scholarly journals Limited role of DWI with apparent diffusion coefficient mapping in breast lesions presenting as non-mass enhancement on dynamic contrast-enhanced MRI

2019 ◽  
Vol 21 (1) ◽  
Author(s):  
Daly Avendano ◽  
Maria Adele Marino ◽  
Doris Leithner ◽  
Sunitha Thakur ◽  
Blanca Bernard-Davila ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Roc Curves ◽  
Breast Cancer Diagnosis ◽  
Breast Lesions ◽  
Mri Findings ◽  
Adc Value ◽  
Dce Mri ◽  
Dynamic Contrast Enhanced ◽  
Contrast Enhanced ◽  
Mass Enhancement

Abstract Background Available data proving the value of DWI for breast cancer diagnosis is mainly for enhancing masses; DWI may be less sensitive and specific in non-mass enhancement (NME) lesions. The objective of this study was to assess the diagnostic accuracy of DWI using different ROI measurement approaches and ADC metrics in breast lesions presenting as NME lesions on dynamic contrast-enhanced (DCE) MRI. Methods In this retrospective study, 95 patients who underwent multiparametric MRI with DCE and DWI from September 2007 to July 2013 and who were diagnosed with a suspicious NME (BI-RADS 4/5) were included. Twenty-nine patients were excluded for lesion non-visibility on DWI (n = 24: 12 benign and 12 malignant) and poor DWI quality (n = 5: 1 benign and 4 malignant). Two readers independently assessed DWI and DCE-MRI findings in two separate randomized readings using different ADC metrics and ROI approaches. NME lesions were classified as either benign (> 1.3 × 10−3 mm2/s) or malignant (≤ 1.3 × 10−3 mm2/s). Histopathology was the standard of reference. ROC curves were plotted, and AUCs were determined. Concordance correlation coefficient (CCC) was measured. Results There were 39 malignant (59%) and 27 benign (41%) lesions in 66 (65 women, 1 man) patients (mean age, 51.8 years). The mean ADC value of the darkest part of the tumor (Dptu) achieved the highest diagnostic accuracy, with AUCs of up to 0.71. Inter-reader agreement was highest with Dptu ADC max (CCC 0.42) and lowest with the point tumor (Ptu) ADC min (CCC = − 0.01). Intra-reader agreement was highest with Wtu ADC mean (CCC = 0.44 for reader 1, 0.41 for reader 2), but this was not associated with the highest diagnostic accuracy. Conclusions Diagnostic accuracy of DWI with ADC mapping is limited in NME lesions. Thirty-one percent of lesions presenting as NME on DCE-MRI could not be evaluated with DWI, and therefore, DCE-MRI remains indispensable. Best results were achieved using Dptu 2D ROI measurement and ADC mean.

scholarly journals Role of Dynamic Contrast Enhanced MRI in the Evaluation and Characterisation of Breast Lesions with Pathological Correlation

2020 ◽  
Author(s):  
Kanta Kumari ◽  
Chaitanya Tapasvi ◽  
Isha Tapasvi ◽  
Vaneet Kaur Sandhu ◽  
Sarbjeet Singh ◽  
...  
Keyword(s):  
Breast Imaging ◽  
Morphological Characteristics ◽  
Breast Lesions ◽  
Pathological Findings ◽  
Mri Findings ◽  
Intravenous Contrast ◽  
Predictive Values ◽  
Dce Mri ◽  
Dynamic Contrast Enhanced ◽  
Contrast Enhanced

Introduction: Magnetic Resonance Imaging (MRI) has an excellent soft tissue resolution and can detect and accurately characterise lesions which are not seen on other imaging modalities like mammography or ultrasonography. Dynamic Contrast Enhanced (DCE) MRI is better for characterisation of fibroglandular tissue and breast lesions as it further improves specificity of MRI. Kinetic Curves (KC) derived from DCE MRI according to the wash in and wash out patterns of intravenous contrast are analysed and correlated with morphology of a lesion. Aim: To evaluate the efficacy of DCE MRI in detection and characterisation of breast lesions according to KC analysis and to correlate MRI findings with pathological findings. Materials and Methods: A prospective observational study was conducted at Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India. DCE MRI was performed after informed consent in 50 females (Age ranging from 17 years to 80 years). MRI was conducted on Siemens “MAGNETOM Avanto” 1.5 Tesla machine using standard dedicated breast matrix coils. The standard MRI protocol included the T1 and T2 weighted fat-sat sequences along with DCE MRI after intravenous administration of Meglumine-Gadoterate (0.1 mmol/kg body weight) followed by a 20-mL saline flush. Post processing manipulation included standard subtraction, reverse subtraction, Maximum-Intensity Projection (MIP) images and KC analysis. Findings of DCE MRI were graded according to Breast Imaging-Reporting and Data System (BI-RADS) category after morphological and KC analysis and were correlated with pathological findings. Results: MRI is a highly sensitive modality to detect breast lesions especially bilateral and multifocal/multicentric lesions with sensitivity of 98.18%. However, specificity was relatively low (55.56%). The Positive and Negative Predictive Values (PPV, NPV) of MRI in characterisation of breast lesions in present study were 93.10% and 83.33%, respectively. Conclusion: Although MRI is extremely sensitive for detecting breast lesions it has a relatively low specificity. Both morphological characteristics and KC analysis should be used in combination for interpretation as it improves the specificity of MRI.

