
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Zhou J, Chen E, Xu H, Ye Q, Li J, Ye S, Cheng Q, Zhao L, Su MY, Wang M. Feasibility and Diagnostic Performance of Voxelwise Computed Diffusion-Weighted Imaging in Breast Cancer. J Magn Reson Imaging 2018; 49:1610-1616. [PMID: 30328211 DOI: 10.1002/jmri.26533] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 09/17/2018] [Accepted: 09/17/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Conventional diffusion-weighted imaging (DWI) with high b-values may improve lesion conspicuity, but with a low signal intensity and thus a low signal-to-noise ratio (SNR). The voxelwise computed DWI (vcDWI) may generate high-quality images with a strong lesion signal and low background. PURPOSE To evaluate the feasibility and diagnostic performance of vcDWI. STUDY TYPE Retrospective. POPULATION In all, 67 patients with 72 lesions, 33 malignant and 39 benign. FIELD STRENGTH/SEQUENCE 3T, including T2 /T1 , DWI with two b-values, and dynamic contrast-enhanced MRI (DCE-MRI). ASSESSMENT Computed DWI (cDWI) with high b-values of 1500, 2000, 2500 s/mm2 (cDWI1500 , cDWI2000 , cDWI2500 ) and vcDWI were generated from measured DWI (mDWI). The mDWI, cDWIs and vcDWI were evaluated by three readers independently to determine lesion conspicuity, background signal suppression, overall image quality using 1-5 rating scales, as well as to give BI-RADS scores. The mean apparent diffusion coefficient (ADC) value for each lesion was measured. STATISTICAL TESTS Agreement among the three readers was evaluated by the intraclass correlation coefficient. Receiver operating characteristic (ROC) analysis was performed to compare the diagnostic performance based on reading of mDWI, cDWIs, vcDWI, and the measured ADC values. RESULTS vcDWI provided the best lesion conspicuity compared with mDWI and cDWIs (P < 0.005). For overall image quality, vcDWI was significantly better than cDWI (P < 0.005), but not significantly better compared with mDWI for two readers (P = 0.037 and P = 0.013) and significantly worse for the third reader (P < 0.005). Background signal suppression was the best on cDWI2500 , and better on vcDWI than on mDWI, cDWI1500 , and cDWI2000 . The AUC value for differential diagnosis was 0.868 for mDWI, 0.862 for cDWI1500 , 0.781 for cDWI2000 , 0.704 for cDWI2500 , 0.946 for vcDWI, 0.704 for ADC value, and 0.961 for DCE-MRI. DATA CONCLUSION: vcDWI was implemented without increasing scanning time, and it provided excellent lesion conspicuity for detection of breast lesions and assisted in differentiating malignant from benign breast lesions. LEVEL OF EVIDENCE 4 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018.
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Affiliation(s)
- Jiejie Zhou
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, P.R. China
| | - Endong Chen
- Department of Thyroid and Breast Surgery, First Affiliated Hospital of Wenzhou Medical University, P.R. China
| | - Huazhi Xu
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, P.R. China
| | - Qiong Ye
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, P.R. China
| | - Jiance Li
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, P.R. China
| | - Shuxin Ye
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, P.R. China
| | - Qinyuan Cheng
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, P.R. China
| | - Liang Zhao
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, P.R. China
| | - Min-Ying Su
- Tu & Yuen Center for Functional Onco-Imaging, Department of Radiological Sciences, University of California, Irvine, California, USA
| | - Meihao Wang
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, P.R. China
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14
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Ertaş G, Onaygil C, Buğdaycı O, Arıbal E. Dual-Phase ADC Modelling of Breast Masses in Diffusion-Weighted Imaging: Comparison with Histopathologic Findings. Eur J Breast Health 2018; 14:85-92. [PMID: 29774316 DOI: 10.5152/ejbh.2018.3829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 12/01/2017] [Indexed: 12/30/2022]
Abstract
Objective To investigate the diagnostic value of dual-phase apparent diffusion coefficient (ADC) compared to traditional ADC values in quantitative diffusion-weighted imaging (DWI) for differentiating between benign and malignant breast masses. Materials and Methods Diffusion-weighted images of pathologically confirmed 88 benign and 85 malignant lesions acquired using a 3.0T MR scanner were analyzed. Small region-of-interests focusing on the highest signal intensity of lesions were used. Lesion ADC estimates were obtained separately from all b-value images (ADC; b=50, 400 and 800s/mm2), lower b-value images (ADClow; b=50 and 400s/mm2) and higher b-value images (ADChigh; b=400 and 800s/mm2). A set of dual-phase ADC (dpADC) models were constructed using ADClow, ADChigh and a perfusion influence factor ranging from 0 to 1. Results Strong positive correlation is observable between ADC and all dpADCs (ρ=0.80-1.00). Differences in ADC and dpADCs between the benign and the malignant lesions are all significant (p<0.05). In detecting malignancy, traditional lesion ADC provides a good performance (AUC=89.9%) however dpADC0.5 (dpADC with a factor of 0.5) accomplishes a better performance (AUC=90.8%). At optimal thresholds, ADC achieves 94.1% sensitivity, 72.7% specificity and 83.2% accuracy while dpADC0.5 leads to 92.9% sensitivity, 79.5% specificity and 86.1% accuracy. Conclusion Dual-phase ADC modelling may improve the accuracy in breast cancer diagnosis using DWI. Further prospective studies are needed to justify its benefit in clinical setting.
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Affiliation(s)
- Gökhan Ertaş
- Department of Biomedical Engineering, Yeditepe University, İstanbul, Turkey
| | - Can Onaygil
- Institute of Diagnostic and Interventional Radiology, Oberlausitz-Kliniken gGmbH, Bautzen, Germany
| | - Onur Buğdaycı
- Department of Radiology, Marmara University School of Medicine, İstanbul, Turkey
| | - Erkin Arıbal
- Department of Radiology, Acıbadem Altunizade Hospital, İstanbul, Turkey
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Grading System to Categorize Breast MRI in BI-RADS 5th Edition: A Multivariate Study of Breast Mass Descriptors in Terms of Probability of Malignancy. AJR Am J Roentgenol 2018; 210:W118-W127. [PMID: 29381382 DOI: 10.2214/ajr.17.17926] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study is to analyze the association between the probability of malignancy and breast mass descriptors in the BI-RADS 5th edition and to devise criteria for grading mass lesions, including subcategorization of category 4 lesions with or without apparent diffusion coefficient (ADC) values. MATERIALS AND METHODS A total of 519 breast masses in 499 patients were selected. Breast MRI was performed with a 1.5-T MRI scanner using a 16-channel dedicated breast radiofrequency coil. Two radiologists determined the morphologic and kinetic features of the breast masses. Mean ADC values were measured on ADC maps by placing round ROIs that encircled the largest possible solid mass portions. An optimal ADC threshold was chosen to maximize the Youden index. Corresponding pathologic diagnoses were obtained by either biopsy or surgery. RESULTS A total of 472 masses were malignant. Multivariate model analysis showed that shape (irregular, p < 0.001), margin type (not circumscribed, p < 0.001), internal enhancement (rim enhancement and heterogeneous enhancement, p = 0.0001), and delayed phase (washout, p = 0.0003) were the significant explanatory variables. The 3-point scoring system for findings suspicious for malignancy and the proposed classification system for breast mass descriptors (with points for category designation ranging from 0 to > 4) were significant with respect to malignancy (p < 0.01). The inclusion of ADC values improved the positive predictive values for categories 3, 4A, and 4B. CONCLUSION The 3-point scoring system for findings suspicious for malignancy and the proposed classification system for breast mass descriptors would be valid as a categorization system. ADC values may be used to downgrade benign lesions in categories 3, 4A, and 4B.
