Qualitative and quantitative diffusion-weighted imaging of the breast at 3T - A useful adjunct to contrast-enhanced MRI in characterization of breast lesions

Richa Bansal; Viral Shah; Bharat Aggarwal

doi:10.4103/0971-3026.169455

Indian Journal of Radiology and Imaging, Table of Contents

CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2015; 25(04): 397-403
DOI: 10.4103/0971-3026.169455

Breast Radiology

Qualitative and quantitative diffusion-weighted imaging of the breast at 3T - A useful adjunct to contrast-enhanced MRI in characterization of breast lesions

Richa Bansal

Department of Radiodiagnosis, Max Super Speciality Hospital, New Delhi, India

,

Viral Shah

Department of Radiodiagnosis, Max Super Speciality Hospital, New Delhi, India

,

Bharat Aggarwal

Department of Radiodiagnosis, Max Super Speciality Hospital, New Delhi, India

› Author Affiliations

Abstract

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Abstract

Objective: To distinguish between benign and malignant breast lesions on the basis of their signal intensity on diffusion-weighted imaging and their apparent diffusion coefficient (ADC) values at 3 T MRI, along with histopathological correlation. Materials and Methods: A retrospective analysis of 500 patients who underwent 3 T MRI between August 2011 and May 2013 was done. Of these, 226 patients with 232 lesions that were proved by histopathology were included in the study. ADC values were calculated at b values of 0, 1000, and 1500 s/mm2 after identification on contrast-enhanced images and appropriate ROI(Region of interest) placement. ADC value and histopathology correlation was analyzed. Results: Out of 232 lesions, 168 lesions were histologically malignant and 64 were histologically benign. With an ADC cut-off value of 1.1 ×10−3 mm2/s for malignant lesions, a sensitivity of 92.80% and specificity of 80.23% was obtained. Out of 12/232 false-negative lesions, 6 were mucinous carcinoma in which a high ADC value of 1.8-1.9 ×10−3 mm2/s was obtained. Purely DCIS (Ductal carcinoma in situ) lesions presenting as non-mass-like enhancement had a high ADC value of 1.2-1.5 ×10−3 mm2/s, thereby reducing specificity. Conclusion: Diffusion-weighted Imaging and quantitative assessment by ADC values may act as an effective parameter in increasing the diagnostic accuracy and specificity of contrast-enhanced breast MRI in characterization of breast lesions.

Keywords

Apparent diffusion coefficient - breast cancer - breast imaging - diffusion‑weighted imaging

