Meta-analysis of quantitative diffusion-weighted MR imaging in the differential diagnosis of breast lesions

Chen, Xin; Li, Wenling; Zhang, Yili; Wu, Qian; Guo, Youmin; Bai, Zhi-lan

doi:10.1186/1471-2407-10-693

Cited by 193 publications

(167 citation statements)

References 36 publications

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“…It is well known that the calculated ADC value is clearly affected from the scanning parameters. Therefore, previous studies using different scanning parameters reported different cutoff values for the discrimination of malignant and benign tumors (13,(21)(22)(23). In our practice, we routinely apply DWI as a part of our standard breast MRI protocol and as ADC threshold we use 0.90 ×10 -3 mm 2 /s, which is the cutoff value that was obtained from our previous DWI study (15).…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, diffusion weighted imaging (DWI) is a newly proposed and highly effective MRI technique used for characterization of breast lesions, especially of masses, by measuring the random motion of free water protons in tissues. DWI is easy to evaluate, does not require contrast injection, has short imaging time and shows higher specificity (reported to be 84% in a meta-analysis) than DCE imaging (13).…”

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confidence: 99%

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Can unenhanced breast MRI be used to decrease negative biopsy rates?

Kul

Oguz²,

Eyüboğlu³

et al. 2015

Diagn Interv Radiol

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T he Breast Imaging Reporting and Data Systems (BI-RADS) lexicon (1) of AmericanCollege of Radiology (ACR) provides an efficient and standardized assessment and management of breast lesions. It also stratifies breast cancer risk for a given lesion by classifying them into categories 1 through 5 according to the degree of suspicion.According to this system, solid masses with a circumscribed margin, oval shape (including those with two or three gentle lobulations) and parallel orientation on ultrasonography (US) exam are classified as BI-RADS 3. These types of masses are commonly seen at diagnostic and screening examinations. In this category malignancy is highly unlikely (less than 2%) and a short interval follow-up is recommended (1). However, up to one-third of such masses undergo biopsy mainly because of radiologist, referring clinician, or patient concern about the substantial risk of malignancy (2-4). Many BI-RADS 3 masses are traditionally referred for biopsy if they are palpable, large in size, patient is of advanced age or has a positive family history for breast cancer.The BI-RADS 4 assessment is reserved for findings that do not have the classic appearance of malignancy but are sufficiently suspicious to justify a recommendation for biopsy. This category is largely indeterminate and highly variable in outcome. Breast lesions in this category carry 2% to 95% risk for malignancy (1). Thus, almost all recommendations for breast biopsies come from assessments made using this category. According to BI-RADS classification; category 4 is subgrouped as 4A, 4B, and 4C to better inform the clinicians, pathologists, and patients of the degree of concern. However, the criteria for distinguishing among these subcategories have not been well delineated. BI-RADS 4A designates lesions with a low suspicion for malignancy. In this group, a benign pathologic diagnosis is expected and considered concordant (1). Studies of several institutions by the use of their internal criteria revealed positive predictive value (PPV) of 7%-9% for 4A lesions, and more than 50% of the suspicious lesions fall into this category. On the other hand, BI-RADS 4B and 4C 287From the Department of Radiology (S.K.  sibel_ozy@ yahoo.com) Karadeniz Technical University, School of Medicine, Trabzon, Turkey. BREAST IMAGING ORIGINAL ARTICLE PURPOSE We aimed to determine whether low-risk breast masses can be effectively managed with unenhanced magnetic resonance imaging (MRI) combining T2-weighted sequences with diffusion-weighted imaging (DWI) instead of immediate biopsy to decrease negative biopsy rates. METHODSAfter institutional review board and patient approvals, 141 consecutive women with 156 low-risk breast masses, who underwent unenhanced MRI and later on received a final diagnosis, were included in the study. There were 72 BI-RADS 3 masses in women with relative risk factors and 84 BI-RADS 4A masses, all referred for biopsy. Apparent diffusion coefficient (ADC) cutoff was 0.90×10-3 mm2/s. According to ADC values and T2-weighted imaging charact...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Can unenhanced breast MRI be used to decrease negative biopsy rates?