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16
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Short tau inversion recovery in breast diffusion-weighted imaging: signal-to-noise ratio and apparent diffusion coefficients using a breast phantom in comparison with spectral attenuated inversion recovery. Radiol Med 2017; 123:296-304. [PMID: 29230679 DOI: 10.1007/s11547-017-0840-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 11/30/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVE This study aimed to compare the signal-to-noise ratios (SNRs) and apparent diffusion coefficients (ADCs) obtained using two fat suppression techniques in breast diffusion-weighted imaging (DWI) of a phantom. MATERIALS AND METHODS The breast phantom comprised agar gels with four different concentrations of granulated sugar (samples 1, 2, 3, and 4). DWI with short tau inversion recovery (STIR-DWI) and that with spectral attenuated inversion recovery (SPAIR-DWI) were performed using 3.0-T magnetic resonance imaging, and the obtained SNRs and ADCs were compared. ADCs were also compared between the right and left breast phantoms. RESULTS For samples 3 and 4, SNRs obtained using STIR-DWI were lower than those obtained using SPAIR-DWI. For samples 2, 3, and 4, overall ADCs obtained using STIR-DWI were significantly higher than those obtained using SPAIR-DWI (p < 0.001 for all), although no significant difference was observed for sample 1 (p = 0.62). STIR-DWI shows a positive bias and wide limits of agreement in Bland-Altman plot. The coefficients of variance of overall ADCs were good in STIR-DWI and SPAIR-DWI. For all samples, STIR-DWI demonstrated slightly larger percentage differences in ADCs between the right and left phantoms than SPAIR-DWI. CONCLUSION SNRs and ADCs obtained using STIR-DWI are influenced by the T 1 value; a shorter T 1 value decreases SNRs, overestimates ADCs, and induces the measurement error in ADCs. STIR-DWI showed a larger difference in ADCs between the right and left phantoms than SPAIR-DWI.
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17
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Xiao Z, Tang Z, Qiang J, Qian W, Zhong Y, Wang R, Wang J, Wu L, Tang W. Differentiation of olfactory neuroblastomas from nasal squamous cell carcinomas using MR diffusion kurtosis imaging and dynamic contrast-enhanced MRI. J Magn Reson Imaging 2017; 47:354-361. [PMID: 28661554 DOI: 10.1002/jmri.25803] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 06/16/2017] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To evaluate the use of magnetic resonance (MR) diffusion kurtosis imaging (DKI) and dynamic contrast-enhanced MR imaging (DCE-MRI) in the differentiation of olfactory neuroblastomas (ONBs) from squamous cell carcinomas (SCCs). MATERIALS AND METHODS DKI and DCE-MRI were performed in 17 patients with ONBs and 23 patients with SCCs on a 3T MR scanner. Parameters derived from DKI and DCE-MRI were measured and compared between ONBs and SCCs using an independent samples t-test. The sensitivity, specificity, accuracy, positive predictive values (PPV), negative predictive values (NPV), and the area under the receiver operating characteristic (ROC) curve were determined. RESULTS The mean kurtosis (K) value of ONBs was significantly higher than that of SCCs (P < 0.001), and the mean fractional volume in the extravascular extracellular space (Ve ) value of ONBs was lower than that of SCCs (P < 0.001). The ROC curve analyses yielded a cutoff K value of 0.953, with a sensitivity of 94.1%, a specificity of 69.6%, and an accuracy of 80.0%; the cutoff Ve value was 0.493, with a sensitivity of 70.6%, a specificity of 95.7%, and an accuracy of 85.0%. A parallel test with K value >0.953 or Ve value ≤0.493 achieved a sensitivity of 94.1%, a specificity of 100.0%, and an accuracy of 97.5% for differentiating ONBs from SCCs. CONCLUSION The K value of DKI and Ve value of DCE-MRI have potential use in the differentiation of ONBs and SCCs. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:354-361.
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Affiliation(s)
- Zebin Xiao
- Department of Radiology, Eye & ENT Hospital of Shanghai Medical School, Fudan University, Shanghai, P.R. China
| | - Zuohua Tang
- Department of Radiology, Eye & ENT Hospital of Shanghai Medical School, Fudan University, Shanghai, P.R. China
| | - Jinwei Qiang
- Department of Radiology, Jinshan Hospital of Shanghai Medical School, Fudan University, Shanghai, P.R. China
| | - Wen Qian
- Department of Radiology, Eye & ENT Hospital of Shanghai Medical School, Fudan University, Shanghai, P.R. China
| | - Yufeng Zhong
- Department of Radiology, Jinshan Hospital of Shanghai Medical School, Fudan University, Shanghai, P.R. China
| | - Rong Wang
- Department of Radiology, Eye & ENT Hospital of Shanghai Medical School, Fudan University, Shanghai, P.R. China
| | - Jie Wang
- Department of Radiotherapy, Eye & ENT Hospital of Shanghai Medical School, Fudan University, Shanghai, P.R. China
| | - Lingjie Wu
- Department of Otolaryngology, Eye & ENT Hospital of Shanghai Medical School, Fudan University, Shanghai, P.R. China
| | - Wenlin Tang
- Siemens Healthcare Ltd, Shanghai, P.R. China
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de Almeida JRM, Gomes AB, Barros TP, Fahel PE, Rocha MDS. Diffusion-weighted imaging of suspicious (BI-RADS 4) breast lesions: stratification based on histopathology. Radiol Bras 2017; 50:154-161. [PMID: 28670026 PMCID: PMC5487229 DOI: 10.1590/0100-3984.2015.0224] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Objective: To test the use of diffusion-weighted imaging (DWI) in stratifying suspicious
breast lesions (BI-RADS 4), correlating them with histopathology. We also
investigated the performance of DWI related to the main enhancement patterns
(mass and non-mass) and tested its reproducibility. Materials and Methods: Seventy-six patients presented 92 lesions during the sampling period. Two
independent examiners reviewed magnetic resonance imaging studies, described
the lesions, and determined the apparent diffusion coefficient (ADC) values.
Differences among benign, indeterminate- to high-risk, and malignant
findings, in terms of the ADCs, were assessed by analysis of variance. Using
receiver operating characteristic (ROC) curves, we compared the performance
of ADC values in masses and non-mass lesions, and tested the reproducibility
of measurements by determining the coefficient of variation and smallest
real difference. Results: Among the 92 lesions evaluated, the histopathology showed that 37 were
benign, 11 were indeterminate- to high-risk, and 44 were malignant. The mean
ADC differed significantly among those histopathological groups, the value
obtained for the malignant lesions (1.10 × 10-3
mm2/s) being significantly lower than that obtained for the
other groups (p < 0.001). ROC curves demonstrated that DWI performed
better when applied to masses than when applied to non-mass lesions (area
under the curve, 0.88 vs. 0.67). Reproducibility was good (coefficient of
variation, 7.03%; and smallest real difference, ± 0.242 ×
10-3 mm2/s). Conclusion: DWI can differentiate between malignant and nonmalignant (benign or
indeterminate- to high-risk) lesions, showing better performance for masses.
