Evaluation of Malignant Breast Lesions Using High-resolution Readout-segmented Diffusion-weighted Echo-planar Imaging: Comparison with Pathology

Abstract

We aimed to investigate the performance of high resolution-diffusion-weighted imaging (HR-DWI) using readout-segmented echo-planar imaging in visualizing malignant breast lesions and evaluating their extent, using pathology as a reference.Methods: This retrospective study included patients who underwent HR-DWI with surgically confirmed malignant breast lesions. Two radiologists blinded to the final diagnosis evaluated HR-DWI independently and identified the lesions, measuring their maximum diameters. Another radiologist confirmed if those lesions were identical to the pathology. The maximum diameters of the lesions between HR-DWI and pathology were compared, and their correlations were calculated using Spearman's correlation coefficient. Apparent diffusion coefficient (ADC) values of the lesions were measured.Results: Ninety-five mass/64 non-mass lesions were pathologically confirmed in 104 females. Both radiologists detected the same 93 mass lesions (97.9%). Spearman's correlation coefficient for mass lesions were 0.89 and 0.90 (P < 0.0001 and 0001) for the two radiologists, respectively. The size differences within 10 mm were 90.3% (84/93) and 94.6% (88/93) respectively. One radiologist detected 35 non-mass lesions (54.7%) and another radiologist detected 32 non-mass lesions (50.0%), of which 28 lesions were confirmed as identical. Spearman's correlation coefficient for non-mass lesions were 0.59 and 0.22 (P = 0.0002 and 0.22), respectively. The mean ADC value of mass lesions and non-mass lesions were 0.80 and 0.89 × 10 −3 mm 2 /s, respectively. Conclusion:Using HR-DWI, malignant mass lesions were depicted with excellent agreement with the pathological evaluation. Approximately half of the non-mass lesions could not be identified, suggesting a current limitation of HR-DWI.

Comparison of high-resolution diffusion-weighted imaging (DWI) with conventional DWI and DCE-MRI in regard to image quality and assessment of breast cancer morphology

“…Based on these results, it can be considered that f-DWI may be a potential competitor to DCE-MRI in evaluating the morphologic features and extent of breast masses and it was thought that the use of high-resolution DWI together with c-DWI could increase the diagnostic accuracy especially in patients who cannot undergo contrast-enhanced imaging. One of the other important results of our study, parallel to the findings in the literature is the determination of the ADC values obtained with f-DWIs to be statistically lower than the ADC values obtained with c-DWIs (28,31,32). Although, this effect has been suggested to be secondary to a reduced partial volume effect of normal fibroglandular tissue and residual fat in high resolution images, the exact mechanism has not yet been fully clarified (2,11).…”

“…In c-DWIs, which is one of the most preferred unenhanced MRI methods, it is tried to obtain information about the quantitative values of breast lesions rather than their qualitative characteristics (26,27). However, in recent years, there have been various publications investigating the diagnostic contribution of DWIs in determining the morphological features of breast lesions (28,16,17,19,20). Kang et al concluded the potential utility of c-DWI in assessing morphologic features of lesions with high accuracy rates, which can be used for benign-malignant differentiation or for prognostic prediction (16).…”

MR Imaging in the 21st Century: Technical Innovation over the First Two Decades

“… 69 Single-shot EPI has been used for dMRI acquisition sequences, which limits spatial resolution and image quality. While various high spatial resolution dMRI acquisition pulse sequences have been proposedand used 70 – 72 in the last decades, there are remaining improvement opportunities to balance scan time, image quality, and spatial resolution.…”

Preoperative Localization of Parathyroid Adenomas with Diffusion MR Imaging: Readout-segmented versus Single-shot Echo-planar Imaging

“…11,12 RS-EPI is expected to improve the diagnostic accuracy of detecting PTAs on DWI as it provides less distortion, and its advantages are reported in some organs including the head and neck. [13][14][15] However, to our knowledge, there is no literature focusing on the usefulness of 3T RS-EPI for the localization and distinction of PTAs. We conducted the present retrospective study to determine whether 3T RS-EPI can reduce image distortion and improve the lesion identification in PTAs compared to 1.5T SS-EPI, and to determine whether PTAs can be differentiated from other soft-tissue structures of the head and neck region by using the ADC value.…”

“… 11 , 12 RS-EPI is expected to improve the diagnostic accuracy of detecting PTAs on DWI as it provides less distortion, and its advantages are reported in some organs including the head and neck. 13 – 15 …”