Can DWI-MRI be an alternative to DCE-MRI in the diagnosis of troublesome breast lesions?

Abstract

Background Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) has always been a problem solver in troublesome breast lesions. Despite its many advantages, the encountered low specificity results in unnecessary biopsies. Diffusion-weighted MRI (DW-MRI) is a well-established technique that helps in characterizing breast lesions according to their water diffusivity. So this work aimed to assess the diagnostic performance of DW-MRI in troublesome breast lesions and see if it can replace DCE-MRI study. Results In our prospective study, we included 86 patients with mammography and/or ultrasound-detected 90 probably benign or probably malignant (BIRADS 3 or 4) breast lesions. Among the studied cases, 49/90 lesions were benign, and 41/90 were malignant. Combined analysis of morphological and kinetic findings in DCE-MRI had achieved the highest sensitivity of 95.1%. DW-MRI alone was less sensitive (73.2%) yet more specific (83.7%) than DCE-MRI (77.6%). Diagnostic accuracy of DCE-MRI was higher (85.6%) as compared to DW-MRI which was (78.9%). Conclusion DCE-MRI is the cornerstone in the workup of troublesome breast lesions. DW-MRI should not be used as supplementary tool unless contrast administration is contraindicated. Combining both DCE-MRI and DW-MRI is the ultimate technique for better lesion evaluation.

MR diffusion-weighted imaging precision in BIRADS downstaging

“…That was superior to the sensitivity and specificity reported by Mehnati et al in [8], which were 30-60 and 40-80, respectively. Nevertheless, the results in the current study were in reproachment to the findings recorded by Eisa et al in [9] and Hashem et al [7] in their studies, who demonstrated a specificity of 74% and 80%, with sensitivity of 68% and 73%, respectively. These paralogisms in the mammography are mainly attributed to the dense breast cases (ACR III and IV), where the fibro glandular tissue almost conceal any breast lesions, yet aided by ultrasound; their sensitivity and specificity to detect and characterize lesions are relatively higher.…”

“…The main symptoms of the included patients in the study were asymmetry in breast size (n = 2/60 3.3%), lump (n = 34/60 56.7%), mastalgia (n = 20/60, 33.3%), and nipple discharge (n = 4/60, 6.7%). On the other hand, in the study conducted by Hashem et al [7], 52.3% of 86 patients had breast lumps (n = 45/86), 7% had inflammatory symptoms (n = 6/86), and 40.7% had postoperative follow-up (n = 35/86).…”

“…The average age of the female participants in the study was 45.3 ± 13.8 years, and their ages ranged from 21 to 69. The research carried out by Hashem et al [7] focused on female patients ranging in age from 25 to 70, with a mean age of 42 ± 12.9.…”

“…On the other hand, the study conducted by Youssef et al [12] recorded six cases of benign nature with non-mass enhancement. In addition, Hashem et al [7] disclosed five cases with non-mass enhancement, all turned out to be of benign nature.…”

Advanced Diffusion-Weighted Imaging Sequences for Breast MRI: Comprehensive Comparison of Improved Sequences and Ultra-High B-Values to Identify the Optimal Combination

“…For screening and specialized incompatible cases, it has even been postulated that DCE-MRI may be omitted, and precise diagnostic accuracy can be achieved using DWI-MRI [27]. Furthermore, DWI sequences are important for not only confirming lesions and distinguishing malignant lesions from benign lesions, but also for achieving the medium-term goal of reducing or even eliminating the need for intravenous contrast-agent administration while maintaining high diagnostic accuracy [28,29]. To enable international comparability in diagnostics by standardizing MRI-breast-examination methods and techniques, the development of new, clinically relevant, and validated techniques by consensus is crucial [1,30].…”