Nevertheless, stratification based on histopathological criteria that are
more refined has yet to be achieved.
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Affiliation(s)
| | - André Boechat Gomes
- MD, Radiologist, Department of Diagnostic Imaging, Clínica de Assistência à Mulher - Grupo CAM, Salvador, BA, Brazil
| | - Thomas Pitangueira Barros
- BMSc, Clínica de Assistência à Mulher - Grupo CAM, Department of Biomedicine, Escola Bahiana de Medicina e Saúde Pública - Campus Brotas, Salvador, BA, Brazil
| | - Paulo Eduardo Fahel
- MD, Pathologist, Clínica de Assistência à Mulher - Grupo CAM, Salvador, BA, Brazil
| | - Mario de Souza Rocha
- MD, PhD, Department of Medicine, Escola Bahiana de Medicina e Saúde Pública - Campus Brotas, Salvador, BA, Brazil
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Christou A, Ghiatas A, Priovolos D, Veliou K, Bougias H. Accuracy of diffusion kurtosis imaging in characterization of breast lesions. Br J Radiol 2017; 90:20160873. [PMID: 28383279 DOI: 10.1259/bjr.20160873] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the accuracy of diffusion kurtosis in the characterization and differentiation of breast lesions. METHODS 49 females with 53 breast lesions underwent breast MRI. The MRI magnetic field is 1.5 T, and the protocol is standard MRI sequences, dynamic sequences pre- and post-contrast agent administration and diffusion images. Diffusion kurtosis imaging (DKI) was applied as part of our standard breast MRΙ protocol. Two experienced radiologists on breast MRI, blinded to the final diagnosis, reviewed the parametric maps and placed a volume of interest on all slices including each lesion. Kurtosis [K apparent (Kapp)] and corrected apparent diffusion coefficient [D apparent (Dapp)] median values were then calculated from the whole-lesion histogram analysis. Receiver-operating characteristic analysis was used to determine the most effective cut-off values for the differentiation between benign and malignant pathologies. Histological analysis of the breast lesions was performed, and further comparative analysis of the results was performed to investigate the accuracy of the method. RESULTS Benign (n = 19) and malignant lesions (n = 34) had mean diameters of 20.8 mm (10.1-31.5 mm) and 26.4 mm (10.5-42.3 mm), respectively. The lowest and the highest kurtosis values (Kapp) of malignant lesions were significantly higher than those of benign lesions. A cut-off of 0.71 provided specificity of 93.7% and sensitivity 97.1%, and the area under the curve (AUC) was 0.976 (p < 0.0001). The lowest and the highest Dapp values of malignant lesions were lower than those of benign lesions. A cut-off value of 1.57 × 10-3 mm2 s-1 provided specificity of 93.7% and sensitivity of 91.2% with AUC of 0.949 (p < 0.0001). CONCLUSION DKI is an accurate additional tool for the characterization and differentiation of breast lesions with high Kapp and Dapp sensitivity and specificity rates. Advances in knowledge: DKI is able to distinguish benign from malignant breast pathologies. DKI increases the specificity of breast MRI.
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Affiliation(s)
- Alexandra Christou
- 1 Department of Medical Imaging, Doncaster and Bassetlaw Hospitals NHS Foundation Trust, Doncaster, UK
| | - Abraham Ghiatas
- 2 Department of Medical Imaging, Director and owner of Global Teleradiology Services, Athens, Greece
| | | | - Konstantia Veliou
- 4 Department of Medical Imaging, at Chatzikosta General Hospital of Ioannina, Ioannina, Greece
| | - Haralambos Bougias
- 5 Department of Medical Imaging, University Hospital of Ioannina, Ioannina, Greece
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Han X, Li J, Wang X. Comparison and Optimization of 3.0 T Breast Images Quality of Diffusion-Weighted Imaging with Multiple B-Values. Acad Radiol 2017; 24:418-425. [PMID: 27955879 DOI: 10.1016/j.acra.2016.11.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 11/03/2016] [Accepted: 11/03/2016] [Indexed: 02/04/2023]
Abstract
RATIONALE AND OBJECTIVES Breast 3.0 T magnetic resonance diffusion-weighted imaging (MR-DWI) of benign and malignant lesions were obtained to measure and calculate the signal-to-noise ratio (SNR), signal intensity ratio (SIR), and contrast-to-noise ratio (CNR) of lesions at different b-values. The variation patterns of SNR and SIR were analyzed with different b-values and the images of DWI were compared at four different b-values with higher image quality. The effect of SIR on the differential diagnostic efficiency of benign and malignant lesions was compared using receiver operating characteristic curves to provide a reference for selecting the optimal b-value. MATERIALS AND METHODS A total of 96 qualified patients with 112 lesions and 14 patients with their contralateral 14 normal breasts were included in this study. The single-shot echo planar imaging sequence was used to perform the DWI and a total of 13 b-values were used: 0, 50, 100, 200, 400, 600, 800, 1000, 1200, 1500, 1800, 2000, and 2500 s/mm2. On DWI, the suitable regions of interest were selected. The SNRs of normal breasts (SNRnormal), SNRlesions, SIR, and CNR of benign and malignant lesions were measured on DWI with different b-values and calculated. The variation patterns of SNR, SIR, and CNR values on DWI for normal breasts, benign lesions, and malignant lesions with different b-values were analyzed by using Pearson correlation analysis. The SNR and SIR of benign and malignant lesions with the same b-values were compared using t-tests. The diagnostic efficiencies of SIR with different b-values for benign and malignant lesions were evaluated using receiver operating characteristic curves. RESULTS Breast DWI had higher CNR for b-values ranging from 600 to 1200 s/mm2. It had the best CNR at b = 1000 s/mm2 for the benign lesions and at b = 1200 s/mm2 for the malignant lesions. The signal intensity and SNR values of normal breasts decreased with increasing b-values, with a negative correlation (r = -0.945, P < 0.01). The mean SNR values of benign and malignant lesions were negatively correlated (r = -0.982 and -0.947, respectively, and P < 0.01), gradually decreasing with increasing b-values. The mean SIR value of benign lesions gradually decreased with increasing b-values, a negative correlation (r = -0.991, P < 0.01). The mean SIR values of malignant lesions gradually increased with increasing b-values between 0 and 1200 s/mm2, and gradually decreased with increasing b-values ≥ 1500 s/mm2. For b-values of 600, 800, 1000, and 1200 s/mm2, the sensitivity and specificity of SIR in identifying benign and malignant lesions gradually increased with increasing b-values, peaking at 1200 s/mm2. CONCLUSIONS Breast DWI had higher image quality for b-values ranging from 600 to 1200 s/mm2, and was best for b-values ranging from 1000 to 1200 s/mm2. The SIR had the highest diagnostic efficiency in differentiating benign and malignant lesions for a b-value of 1200 s/mm2.
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Affiliation(s)
- Xiaowei Han
- Department of Radiology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi City, Shanxi Province, China
| | - Junfeng Li
- Department of Radiology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi City, Shanxi Province, China
| | - Xiaoyi Wang
- Department of Radiology, Xiangya Hospital, Central South University, No.87, Xiangya Road, Changsha City, Hunan Province 410008, China.