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References

References
1 Woodhams R, Ramadan S, Stanwell P, Sakamoto S, Hata H, Ozaki M, et al. Diffusion-weighted imaging of the breast: Principles and clinical applications. Radiographics 2011;31:1059-84.
2 Yabuuchi H, Matsuo Y, Okafuji T, Kamitani T, Soeda H, Setoguchi T, et al. Enhanced mass on contrast-enhanced breast MR imaging: Lesion characterization using combination of dynamic contrast-enhanced and diffusion-weighted MR images. J Magn Reson Imaging 2008;28:1157-65.
3 Partridge SC, Mullins CD, Kurland BF, Allain MD, DeMartini WB, Eby PR, et al. Apparent diffusion coefficient values for discriminating benign and malignant breast MRI lesions: Effects of lesion type and size. AJR Am J Roentgenol 2010;194:1664-73.
4 Gilles R, Guinebretière JM, Lucidarme O, Cluzel P, Janaud G, Finet JF, et al. Nonpalpable breast tumors: Diagnosis with contrast-enhanced subtraction dynamic MR imaging. Radiology 1994;191:625-31.
5 Petralia G, Bonello L, Priolo F, Summers P, Bellomi M. Breast MR with special focus on DW-MRI and DCE-MRI. Cancer Imaging 2011;11:76-90.
6 Bammer R. Basic principles of diffusion-weighted imaging. Eur J Radiol 2003;45:169-84.
7 Brandão AC, Lehman CD, Partridge SC. Breast magnetic resonance imaging: Diffusion-weighted imaging. Magn Reson Imaging Clin N Am 2013;21:321-36.
8 Koh DM, Collins DJ. Diffusion-weighted MRI in the body: Applications and challenges in oncology. AJR Am J Roentgenol 2007;188:1622-35.
9 Pereira FP, Martins G, Figueiredo E, Domingues MN, Domingues RC, da Fonseca LM, et al. Assessment of breast lesions with diffusion-weighted MRI: Comparing the use of different b values. AJR Am J Roentgenol 2009;193:1030-5.
10 Park MJ, Cha ES, Kang BJ, Ihn YK, Baik JH. The role of diffusion-weighted imaging and the apparent diffusion coefficient (ADC) values for breast tumors. Korean J Radiol 2007;8:390-6.
11 Baron P, Dorrius MD, Kappert P, Oudkerk M, Sijens PE. Diffusion-weighted imaging of normal fibroglandular breast tissue: Influence of microperfusion and fat suppression technique on the apparent diffusion coefficient. NMR Biomed 2010;23:399-405.
12 Jin G, An N, Jacobs MA, Li K. The role of parallel diffusion-weighted imaging and apparent diffusion coefficient (ADC) maP values for evaluating breast lesions: Preliminary results. Acad Radiol 2010;17:456-63.
13 Baltzer PA, Benndorf M, Dietzel M, Gajda M, Camara O, Kaiser WA. Sensitivity and specificity of unenhanced MR mammography (DWI combined with T2-weighted TSE imaging, ueMRM) for the differentiation of mass lesions. Eur Radiol 2010;20:1101-10.
14 Schott AF, Roubidoux MA, Helvie MA, Hayes DF, Kleer CG, Newman LA, et al. Clinical and radiologic assessments to predict breast cancer pathologic complete response to neoadjuvant chemotherapy. Breast Cancer Res Treat 2005;92:231-8.
15 Rieber A, Brambs HJ, Gabelmann A, Heilmann V, Kreienberg R, Kühn T. Breast MRI for monitoring response of primary breast cancer to neo-adjuvant chemotherapy. Eur Radiol 2002;12:1711-9.
16 Matsuoka A, Minato M, Harada M, Kubo H, Bandou Y, Tangoku A, et al. Comparison of 3.0- and 1.5-tesla diffusion-weighted imaging in the visibility of breast cancer. Radiat Med 2008;26:15-20.
17 Lo GG, Ai V, Chan JK, Li KW, Cheung PS, Wong TT, et al. Diffusion-weighted magnetic resonance imaging of breast lesions:First experiences at 3 T. J Comput Assist Tomogr 2009;33:63-9.
18 Woodhams R, Matsunaga K, Iwabuchi K, Kan S, Hata H, Kuranami M, et al. Diffusion-weighted imaging of malignant breast tumors: The usefulness of apparent diffusion coefficient (ADC) value and ADC map for the detection of malignant breast tumors and evaluation of cancer extension. J Comput Assist Tomogr 2005;29:644-9.
19 Woodhams R, Matsunaga K, Kan S, Hata H, Ozaki M, Iwabuchi K, et al. ADC mapping of benign and malignant breast tumors. Magn Reson Med Sci 2005;4:35-42.
20 Sinha S, Lucas-Quesada FA, Sinha U, DeBruhl N, Bassett LW.In vivo diffusion-weighted MRI of the breast: Potential for lesion characterization. J Magn Reson Imaging 2002;15:693-704.
21 Rubesova E, Grell AS, De Maertelaer V, Metens T, Chao SL, Lemort M. Quantitative diffusion imaging in breast cancer: A clinical prospective study. J Magn Reson Imaging 2006;24:319-24.
22 Min Q, Shao K, Zhai L, Liu W, Zhu C, Yuan L, et al. Differential diagnosis of benign and malignant breast masses using diffusion-weighted magnetic resonance imaging. World J Surg Oncol 2015;13:32.
23 Guo Y, Cai YQ, Cai ZL, Gao YG, An NY, Ma L, et al. Differentiation of clinically benign and malignant breast lesions using diffusion-weighted imaging. J Magn Reson Imaging 2002;16:172-8.
24 Ei Khouli RH, Jacobs MA, Mezban SD, Huang P, Kamel IR, Macura KJ, et al. Diffusion-weighted imaging improves the diagnostic accuracy of conventional 3.0-T breast MR Imaging. Radiology 2010;256:64-73.
25 Buadu LD, Murakami J, Murayama S, Hashiguchi N, Sakai S, Masuda K, et al. Breast lesions correlation of contrast medium enhancement patterns on MR imaging with histopathologic findings and tumor angiogenesis. Radiology 1996;200:639-49.
26 Hatakenaka M, Soeda H, Yabuuchi H, Matsuo Y, Kamitani T, Oda Y, et al. Apparent diffusion coefficients of breast tumors: Clinical application. Magn Reson Med Sci 2008;7:23-9.
27 Woodhams R, Kakita S, Hata H, Iwabuchi K, Umeoka S, Mountford CE, et al. Diffusion-weighted imaging of mucinous carcinoma of the breast: Evaluation of apparent diffusion coefficient and signal intensity in correlation with histologic findings. AJR Am J Roentgenol 2009;193:260-6.
28 Imamura T, Isomoto I, Sueyoshi E, Yano H, Uga T, Abe K, et al. Diagnostic performance of ADC for Non-mass-like breast lesions on MR imaging. Magn Reson Med Sci 2010;9:217-25.