Assessment of Breast Lesions With Diffusion-Weighted MRI: Comparing the Use of Different b Values

Pereira, Fernanda Philadelpho Arantes; Martins, Gabriela Botelho; Figueiredo, Eduardo; Domingues, Marisa Nassar Aidar; Domingues, Romeu Côrtes; Fonseca, Léa Mirian Barbosa da; Gasparetto, Emerson L.

doi:10.2214/ajr.09.2522

Cited by 142 publications

(97 citation statements)

References 31 publications

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“…A threshold ADC value of 1.30x10 -3 mm 2 /s in the study is compatible with the range of 1.1-1.60x10 -3 mm 2 /s, which has been reported in the literature and helps to distinguish benign vs malignant lesions with 89.1% sensitivity and 100% specificity (15,(22)(23)(24)(25)(26).…”

Section: Discussionsupporting

confidence: 87%

“…As a consequence, lower b values result in higher ADC values. Although no consensus exists on the appropriate b value, Pereira et al (26) compared the ADC values of malign breast tumors acquired at various b values and reported the ADC values at 750 mm²/s to be more sensitive than lower ones for the estimation of malignant potential (19). Similarly, as the preferred b value at our institution, 750 mm²/s was implemented.…”

Section: Balkanmentioning

confidence: 99%

“…Since prolonged acquisition time may lead to misalignment artifacts caused by patient motion, we utilized a combined b value of 0 and 750 mm²/s. However, whether the selection of b values would influence ADC measurements acquired from breast lesions is controversial (26,38). Thus, the optimum ADC value, reducing T2 shine through and perfusion effect while maintaining resolution, should be investigated with further clinical studies.…”

Section: Balkanmentioning

confidence: 99%

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Value of Apparent Diffusion Coefficient Values in Differentiating Malignant and Benign Breast Lesions

T¹,

G²,

Sezgin³

et al. 2016

Balkan Med J

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Background: Magnetic resonance imaging (MRI) has become a diagnostic and problem solving method for the breast examinations in addition to conventional breast examination methods. Diffusion-weighted imaging (DWI) adds valuable information to conventional MRI. Aims: Our aim was to show the impact of apparent diffusion coefficient (ADC) values acquired with DWI to differentiate benign and malignant breast lesions. Study Design: Diagnostic accuracy study. Methods: Forty-six women with 58 breast masses (35 malignant, 23 benign) were examined on a 1.5 T clinical MRI scanner. The morphologic characteristics of the lesions on conventional MRI sequences and contrast uptake pattern were assessed. ADC values of both lesions and normal breast parenchyma were measured. The ADC values obtained were statistically compared with the histopathologic results using Paired Samples t-Test. Results: Multiple lesions were detected in 12 (26%) of the patients, while only one lesion was detected in 34 (74%). Overall, 35 lesions out of 58 were histopathologically proven to be malignant. In the dynamic contrast-enhanced series, 5 of the malignant lesions were type 1, while 8 benign lesions revealed either type 2 or 3 time signal intensity curves (85% sensitivity, 56% spesifity Breast cancer is the most common cancer in females worldwide and the second main cause of cancer death following lung cancer. Approximately 12% of women will experience breast cancer during their lifetime (1). Therefore, breast cancer maintains its importance as a serious public health issue. The major risk factors comprise family history, genetic predisposition caused by the presence of a BRCA1 or BRCA2 gene mutation, and previously acquired breast lesions including fibrovascular papilloma, atypical ductal and lobular hyperplasia, and ductal and lobular carcinoma in situ (2,3).Imaging is crucial to diagnose and evaluate the stage and extent of breast cancer. Therefore, three types of radiologic techniques, including mammography, ultrasonography (US) and breast magnetic resonance imaging (MRI), are implemented. As a basic breast cancer scanning method, mammography is highly available, with a short scanning time.

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Section: Discussionsupporting

confidence: 87%

Section: Balkanmentioning

confidence: 99%

Section: Balkanmentioning

confidence: 99%

See 1 more Smart Citation

Value of Apparent Diffusion Coefficient Values in Differentiating Malignant and Benign Breast Lesions

T¹,

G²,

Sezgin³

et al. 2016

Balkan Med J

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“…The first study found no significant difference in the diagnostic performance of ADC (42). The optimum cut-off values varied in these studies, which was likely a result of different calculation methods and differences in patient populations (43)(44)(45). Despite the ability of DWI to statistically differentiate benign from malignant breast lesions, there is typically a considerable overlap of values in the two groups.…”

Section: Breast Applicationsmentioning

confidence: 96%

“…The range of b values reported in the literature for breast DWI is 0-1000. Two studies have investigated multiple combinations of b values to determine their effect on image quality and the calculated ADC value (42,43). The first study found no significant difference in the diagnostic performance of ADC (42).…”

Section: Breast Applicationsmentioning

confidence: 99%

Diffusion weighted MRI for detecting and monitoring cancer: a review of current applications in body imaging