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Nogueira L, Brandão S, Matos E, Nunes RG, Ferreira HA, Loureiro J, Ramos I. Region of interest demarcation for quantification of the apparent diffusion coefficient in breast lesions and its interobserver variability. Diagn Interv Radiol 2016; 21:123-7. [PMID: 25698095 DOI: 10.5152/dir.2014.14217] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to compare two different methods of region of interest (ROI) demarcation and determine interobserver variability on apparent diffusion coefficient (ADC) in breast lesions. METHODS Thirty-two patients with 39 lesions were evaluated with a 3.0 Tesla scanner using a diffusion-weighted sequence with several b-values. Two observers independently performed the ADC measurements using: 1) a small fixed area of 10 mm2 ROI within the area with highest restriction; 2) a large ROI so as to include the whole lesion. Differences were assessed using the Wilcoxon-rank test. Bland-Altman method and Spearman coefficient were applied for interobserver variability and correlation analysis. RESULTS ADC values measured using the two ROI demarcation methods were significantly different for both observers (P = 0.026; P = 0.033). There was no interobserver variability in ADC values using either method (large ROI, P = 0.21; small ROI, P = 0.64). ADC values of malignant lesions were significantly different between the two methods (P < 0.001). Variability in ADC was ≤0.008×10-3 mm2/s for both methods. When using the same method, ADC values were significantly correlated between the observers (small ROI: r=0.990, P < 0.001; large ROI: r=0.985, P < 0.001). CONCLUSION The choice of ROI demarcation method influences ADC measurements. Small ROIs show less overlap in ADC values and higher ADC reproducibility, suggesting that this method may improve lesion discrimination. Interobserver variability was low for both methods.
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Affiliation(s)
- Luísa Nogueira
- Department of Radiology, Hospital São João, Porto University School of Medicine, Porto, Portugal; School of Allied Health Sciences, Oporto Polytechnic Institute, Porto, Portugal.
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Jiang JX, Tang ZH, Zhong YF, Qiang JW. Diffusion kurtosis imaging for differentiating between the benign and malignant sinonasal lesions. J Magn Reson Imaging 2016; 45:1446-1454. [PMID: 27758016 DOI: 10.1002/jmri.25500] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 09/20/2016] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The study aimed to evaluate diffusion kurtosis imaging (DKI) in the differentiation between benign and malignant sinonasal lesions, and to compare the diagnostic performance of DKI with diffusion weighted imaging (DWI). MATERIALS AND METHODS Eight-one patients with solid sinonasal lesions confirmed by surgery and pathology (46 malignant and 35 benign) underwent conventional MRI, DWI, and DKI. DKI was performed employing a 13 extended b-value ranging from 0 to 2500 s/mm2 . Apparent diffusion coefficient (ADC) from DWI, kurtosis (K), and diffusion coefficient (D) from DKI were measured and compared between two groups. RESULTS ADC and D values were significantly lower in the malignant sinonasal lesions than in the benign sinonasal lesions (1.11 ± 0.41 versus 1.58 ± 0.50 × 10-3 mm2 /s and 1.45 ± 0.36 versus 2.03 ± 0.49 × 10-3 mm2 /s, respectively, both P < 0001). K value was significantly higher in the malignant lesions than in the benign lesions (0.91 ± 0.23 versus 0.57 ± 0.24, P < 0001). The receiver operating characteristic curve analyses yielded a cutoff ADC value of 1.27 × 10-3 mm2 /s for differentiating between benign and malignant lesions, with a sensitivity of 69.6%, a specificity of 77.1% and an accuracy of 74.0%; a cutoff D value of 1.75 × 10-3 mm2 /s, with a sensitivity of 82.6%, a specificity of 77.1% and an accuracy of 80.2%; a cutoff K value of 0.63 with a sensitivity of 95.7%, a specificity of 77.1% and an accuracy of 87.7%. The area under the curve of K value was significantly larger than that of ADC value (0.875 versus 0.762; P < 0.05). CONCLUSION K value of DKI demonstrates significantly higher accuracy compared with ADC value for the differentiation between benign and malignant sinonasal lesions. DKI may be a noninvasive method to evaluate the sinonasal lesions. LEVEL OF EVIDENCE 1 J. MAGN. RESON. IMAGING 2017;45:1446-1454.
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Affiliation(s)
- Jing Xuan Jiang
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
| | - Zuo Hua Tang
- Department of Radiology, Eye and ENT Hospital, Fudan University Shanghai, China
| | - Yu Feng Zhong
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
| | - Jin Wei Qiang
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
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Bougias H, Ghiatas A, Priovolos D, Veliou K, Christou A. Whole-lesion apparent diffusion coefficient (ADC) metrics as a marker of breast tumour characterization-comparison between ADC value and ADC entropy. Br J Radiol 2016; 89:20160304. [PMID: 27718592 DOI: 10.1259/bjr.20160304] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To prospectively assess the role of whole-lesion apparent diffusion coefficient (ADC) metrics in the characterization of breast tumours by comparing ADC value with ADC entropy. METHODS 49 patients with 53 breast lesions underwent phased-array breast coil 1.5-T MRI. Two radiologists experienced in breast MRI, blinded to the final diagnosis, reviewed the ADC maps and placed a volume of interest on all slices including each lesion on the ADC map to obtain whole-lesion mean ADC value and ADC entropy. The mean ADC value and ADC entropy in benign and malignant lesions were compared by the Mann-Whitney U-test. Receiver-operating characteristic analysis was performed to assess the sensitivity and specificity of the two variables in the characterization of the breast lesions. RESULTS The benign (n = 19) and malignant lesions (n = 34) had mean diameters of 20.8 mm (10.1-31.5 mm) and 26.4 mm (10.5-42.3 mm), respectively. The mean ADC value of the malignant lesions was significantly lower than that of the benign ones (0.87 × 10-3 vs 1.49 × 10-3 mm2 s-1; p < 0.0001). Malignant ADC entropy was higher than benign entropy, without reaching levels of statistical significance (5.4 vs 5.0; p = 0.064). At a mean ADC cut-off value of 1.16 × 10-3 mm2 s-1, the sensitivity and specificity for diagnosing malignancy became optimal (97.1% and 93.7, respectively) with an area under the curve (AUC) of 0.975. With regard to ADC entropy, the sensitivity and specificity at a cut-off of 5.18 were 67.6 and 68.7%, respectively, with an AUC of 0.664. CONCLUSION Whole-lesion mean ADC could be a helpful index in the characterization of suspicious breast lesions, with higher sensitivity and specificity than ADC entropy. Advances in knowledge: Two separate parameters of the whole-lesion histogram were compared for their diagnostic accuracy in characterizing breast lesions. Mean ADC was found to be able to characterize breast lesions, whereas entropy proved to be unable to differentiate benign from malignant breast lesions. It is, however, likely that entropy may distinguish these two groups if a larger cohort were used, or the fact that this may be influenced by the molecular subtypes of breast cancers included.