Kul

Oguz²,

Eyüboğlu³

et al. 2015

Diagn Interv Radiol

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“…DCE-MRI of the breast provides high-resolution anatomic information and enables the depiction of increased microvascular density and capillary leaks in malignant breast tumors as a marker of neoangiogenesis (29). DWI depicts cellular diffusivity, which is typically restricted in malignant tissue (7,20). 3D 1 H-MRSI detects elevated levels of the metabolite choline as a marker of an increased cell membrane turnover (6).…”

Section: Discussionmentioning

confidence: 99%

“…MP MRI provides morphologic and functional information that results in a high sensitivity and improved specificity (5)(6)(7)(8). 18 Fluorodeoxyglucose ( 18 FDG)-PET provides functional data on tumor metabolism and has been found to be of complementary value (9,10).…”

Section: Introductionmentioning

confidence: 99%

Improved Differentiation of Benign and Malignant Breast Tumors with Multiparametric 18Fluorodeoxyglucose Positron Emission Tomography Magnetic Resonance Imaging: A Feasibility Study

Pinker

Bogner

Baltzer

et al. 2014

Clinical Cancer Research

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“…A meta-analysis of thirteen studies evaluating the diagnostic performance of ADC in quantitative breast DWI from 964 lesions (615 malignant and 349 benign) demonstrates that pooled mean ADC from malignant lesions is significantly lower than that of benign lesions that may range from 0.87 to 1.61×10 (27). In the current study, ADC estimations are performed by nonlinear fitting the mono-exponential model to average lesion signal intensity data to ensure high precision in the estimates (use of commonly preferred linear fitting complemented with log transformation in ADC estimations is reported to lower the precision (28)).…”

Section: Discussionmentioning

confidence: 99%

Dual-Phase ADC Modelling of Breast Masses in Diffusion-Weighted Imaging: Comparison with Histopathologic Findings

Ertaş

Onaygil

Bugdayci

et al. 2018

Eur J Breast Health

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IntroductionDiffusion-weighted imaging (DWI) utilizes diffusion signal attenuated due to the random microscopic motion of water molecules influenced by cell density, membrane integrity, tissue microstructure, perfusion and diffusion heterogeneity within the tissue (1). When compared with benign lesions and healthy tissue, more restricted water mobility of malignant lesions engenders slower attenuation of the diffusion signal captured from a set of images acquired with different degrees of diffusion weighting (reported as b-value) (2).Quantitative diagnosis of cancer from DWI relies on metrics computed as the parameters of a "signal attenuation" model fitted to the diffusion signal data. The need for reliable and precise metrics motivates new studies on development of advanced models for better fittings to the diffusion signal data or advanced methods for optimized estimation of diffusion metrics (3). There exist several advanced exponential signal attenuation models such as stretched exponential (4), bi-exponential (known as intravoxel incoherent motion) (5), statistical (6) and kurtosis (7) capable of describing complex diffusion processes of the breast tissue. However, the parameters derived from these models are difficult to estimate and quite complex for use in diagnosis. For instance, physiological basis of the heterogeneity index of the stretched exponential model is reported to be uncertain and likewise pseudo-diffusion coefficient of the biexponential model is thought to be unreliable (8). On the other hand, these models involve several parameters that complicate both the diffusion estimation process and the diffusion weighted imaging protocol. To get accurate diffusion estimates, the initial value and the limits for any model parameter should be determined very carefully and an appropriate optimization method should be employed (9). To reach consistent numerical solutions, the number of b-values of the diffusion weighted imaging protocol must set to be more than the number of parameters in the model and Eur J Breast Health 2018; 14: 85-92 DOI: 10.5152/ejbh.2018.3829 85 ABSTRACT Objective: To investigate the diagnostic value of dual-phase apparent diffusion coefficient (ADC) compared to traditional ADC values in quantitative diffusion-weighted imaging (DWI) for differentiating between benign and malignant breast masses. Materials and Methods:Diffusion-weighted images of pathologically confirmed 88 benign and 85 malignant lesions acquired using a 3.0T MR scanner were analyzed. Small region-of-interests focusing on the highest signal intensity of lesions were used. Lesion ADC estimates were obtained separately from all b-value images (ADC; b=50, 400 and 800s/mm 2 ), lower b-value images (ADC low ; b=50 and 400s/mm 2 ) and higher b-value images (ADC high ; b=400 and 800s/mm 2 ). A set of dual-phase ADC (dpADC) models were constructed using ADC low , ADC high and a perfusion influence factor ranging from 0 to 1. Results:Strong positive correlation is observable between ADC and all dpADCs (ρ=0.80-1.00). ...

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Meta-analysis of quantitative diffusion-weighted MR imaging in the differential diagnosis of breast lesions

Cited by 193 publications

References 36 publications

Can unenhanced breast MRI be used to decrease negative biopsy rates?

Can unenhanced breast MRI be used to decrease negative biopsy rates?

Improved Differentiation of Benign and Malignant Breast Tumors with Multiparametric 18Fluorodeoxyglucose Positron Emission Tomography Magnetic Resonance Imaging: A Feasibility Study

Dual-Phase ADC Modelling of Breast Masses in Diffusion-Weighted Imaging: Comparison with Histopathologic Findings

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