Türkbey

Aras

Karabulut

et al. 2011

Diagn Interv Radiol

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Imaging is used to detect, characterize, and monitor cancer. Recently, diffusion-weighted magnetic resonance imaging (DWI) has become a useful adjunct for assessing tumors with magnetic resonance imaging (MRI). DWI involves the acquisition of a magnetic resonance signal related to random thermal motion (Brownian motion) or the "diffusion" of water protons in tissue. The signal obtained with DWI is a measure of the net displacement of water molecules, e.g., the water path length in the extracellular, intracellular and intravascular spaces. This motion is largely random and can be reduced by structural barriers, such as cell membranes and collagen. Restricted diffusion in biological tissues is inversely proportional to tissue cellularity and the integrity of cell membranes, and it can be quantified with apparent diffusion coefficient (ADC) measurements (1). Depending on the microarchitecture, either restricted or increased diffusion can occur in malignant tumors. For instance, diffusion is restricted in cellular portions of the tumor, but it may be increased in necrotic portions (2, 3). Other causes of enhanced diffusion include increased water content arising from intratumoral edema and cystic tumor components (4-6).Although initially used to evaluate neurological diseases, the applications of DWI have been extended to oncologic imaging throughout the body made possible by improvements in MRI hardware and new sequences. The use of DWI as a complement to conventional MRI methods has led to improvements in the detection and characterization of tumors, treatment response monitoring, and detection of recurrence in oncology patients. Basic concepts of DWIIn 1965, Stejskal and Tanner (7) proposed the application of a symmetric pair of additional gradients on either side of the 180˚ refocusing radiofrequency pulse. The Stejskal-Tanner sequence is still the basis of modern DWI. For static water molecules, the phasing effect caused by the first gradient will be reversed by the second gradient, leading to no signal loss; however, this phasing effect will not be completely reversed if the water molecules are not stationary, which results in the observed well-known diffusion signal decay. The amount of diffusion weighting is determined by the b value, which describes the amplitude, duration of the applied gradient, and time interval between the two diffusion gradients (4). The degree of signal attenuation from water molecules is cor- ABSTRACT Diffusion-weighted magnetic resonance imaging (MRI), which involves the acquisition of a magnetic resonance signal related to the Brownian motion of water protons in tissue, has become a useful technique for assessing tumors. In this article, we review the basic concepts, imaging strategies, and body applications of diffusion-weighted MRI in detecting and monitoring cancer.

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High-resolution diffusion-weighted imaging for the separation of benign from malignant BI-RADS 4/5 lesions found on breast MRI at 3T

Wisner

Rogers

Deshpande

et al. 2013

J. Magn. Reson. Imaging

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Purpose To determine whether readout-segmented echo-planar diffusion imaging (RESOLVE) improves separation of malignant versus benign lesions compared to standard single-shot echo-planar imaging (ss-EPI) on BI-RADS 4/5 lesions detected on breast MRI. Materials and Methods Consecutive 3T breast MRI studies with BI-RADS 4/5 designation and subsequent biopsy or benign mastectomy were retrospectively identified. Freehand ROI’s were drawn on lesions and also on normal background fibroglandular tissue for comparison. Lesion-to-background contrast was evaluated by normalizing signal intensity of the lesion ROI by the normal background tissue ROI at b=800. Statistical analysis used the Mann-Whitney/Wilcoxon rank-sum test for unpaired and Wilcoxon signed-rank for paired comparisons. Results Of 38 lesions in 32 patients,10 were malignant. Lesion-to-background contrast was higher on RESOLVE than ss-EPI (1.80±0.71 vs. 1.62±0.63, p=0.03). Mean ADC was the same or lower on RESOLVE than ss-EPI, and this effect was largest in malignant lesions (RESOLVE 0.90±0.13; ss-EPI 1.00±0.13; median difference −0.10 (95%CI: −0.17,−0.02) ×10−3mm2/sec; p=0.014). By either diffusion method, there was a statistically significant difference between benign and malignant mean ADC (p<0.001). Conclusion Increased lesion-to-background contrast and improved separation of benign from malignant lesions by RESOLVE compared to standard diffusion, suggest that RESOLVE may show promise as an adjunct to clinical breast MRI.

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Assessment of Breast Lesions With Diffusion-Weighted MRI: Comparing the Use of Different b Values

Abstract: Diffusion-weighted imaging is a potential resource as a coadjutant of MRI in the differentiation between benign and malignant lesions. Such imaging can be performed without a significant increase in examination time, especially because it can be done with lower b values.

Cited by 142 publications

References 31 publications

Value of Apparent Diffusion Coefficient Values in Differentiating Malignant and Benign Breast Lesions

Value of Apparent Diffusion Coefficient Values in Differentiating Malignant and Benign Breast Lesions

Diffusion weighted MRI for detecting and monitoring cancer: a review of current applications in body imaging

High-resolution diffusion-weighted imaging for the separation of benign from malignant BI-RADS 4/5 lesions found on breast MRI at 3T

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