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Affiliation(s)
- Haralambos Bougias
- 1 Department of Medical Imaging University Hospital of loannina, loannina, Greece
| | - Abraham Ghiatas
- 2 Department of Medical Imaging IASO Maternity Hospital, Athens, Greece
| | | | - Konstantia Veliou
- 3 Department of Medical Imaging Chatzikosta General Hospital of loannina, loannina, Greece
| | - Alexandra Christou
- 4 Department of Medical Imaging, Doncaster and Bassetlaw Hospitals NHS Foundation Trust, Doncaster, UK
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El-nasr SIS, Rahman RWA, Abdelrahman SF, Helal MH, Hamed ST. Role of diffusion weighted imaging and dynamic contrast enhanced MR mammography to detect recurrence in breast cancer patients after surgery. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2016.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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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: 0.8] [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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Subcategorization of Suspicious Breast Lesions (BI-RADS Category 4) According to MRI Criteria: Role of Dynamic Contrast-Enhanced and Diffusion-Weighted Imaging. AJR Am J Roentgenol 2015; 205:222-31. [PMID: 26102403 DOI: 10.2214/ajr.14.13834] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The purposes of this study were to investigate whether dynamic contrast-enhanced MRI is adequate for subcategorization of suspicious lesions (BI-RADS category 4) and to evaluate whether use of DWI improves diagnostic performance. MATERIALS AND METHODS The study group was composed of 103 suspicious lesions found in 83 subjects. Patient ages and lesion sizes were compiled, and two radiologists reanalyzed the images; subcategorized the findings as BI-RADS 4A, 4B, or 4C; and calculated apparent diffusion coefficient (ADC) values. The stratified variables were tested by univariate analysis and inserted in two multivariate predictive models, which were used to generate ROC curves and compare AUCs. Positive predictive values (PPVs) for each subcategory and ADC level were calculated, and interobserver agreement was tested. RESULTS Forty-four (42.7%) suspicious findings proved malignant. Except for age (p = 0.08), all stratified predictor variables were significant in univariate analyses (p < 0.01). Logistic regression models did not differ substantially after comparison of the ROC curves (p = 0.09), but the one including ADC values was slightly better: AUC of 0.89 (95% CI, 0.82-0.95) against AUC of 0.85 (95% CI, 0.78-0.93). PPV increased progressively in each BI-RADS 4 subcategory (4A, 0.15; 4B, 0.37; 4C, 0.84). ADC values of 1.10 × 10(-3) mm(2)/s or less had the second highest PPV (0.77). Interobserver agreement was substantial at a kappa value of 0.80 (95% CI, 0.70-0.90; p < 0.01). CONCLUSION Risk stratification of suspicious lesions (BI-RADS category 4) can be satisfactorily performed with DCE-MRI and slightly improved when DWI is introduced.
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Hales PW, Olsen ØE, Sebire NJ, Pritchard-Jones K, Clark CA. A multi-Gaussian model for apparent diffusion coefficient histogram analysis of Wilms' tumour subtype and response to chemotherapy. NMR IN BIOMEDICINE 2015; 28:948-957. [PMID: 26058670 DOI: 10.1002/nbm.3337] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 04/01/2015] [Accepted: 05/11/2015] [Indexed: 06/04/2023]
Abstract
Wilms' tumours (WTs) are large heterogeneous tumours, which typically consist of a mixture of histological cell types, together with regions of chemotherapy-induced regressive change and necrosis. The predominant cell type in a WT is assessed histologically following nephrectomy, and used to assess the tumour subtype and potential risk. The purpose of this study was to develop a mathematical model to identify subregions within WTs with distinct cellular environments in vivo, determined using apparent diffusion coefficient (ADC) values from diffusion-weighted imaging (DWI). We recorded the WT subtype from the histopathology of 32 tumours resected in patients who received DWI prior to surgery after pre-operative chemotherapy had been administered. In 23 of these tumours, DWI data were also available prior to chemotherapy. Histograms of ADC values were analysed using a multi-Gaussian model fitting procedure, which identified 'subpopulations' with distinct cellular environments within the tumour volume. The mean and lower quartile ADC values of the predominant viable tissue subpopulation (ADC(1MEAN), ADC(1LQ)), together with the same parameters from the entire tumour volume (ADC(0MEAN), ADC(0LQ)), were tested as predictors of WT subtype. ADC(1LQ) from the multi-Gaussian model was the most effective parameter for the stratification of WT subtype, with significantly lower values observed in high-risk blastemal-type WTs compared with intermediate-risk stromal, regressive and mixed-type WTs (p < 0.05). No significant difference in ADC(1LQ) was found between blastemal-type and intermediate-risk epithelial-type WTs. The predominant viable tissue subpopulation in every stromal-type WT underwent a positive shift in ADC(1MEAN) after chemotherapy. Our results suggest that our multi-Gaussian model is a useful tool for differentiating distinct cellular regions within WTs, which helps to identify the predominant histological cell type in the tumour in vivo. This shows potential for improving the risk-based stratification of patients at an early stage, and for guiding biopsies to target the most malignant part of the tumour.
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Affiliation(s)
- Patrick W Hales
- Developmental Imaging and Biophysics Section, Institute of Child Health, University College London, London, UK
| | - Øystein E Olsen
- Radiology Department, Great Ormond Street Hospital, London, UK
| | - Neil J Sebire
- Developmental Biology and Cancer, Institute of Child Health, University College London, London, UK
| | - Kathy Pritchard-Jones
- Developmental Biology and Cancer, Institute of Child Health, University College London, London, UK
| | - Chris A Clark
- Developmental Imaging and Biophysics Section, Institute of Child Health, University College London, London, UK
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Fat suppression techniques (STIR vs. SPAIR) on diffusion-weighted imaging of breast lesions at 3.0 T: preliminary experience. Radiol Med 2015; 120:705-13. [PMID: 25665796 DOI: 10.1007/s11547-015-0508-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 05/19/2014] [Indexed: 12/24/2022]
Abstract
PURPOSE The aim of this work was to perform a qualitative and quantitative comparison of the performance of two fat suppression techniques on breast diffusion-weighted imaging (DWI). MATERIALS AND METHODS Fifty-one women underwent clinical breast magnetic resonance imaging, including DWI with short TI inversion recovery (STIR) and spectral attenuated inversion recovery (SPAIR). Four were excluded from the analysis due to image artefacts. Rating of fat suppression uniformity and lesion visibility were performed. Agreement between the two sequences was evaluated. Additionally, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and apparent diffusion coefficient (ADC) values for normal gland, benign and malignant lesions were compared. Receiver operating characteristic analysis was also performed. RESULTS From the 52 lesions found, 47 were detected by both sequences. DWI-STIR evidenced more homogeneous fat suppression (p = 0.03). Although these lesions were seen with both techniques, DWI-SPAIR evidenced higher score for lesion visibility in nine of them. SNR and CNR were comparable, except for SNR in benign lesions (p < 0.01), which was higher for DWI-SPAIR. Mean ADC values for lesions were similar. ADC for normal fibroglandular tissue was higher when using DWI-STIR (p = 0.006). Sensitivity, specificity, accuracy and area under the curve values were alike: 84.0 % for both; 77.3, 71.4 %; 80.9, 78.3 %; 82.5, 81.3 % for DWI-SPAIR and DWI-STIR, respectively. CONCLUSION DWI-STIR showed superior fat suppression homogeneity. No differences were found for SNR and CNR, except for SNR in benign lesions. ADCs for lesions were comparable. Findings in this study are consistent with previous studies at 1.5 T, meaning that both fat suppression techniques are appropriate for breast DWI at 3.0 T.
