Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 26, 2022; 10(18): 6021-6031
Published online Jun 26, 2022. doi: 10.12998/wjcc.v10.i18.6021
Value of magnetic resonance diffusion combined with perfusion imaging techniques for diagnosing potentially malignant breast lesions
Hui Zhang, Xin-Yi Zhang, Yong Wang
Hui Zhang, Department of Radiology, Hebei General Hospital, Shijiazhuang 050000, Hebei Province, China
Xin-Yi Zhang, Yong Wang, Department of Radiology, the First Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
Author contributions: Zhang H and Wang Y designed the experiment. Zhang XY implemented the experiment; Zhang H and Wang Y drafted the manuscript; Wang Y was responsible for the paper.
Institutional review board statement: The study was reviewed and approved by the First Hospital of Hebei Medical University Institutional Review Board, No. 20210907.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at wy80868@163.com. Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yong Wang, MHSc, Department of Radiology, the First Hospital of Hebei Medical University, No. 89 Donggang Road, Shijiazhuang 050000, Hebei Province, China. wy80868@163.com
Received: December 7, 2021
Peer-review started: December 7, 2021
First decision: January 25, 2022
Revised: March 23, 2022
Accepted: April 21, 2022
Article in press: April 21, 2022
Published online: June 26, 2022
Processing time: 191 Days and 12.8 Hours
ARTICLE HIGHLIGHTS
Research background

In recent years, the incidence of breast cancer has increased year by year, topping all types of cancer in Chinese women. Novel functional magnetic resonance imaging (MRI) techniques, including diffusion-weighted imaging (DWI), perfusion-weighted imaging (PWI), and other non-invasive detection methods, have enabled the detection of pathological conditions of tissues to reach on a molecular-level, as well as the detection of functional status and change in mechanisms of organs, tissues, and cells in vivo. According to the MRI breast imaging reporting and data system (BI-RADS) (5th edition), potentially malignant breast lesions are classified as the 4th category (BI-RADS 4) with a wide variation with regard to the risk of malignancy, from 2% to 95%. The results of this study help to decide the exact nature of breast lesions before the patients undergo biopsy.

Research motivation

This study aimed to evaluate the value of DWI and PWI in diagnosing BI-RADS 4 breast lesions and analyze the diagnostic efficacy of DWI and PWI respectively and jointly, which could help to decide the exact nature of breast lesions.

Research objectives

The main objective of this study is to improve the specificity of MRI in detecting breast. MRI has become an essential examination method to diagnose breast lesions due to the avoidance of ionizing radiation, high soft-tissue resolution, multi-parameter imaging, multi-sequence imaging, and high sensitivity. When realizing the objective, the diagnostic efficiency of the apparent diffusion coefficient (ADC) combined with PWI in determining the nature of lesions categorized as BI-RADS 4 will be improved.

Research methods

This retrospective study included patients who underwent breast MRI between May 2017 and May 2019. 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 combinely.

Research results

The mean ADC value of the malignant group was lower than that of the benign group (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). The sensitivity and specificity of PWI combined with DWI (91.7% and 89.3%, respectively) were higher than that of PWI or DWI alone. Studies with larger sample size are necessary to determine the real diagnostic value of DWI combined for PWI and determine the adequate cutoff values for the different quantitative parameters.

Research conclusions

The sensitivity and specificity of combined PWI and DWI were higher than those of PWI or DWI alone. DWI, combined with PWI, might possibly help distinguish benign breast lesions from malignant ones and provide clear diagnostic results for patients with potentially malignant BI-RADS 4 lesions at mammography.

Research perspectives

To improve the accuracy of combining PWI and DWI in predicting pathological results.