Tri-Compartmental Restriction Spectrum Imaging Breast Model Distinguishes Malignant Lesions from Benign Lesions and Healthy Tissue on Diffusion-Weighted Imaging

Population‐based breast cancer screening using mammography as the gold standard imaging modality has been in clinical practice for over 40 years. However, the limitations of mammography in terms of sensitivity and high false‐positive rates, particularly in high‐risk women, challenge the indiscriminate nature of population‐based screening. Additionally, in light of expanding research on new breast cancer risk factors, there is a growing consensus that breast cancer screening should move toward a risk‐adapted approach. Recent advancements in breast imaging technology, including contrast material‐enhanced mammography (CEM), ultrasound (US) (automated‐breast US, Doppler, elastography US), and especially magnetic resonance imaging (MRI) (abbreviated, ultrafast, and contrast‐agent free), may provide new opportunities for risk‐adapted personalized screening strategies. Moreover, the integration of artificial intelligence and radiomics techniques has the potential to enhance the performance of risk‐adapted screening. This review article summarizes the current evidence and challenges in breast cancer screening and highlights potential future perspectives for various imaging techniques in a risk‐adapted breast cancer screening approach.Evidence Level1.Technical EfficacyStage 5.

Section: Mri Techniquesmentioning

confidence: 99%

New Approaches and Recommendations for Risk‐Adapted Breast Cancer Screening

Tsarouchi

Hoxhaj

Mann

2023

Tri‐Compartmental Restriction Spectrum Imaging Based on ¹⁸F‐FDG PET/MR for Identification of Primary Benign and Malignant Lung Lesions

Liu,

Meng,

Zhou

et al. 2024

BackgroundRestriction spectrum imaging (RSI), as an advanced quantitative diffusion‐weighted magnetic resonance imaging technique, has the potential to distinguish primary benign and malignant lung lesions.ObjectiveTo explore how well the tri‐compartmental RSI performs in distinguishing primary benign from malignant lung lesions compared with diffusion‐weighted imaging (DWI), and to further explore whether positron emission tomography/magnetic resonance imaging (PET/MRI) can improve diagnostic efficacy.Study TypeProspective.Population137 patients, including 108 malignant and 29 benign lesions (85 males, 52 females; average age = 60.0 ± 10.0 years).Field Strength/SequenceT2WI, T1WI, multi‐b value DWI, MR‐based attenuation correction, and PET imaging on a 3.0 T whole‐body PET/MR system.AssessmentThe apparent diffusion coefficient (ADC), RSI‐derived parameters (restricted diffusion , hindered diffusion , and free diffusion ) and the maximum standardized uptake value (SUVmax) were calculated and analyzed for diagnostic efficacy individually or in combination.Statistical TestsStudent's t‐test, Mann–Whitney U test, receiver operating characteristic (ROC) curves, Delong test, Spearman's correlation analysis. P < 0.05 was considered statistically significant.ResultsThe , SUVmax were significantly higher, and , ADC were significantly lower in the malignant group [0.717 ± 0.131, 9.125 (5.753, 13.058), 0.194 ± 0.099, 1.240 (0.972, 1.407)] compared to the benign group [0.504 ± 0.236, 3.390 (1.673, 6.030), 0.398 ± 0.195, 1.485 ± 0.382]. The area under the ROC curve (AUC) values ranked from highest to lowest as follows: AUC (SUVmax) > AUC () > AUC () > AUC (ADC) > AUC () (AUC = 0.819, 0.811, 0.770, 0.745, 0549). The AUC (AUC = 0.900) of the combined model of RSI with PET was significantly higher than that of either single‐modality imaging.ConclusionRSI‐derived parameters (, ) might help to distinguish primary benign and malignant lung lesions and the discriminatory utility of was not observed. The RSI exhibits comparable or potentially enhanced performance compared with DWI, and the combined RSI and PET model might improve diagnostic efficacy.Level of Evidence2.Technical EfficacyStage 2.

Discrimination Between Benign and Malignant Lesions With Restriction Spectrum Imaging MRI in an Enriched Breast Cancer Screening Cohort

Loubrie,

Zou,

Rodriguez‐Soto

et al. 2024

BackgroundBreast cancer screening with dynamic contrast‐enhanced MRI (DCE‐MRI) is recommended for high‐risk women but has limitations, including variable specificity and difficulty in distinguishing cancerous (CL) and high‐risk benign lesions (HRBL) from average‐risk benign lesions (ARBL). Complementary non‐invasive imaging techniques would be useful to improve specificity.PurposeTo evaluate the performance of a previously‐developed breast‐specific diffusion‐weighted MRI (DW‐MRI) model (BS‐RSI3C) to improve discrimination between CL, HRBL, and ARBL in an enriched screening population.Study TypeProspective.SubjectsExactly 187 women, either with mammography screening recommending additional imaging (N = 49) or high‐risk individuals undergoing routine breast MRI (N = 138), before the biopsy.Field Strength/SequenceMultishell DW‐MRI echo planar imaging sequence with a reduced field of view at 3.0 T.AssessmentA total of 72 women had at least one biopsied lesion, with 89 lesions categorized into ARBL, HRBL, CL, and combined CLs and HRBLs (CHRLs). DW‐MRI data were processed to produce apparent diffusion coefficient (ADC) maps, and estimate signal contributions (C1, C2, and C3—restricted, hindered, and free diffusion, respectively) from the BS‐RSI3C model. Lesion regions of interest (ROIs) were delineated on DW images based on suspicious DCE‐MRI findings by two radiologists; control ROIs were drawn in the contralateral breast.Statistical TestsOne‐way ANOVA and two‐sided t‐tests were used to assess differences in signal contributions and ADC values among groups. P‐values were adjusted using the Bonferroni method for multiple testing, P = 0.05 was used for the significance level. Receiver operating characteristics (ROC) curves and intra‐class correlations (ICC) were also evaluated.ResultsC1, √C1C2, and were significantly different in HRBLs compared with ARBLs (P‐values < 0.05). The had the highest AUC (0.821) in differentiating CHRLs from ARBLs, performing better than ADC (0.696), especially in non‐mass enhancement (0.776 vs. 0.517).Data ConclusionThis study demonstrated the BS‐RSI3C could differentiate HRBLs from ARBLs in a screening population, and separate CHRLs from ARBLs better than ADC.Level of Evidence1.Technical Efficacy Stage2.