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Pinker K, Helbich TH, Magometschnigg H, Fueger B, Baltzer P. [Molecular breast imaging. An update]. Radiologe 2014; 54:241-53. [PMID: 24557495 DOI: 10.1007/s00117-013-2580-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
CLINICAL/METHODICAL ISSUE The aim of molecular imaging is to visualize and quantify biological, physiological and pathological processes at cellular and molecular levels. Molecular imaging using various techniques has recently become established in breast imaging. STANDARD RADIOLOGICAL METHODS Currently molecular imaging techniques comprise multiparametric magnetic resonance imaging (MRI) using dynamic contrast-enhanced MRI (DCE-MRI), diffusion-weighted imaging (DWI), proton MR spectroscopy ((1)H-MRSI), nuclear imaging by breast-specific gamma imaging (BSGI), positron emission tomography (PET) and positron emission mammography (PEM) and combinations of techniques (e.g. PET-CT and multiparametric PET-MRI). METHODICAL INNOVATIONS Recently, novel techniques for molecular imaging of breast tumors, such as sodium imaging ((23)Na-MRI), phosphorus spectroscopy ((31)P-MRSI) and hyperpolarized MRI as well as specific radiotracers have been developed and are currently under investigation. PRACTICAL RECOMMENDATIONS It can be expected that molecular imaging of breast tumors will enable a simultaneous assessment of the multiple metabolic and molecular processes involved in cancer development and thus an improved detection, characterization, staging and monitoring of response to treatment will become possible.
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Affiliation(s)
- K Pinker
- Abteilung für Molekulare Bildgebung, Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
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Chan RW, von Deuster C, Giese D, Stoeck CT, Harmer J, Aitken AP, Atkinson D, Kozerke S. Characterization and correction of eddy-current artifacts in unipolar and bipolar diffusion sequences using magnetic field monitoring. JOURNAL OF MAGNETIC RESONANCE (SAN DIEGO, CALIF. : 1997) 2014; 244:74-84. [PMID: 24880880 DOI: 10.1016/j.jmr.2014.04.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 04/25/2014] [Accepted: 04/30/2014] [Indexed: 06/03/2023]
Abstract
Diffusion tensor imaging (DTI) of moving organs is gaining increasing attention but robust performance requires sequence modifications and dedicated correction methods to account for system imperfections. In this study, eddy currents in the "unipolar" Stejskal-Tanner and the velocity-compensated "bipolar" spin-echo diffusion sequences were investigated and corrected for using a magnetic field monitoring approach in combination with higher-order image reconstruction. From the field-camera measurements, increased levels of second-order eddy currents were quantified in the unipolar sequence relative to the bipolar diffusion sequence while zeroth and linear orders were found to be similar between both sequences. Second-order image reconstruction based on field-monitoring data resulted in reduced spatial misalignment artifacts and residual displacements of less than 0.43 mm and 0.29 mm (in the unipolar and bipolar sequences, respectively) after second-order eddy-current correction. Results demonstrate the need for second-order correction in unipolar encoding schemes but also show that bipolar sequences benefit from second-order reconstruction to correct for incomplete intrinsic cancellation of eddy-currents.
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Affiliation(s)
- Rachel W Chan
- Centre for Medical Imaging, University College London, London, United Kingdom.
| | - Constantin von Deuster
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland; Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
| | - Daniel Giese
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
| | - Christian T Stoeck
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Jack Harmer
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
| | - Andrew P Aitken
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
| | - David Atkinson
- Centre for Medical Imaging, University College London, London, United Kingdom
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland; Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
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Mürtz P, Tsesarskiy M, Kowal A, Träber F, Gieseke J, Willinek WA, Leutner CC, Schmiedel A, Schild HH. Diffusion-weighted magnetic resonance imaging of breast lesions: the influence of different fat-suppression techniques on quantitative measurements and their reproducibility. Eur Radiol 2014; 24:2540-51. [DOI: 10.1007/s00330-014-3235-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 04/11/2014] [Accepted: 05/12/2014] [Indexed: 12/26/2022]
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Moukhtar FZ, Abu El Maati AA. Apparent diffusion coefficient values as an adjunct to dynamic contrast enhanced MRI for discriminating benign and malignant breast lesions presenting as mass and non-mass like enhancement. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2014.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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Nogueira L, Brandão S, Matos E, Nunes RG, Loureiro J, Ferreira HA, Ramos I. Diffusion-weighted imaging: determination of the best pair of b-values to discriminate breast lesions. Br J Radiol 2014; 87:20130807. [PMID: 24834475 DOI: 10.1259/bjr.20130807] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE In breast diffusion-weighted imaging (DWI), the apparent diffusion coefficient (ADC) is used to discriminate between malignant and benign lesions. As ADC estimates can be affected by the weighting factors, our goal was to determine the optimal pair of b-values for discriminating breast lesions at 3.0 T. METHODS 152 females with 157 lesions (89 malignant and 68 benign) underwent breast MRI, including a DWI sequence sampling six b-values 50, 200, 400, 600, 800 and 1000 s mm(-2). ADC values were computed from different pairs of b-values and compared with ADC obtained by fitting the six b-values using a mono-exponential diffusion model (ADCall). Cut-off ADC values were determined and diagnostic performance evaluated by receiver operating characteristic analysis using Youden statistics. Mean ADCs were determined for normal tissue and lesions. Differences were evaluated by lesion and histological types. RESULTS Considering the cut-off values 1.46 and 1.49 × 10(3)mm(2) s(-1), the pairs 50, 1000 and 200, 800 s mm(-2) showed the highest accuracy, 77.5% and 75.4% with areas under the curve 84.4% and 84.2%, respectively. The best pair for ADC quantification was 50, 1000 s mm(-2) with 38/49 true-negative and 69/89 true-positive cases respectively; mean ADCs were 1.86 ± 0.46, 1.77 ± 0.37 and 1.15 ± 0.46 × 10(-3) mm(2) s(-1) for normal, benign and malignant lesions. There were no significant differences in these ADC values when compared with ADCall (ADC calculated from the full set of b - values) [difference = 0.0075 × 10(-3) mm(2) s(-1); confidence interval 95%: (-0.0036; 0.0186); p = 0.18]. CONCLUSION The diagnostic performance in differentiating malignant and benign lesions was most accurate for the b-value pair 50, 1000 s mm(-2). ADVANCES IN KNOWLEDGE The best b-value pair for lesion discrimination and characterization through ADC quantification was 50, 1000 s mm(-2).
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Affiliation(s)
- L Nogueira
- 1 Department of Radiology, School of Allied Health Sciences, Oporto Polytechnic Institute (ESTSP/IPP), Vila Nova de Gaia, Portugal
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Diffusion-weighted breast imaging at 3 T: Preliminary experience. Clin Radiol 2014; 69:378-84. [DOI: 10.1016/j.crad.2013.11.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Revised: 10/29/2013] [Accepted: 11/07/2013] [Indexed: 12/16/2022]
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Nogueira L, Brandão S, Matos E, Nunes RG, Loureiro J, Ramos I, Ferreira HA. Application of the diffusion kurtosis model for the study of breast lesions. Eur Radiol 2014; 24:1197-203. [PMID: 24658871 DOI: 10.1007/s00330-014-3146-5] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 02/17/2014] [Accepted: 03/05/2014] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To evaluate diffusion-weighted imaging (DWI) and diffusion kurtosis imaging (DKI) in the differentiation and characterisation of breast lesions. METHODS Thirty-six women underwent breast magnetic resonance imaging (MRI) including a DWI sequence with multiple b-values (50-3,000 s/mm(2)). Mean values for apparent diffusion coefficient (ADC), mean diffusivity (MD) and mean kurtosis (MK) were calculated by lesion type and histological subtype. Differences and correlation between parameters were determined. RESULTS Forty-four lesions were found. There were significant differences between benign and malignant lesions for all parameters (ADC, p = 0.017; MD, p = 0.028; MK, p = 0.017). ADC and MD were higher for benign (1.96 ± 0.41 × 10(-3) and 2.17 ± 0.42 × 10(-3) mm(2)/s, respectively) than for malignant lesions (1.33 ± 0.18 × 10(-3) and 1.52 ± 0.50 × 10(-3) mm(2)/s). MK was higher for malignant (0.61 ± 0.27) than benign lesions (0.37 ± 0.18). We found differences between invasive ductal carcinoma (IDC) and fibroadenoma (FA) for all parameters (ADC, MD and MK): p = 0.016, 0.022 and 0.016, respectively. FA and fibrocystic change (FC) showed differences only in MK (p = 0.016). CONCLUSIONS Diffusion in breast lesions follows a non-Gaussian distribution. MK enables differentiation and characterisation of breast lesions, providing new insights into microstructural complexity. To confirm these results, further investigation in a broader sample should be performed.
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Affiliation(s)
- Luísa Nogueira
- Department of Radiology, School of Health Technology of Porto/Polytechnic Institute of Porto (ESTSP/IPP), Rua Valente Perfeito, 322, 4400-330, Vila Nova de Gaia, Portugal,
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Giannelli M, Sghedoni R, Iacconi C, Iori M, Traino AC, Guerrisi M, Mascalchi M, Toschi N, Diciotti S. MR scanner systems should be adequately characterized in diffusion-MRI of the breast. PLoS One 2014; 9:e86280. [PMID: 24489711 PMCID: PMC3904912 DOI: 10.1371/journal.pone.0086280] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 12/12/2013] [Indexed: 12/13/2022] Open
Abstract
Breast imaging represents a relatively recent and promising field of application of quantitative diffusion-MRI techniques. In view of the importance of guaranteeing and assessing its reliability in clinical as well as research settings, the aim of this study was to specifically characterize how the main MR scanner system-related factors affect quantitative measurements in diffusion-MRI of the breast. In particular, phantom acquisitions were performed on three 1.5 T MR scanner systems by different manufacturers, all equipped with a dedicated multi-channel breast coil as well as acquisition sequences for diffusion-MRI of the breast. We assessed the accuracy, inter-scan and inter-scanner reproducibility of the mean apparent diffusion coefficient measured along the main orthogonal directions (<ADC>) as well as of diffusion-tensor imaging (DTI)-derived mean diffusivity (MD) measurements. Additionally, we estimated spatial non-uniformity of <ADC> (NU<ADC>) and MD (NUMD) maps. We showed that the signal-to-noise ratio as well as overall calibration of high strength diffusion gradients system in typical acquisition sequences for diffusion-MRI of the breast varied across MR scanner systems, introducing systematic bias in the measurements of diffusion indices. While <ADC> and MD values were not appreciably different from each other, they substantially varied across MR scanner systems. The mean of the accuracies of measured <ADC> and MD was in the range [−2.3%,11.9%], and the mean of the coefficients of variation for <ADC> and MD measurements across MR scanner systems was 6.8%. The coefficient of variation for repeated measurements of both <ADC> and MD was < 1%, while NU<ADC> and NUMD values were <4%. Our results highlight that MR scanner system-related factors can substantially affect quantitative diffusion-MRI of the breast. Therefore, a specific quality control program for assessing and monitoring the performance of MR scanner systems for diffusion-MRI of the breast is highly recommended at every site, especially in multicenter and longitudinal studies.
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Affiliation(s)
- Marco Giannelli
- Medical Physics Unit, Pisa University Hospital “Azienda Ospedaliero-Universitaria Pisana”, Pisa, Italy
- * E-mail:
| | - Roberto Sghedoni
- Department of Oncology and Advanced Techniques, Medical Physics Unit, IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Chiara Iacconi
- Division of Radiology, Breast Unit, Massa Hospital, Azienda USL Massa e Carrara, Massa, Italy
| | - Mauro Iori
- Department of Oncology and Advanced Techniques, Medical Physics Unit, IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Antonio Claudio Traino
- Medical Physics Unit, Pisa University Hospital “Azienda Ospedaliero-Universitaria Pisana”, Pisa, Italy
| | - Maria Guerrisi
- Department of Biomedicine and Prevention, Medical Physics Section, University of Rome “Tor Vergata”, Rome, Italy
| | - Mario Mascalchi
- Department of Clinical and Experimental Biomedical Sciences, University of Florence, Florence, Italy
| | - Nicola Toschi
- Department of Biomedicine and Prevention, Medical Physics Section, University of Rome “Tor Vergata”, Rome, Italy
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Stefano Diciotti
- Department of Clinical and Experimental Biomedical Sciences, University of Florence, Florence, Italy
- Department of Electrical, Electronic, and Information Engineering “Guglielmo Marconi”, University of Bologna, Cesena, Italy
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Park AY, Gweon HM, Son EJ, Yoo M, Kim JA, Youk JH. Ductal carcinoma in situ diagnosed at US-guided 14-gauge core-needle biopsy for breast mass: preoperative predictors of invasive breast cancer. Eur J Radiol 2014; 83:654-9. [PMID: 24534119 DOI: 10.1016/j.ejrad.2014.01.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 01/07/2014] [Accepted: 01/13/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To identify preoperative features that could be used to predict invasive breast cancer in women with a diagnosis of ductal carcinoma in situ (DCIS) at ultrasound (US)-guided 14-gauge core needle biopsy (CNB). METHODS A total of 86 DCIS lesions that were diagnosed at US-guided 14-gauge CNB and excised surgically in 84 women were assessed. We retrospectively reviewed the patients' medical records, mammography, US, and MR imaging. We compared underestimation rates of DCIS for the collected clinical and radiologic variables and determined the preoperative predictive factors for upstaging to invasive cancer. RESULTS Twenty-seven (31.4%) of 86 DCIS lesions were upgraded to invasive cancer. Preoperative features that showed a significantly higher underestimation of DCIS were palpability or nipple discharge (p=0.040), number of core specimens less than 5 (p=0.011), mammographic maximum lesion size of 25 mm or larger (p=0.022), mammographic mass size of 40 mm or larger (p=0.046), sonographic mass size of 32 mm or larger (p=0.009), lesion size of 30 mm on MR (p=0.004), lower signal intensity (SI) on fat-saturated T2-weighted MR images (FS-T2WI) (p=0.005), heterogeneous or rim enhancement on MR images (p=0.009), and apparent diffusion coefficient (ADC) values lower than 1.04 × 10(-3)mm(2)/s on diffusion-weighted MR imaging (DWI) (p<0.001). CONCLUSION Clinical symptom of palpability or nipple discharge, number of core specimen, mammographic maximum lesion or mass size, SI on FS-T2WI, heterogeneous or rim enhancement on MR, and ADC value may be helpful in predicting the upgrade to invasive breast cancer for DCIS diagnosed at US-guided 14-gauge CNB.
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Affiliation(s)
- Ah Young Park
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Hye Mi Gweon
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Eun Ju Son
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Miri Yoo
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jeong-Ah Kim
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Ji Hyun Youk
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
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Kul S, Eyuboglu I, Cansu A, Alhan E. Diagnostic efficacy of the diffusion weighted imaging in the characterization of different types of breast lesions. J Magn Reson Imaging 2013; 40:1158-64. [DOI: 10.1002/jmri.24491] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 09/11/2013] [Indexed: 12/24/2022] Open
Affiliation(s)
- Sibel Kul
- Karadeniz Technical University; School of Medicine; Trabzon Turkey
| | - Ilker Eyuboglu
- Karadeniz Technical University; School of Medicine; Trabzon Turkey
| | - Aysegul Cansu
- Karadeniz Technical University; School of Medicine; Trabzon Turkey
| | - Etem Alhan
- Karadeniz Technical University; School of Medicine; Trabzon Turkey
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Partridge SC, McDonald ES. Diffusion weighted magnetic resonance imaging of the breast: protocol optimization, interpretation, and clinical applications. Magn Reson Imaging Clin N Am 2013; 21:601-24. [PMID: 23928248 DOI: 10.1016/j.mric.2013.04.007] [Citation(s) in RCA: 134] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Diffusion-weighted magnetic resonance (MR) imaging (DWI) has shown promise for improving the positive predictive value of breast MR imaging for detection of breast cancer, evaluating tumor response to neoadjuvant chemotherapy, and as a noncontrast alternative to MR imaging in screening for breast cancer. However, data quality varies widely. Before implementing DWI into clinical practice, one must understand the pertinent technical considerations and current evidence regarding clinical applications of breast DWI. This article provides an overview of basic principles of DWI, optimization of breast DWI protocols, imaging features of benign and malignant breast lesions, promising clinical applications, and potential future directions.
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Affiliation(s)
- Savannah C Partridge
- Department of Radiology, Seattle Cancer Care Alliance, University of Washington School of Medicine, Seattle, WA 98109-1023, USA.
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Xu D, Maier JK, King KF, Collick BD, Wu G, Peters RD, Hinks RS. Prospective and retrospective high order eddy current mitigation for diffusion weighted echo planar imaging. Magn Reson Med 2013; 70:1293-305. [PMID: 23325564 DOI: 10.1002/mrm.24589] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 11/12/2012] [Accepted: 11/15/2012] [Indexed: 01/31/2023]
Abstract
PURPOSE The proposed method is aimed at reducing eddy current (EC) induced distortion in diffusion weighted echo planar imaging, without the need to perform further image coregistration between diffusion weighted and T2 images. These ECs typically have significant high order spatial components that cannot be compensated by preemphasis. THEORY AND METHODS High order ECs are first calibrated at the system level in a protocol independent fashion. The resulting amplitudes and time constants of high order ECs can then be used to calculate imaging protocol specific corrections. A combined prospective and retrospective approach is proposed to apply correction during data acquisition and image reconstruction. RESULTS Various phantom, brain, body, and whole body diffusion weighted images with and without the proposed method are acquired. Significantly reduced image distortion and misregistration are consistently seen in images with the proposed method compared with images without. CONCLUSION The proposed method is a powerful (e.g., effective at 48 cm field of view and 30 cm slice coverage) and flexible (e.g., compatible with other image enhancements and arbitrary scan plane) technique to correct high order ECs induced distortion and misregistration for various diffusion weighted echo planar imaging applications, without the need for further image post processing, protocol dependent prescan, or sacrifice in signal-to-noise ratio.
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Affiliation(s)
- Dan Xu
- Applied Science Laboratory, General Electric Healthcare, Milwaukee, Wisconsin, USA
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Triple-negative invasive breast cancer on dynamic contrast-enhanced and diffusion-weighted MR imaging: comparison with other breast cancer subtypes. Eur Radiol 2012; 22:1724-34. [PMID: 22527371 DOI: 10.1007/s00330-012-2425-2] [Citation(s) in RCA: 164] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Revised: 01/19/2012] [Accepted: 02/11/2012] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To determine the MRI features of triple-negative invasive breast cancer (TNBC) on dynamic contrast-enhanced MR imaging (DCE-MRI) and diffusion-weighted MR imaging (DWI) in comparison with ER-positive/HER2-negative (ER+) and HER2-positive cancer (HER2+). METHODS A total of 271 invasive cancers in 269 patients undergoing preoperative MRI and surgery were included. Two radiologists retrospectively assessed morphological and kinetic characteristics on DCE-MRI and tumour detectability on DWI. Apparent diffusion coefficient (ADC) values of lesions were measured. Clinical and MRI features of the three subtypes were compared. RESULTS Compared with ER+ (n = 119) and HER2+ (n = 94), larger size, round/oval mass shape, smooth mass margin, and rim enhancement on DCE-MRI were significantly associated with TNBC (n = 58; P < 0.0001). On DWI, mean ADC value (× 10(-3) mm(2)/s) of TNBC (1.03) was higher than the mean ADC values for ER+ and HER2+ (0.89 and 0.84; P < 0.0001). There was no difference in tumour detectability (P = 0.099). Tumour size (P = 0.009), mass margin (smooth, P < 0.0001; irregular, P = 0.020), and ADC values (P = 0.002) on DCE-MRI and DWI were independent features of TNBC. CONCLUSIONS In addition to the morphological features, higher ADC values on DWI were independently associated with TNBC and could be useful in differentiating TNBC from ER+ and HER2+. KEY POINTS • Triple-negative breast cancers (TNBC) lack oestrogen/progesterone receptors and HER2 expression/amplification. • TNBCs are larger, better defined and more necrotic than conventional cancers. • On MRI, necrosis yields high T2-weighted signal intensity and ADCs. • High ADC values can be useful in diagnosing TNBC.
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Malayeri AA, El Khouli RH, Zaheer A, Jacobs MA, Corona-Villalobos CP, Kamel IR, Macura KJ. Principles and applications of diffusion-weighted imaging in cancer detection, staging, and treatment follow-up. Radiographics 2012; 31:1773-91. [PMID: 21997994 DOI: 10.1148/rg.316115515] [Citation(s) in RCA: 212] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Diffusion-weighted imaging relies on the detection of the random microscopic motion of free water molecules known as Brownian movement. With the development of new magnetic resonance (MR) imaging technologies and stronger diffusion gradients, recent applications of diffusion-weighted imaging in whole-body imaging have attracted considerable attention, especially in the field of oncology. Diffusion-weighted imaging is being established as a pivotal aspect of MR imaging in the evaluation of specific organs, including the breast, liver, kidney, and those in the pelvis. When used in conjunction with apparent diffusion coefficient mapping, diffusion-weighted imaging provides information about the functional environment of water in tissues, thereby augmenting the morphologic information provided by conventional MR imaging. Detected changes include shifts of water from extracellular to intracellular spaces, restriction of cellular membrane permeability, increased cellular density, and disruption of cellular membrane depolarization. These findings are commonly associated with malignancies; therefore, diffusion-weighted imaging has many applications in oncologic imaging and can aid in tumor detection and characterization and in the prediction and assessment of response to therapy.
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Affiliation(s)
- Ashkan A Malayeri
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, 600 N Wolfe St, Baltimore, MD 21287, USA.
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