Multiparametric Approach with Dynamic Contrast-Enhanced Mri, Diffusion-Weighted Imaging and Mrs of The Breast in Assessment of Suspicious Breast Lesions

2020 ◽  
Vol 106 (1_suppl) ◽  
pp. 16-16
Author(s):  
SM Abd Elsalam ◽  
AH Said ◽  
MH Sarah
Keyword(s):  
Magnetic Resonance ◽  
Diffusion Weighted Imaging ◽  
Kinetic Curve ◽  
Resonance Spectroscopy ◽  
Breast Lesions ◽  
Adc Value ◽  
Dynamic Contrast Enhanced ◽  
Cancer Breast ◽  
Diffusion Weighted ◽  
Contrast Enhanced

Introduction: Breast cancer is the most invasive malignant tumour in females worldwide and is the second leading cause of cancer death in females after lung cancer. In Egypt, cancer breast is the first common site of tumours among females (32%) and the second common tumour site in both sexes. The aim of this study was to evaluate and compare the diagnostic performance of quantitative parameters derived from diffusion-weighted imaging (DWI), dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and magnetic resonance spectroscopy (MRS) with ultrasound +/- conventional mammography in differentiating suspicious breast masses (BI-RADS III and IV) and to suggest the most accurate imaging combination for early diagnosis and treatment of cancer breast. Materials and Methods: The study included 40 patients with suspicious breast lesions detected by clinical examination, ultrasound+/- mammography . Dynamic MRI study was performed using 1.5T MRI. Lesions were analyzed regarding their morphology, kinetic curve pattern, ADC value and tCho peak measurement. The results of each MRI parameter were correlated to histo-pathology. Results: In this study sensitivity of sono-mammography was 70% and its specificity was 66.6%. According to using MRI sensitivity was 90% and specificity was 80% by using morphological and curve patterns. As regarding MRS sensitivity was 50% and specificity was 86.7%. Regarding sensitivity of ADC was 90%while its specificity was 93%. The cut off ADC value was 0.95 x 10−3 mm2/s. By using MRI with additive modalities (ADC and MRS) sensitivity was 100% and specificity was 93%. Conclusion: In comparison with MRI, sonomammography alone lack both sensitivity and specificity in detection of breast lesions in suspicious cases. MRI with additive modalities (ADC and MRS) is the best imaging modality in detection of malignant cases and exclusion of benign cases.

Role of Various DW MRI and DCE MRI Parameters as Predictors of Malignancy in Solid Pulmonary Lesions

2020 ◽  
pp. 084653712091489
Author(s):  
Neeraj Kumar ◽  
Mini Sharma ◽  
Neeti Aggarwal ◽  
Sanjiv Sharma ◽  
Malay Sarkar ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Diffusion Weighted Imaging ◽  
Breath Hold ◽  
Data Set ◽  
Predictive Values ◽  
Pulmonary Lesions ◽  
Dce Mri ◽  
Dynamic Contrast Enhanced ◽  
Diffusion Weighted ◽  
Contrast Enhanced

Purpose: We aimed to evaluate various diffusion and dynamic contrast-enhanced magnetic resonance imaging (DCE MRI) parameters in differentiating malignant from benign pulmonary lesions. Methods: We enrolled 31 (22 males) patients who had solid pulmonary lesion(s) >2 cm in our cross sectional study. Of these, 23 (74.2%) were found to be malignant on histopathology. Dynamic contrast-enhanced MRI was performed using 36 dynamic measurements (volumetric interpolated breath-hold examination). Diffusion-weighted MRI (DW MRI) performed at b value of 800 s/mm2. We measured different diffusion and perfusion parameters, for example, diffusion-weighted imaging (DWI) SI, mean apparent diffusion coefficient (ADC), minimum ADC, lesion-to-spinal cord ratio, DWI score, T2 score, Ktrans, Kep, and Ve. We stratified values of each parameter as high if it was >median of values observed in our data set and low if it was ≤median. Normally distributed data were compared by unpaired t test, whereas non-normal continuous data were compared by Kruskal Wallis-H test. We applied Wilson score method to calculate sensitivity, specificity, and predictive values of parameters that were statistically significant by type of lesion with reference to histopathological examination as gold standard. Results: Diffusion-weighted imaging SI, mean ADC, minimum ADC, DWI score and Ktrans values were found to be significantly different ( P value < .05) by type of lesion. Ktrans was found to have the highest diagnostic accuracy (74.2%) among these parameters. Conclusion: Ktrans and mean ADC had similar sensitivity of 65.2%. However, Ktrans had highest diagnostic accuracy among various DWI and DCE MRI parameters in predicting malignancy in solid pulmonary lesions. In our study, we found a cutoff value 0.251 min−1 for Ktrans as 100% specific.

scholarly journals Differentiation of breast tuberculosis and breast cancer using diffusion-weighted, T2-weighted and dynamic contrast-enhanced magnetic resonance imaging

2018 ◽  
Vol 22 (2) ◽  
Author(s):  
Dibuseng P. Ramaema ◽  
Richard J. Hift
Keyword(s):  
Breast Cancer ◽  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Resonance Imaging ◽  
Adc Value ◽  
Dce Mri ◽  
Dynamic Contrast Enhanced ◽  
Diffusion Weighted ◽  
Breast Tuberculosis ◽  
Contrast Enhanced

Background: The use of multi-parametric magnetic resonance imaging (MRI) in the evaluation of breast tuberculosis (BTB).Objectives: To evaluate the value of diffusion-weighted imaging (DWI), T2-weighted (T2W) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in differentiating breast cancer (BCA) from BTB.Method: We retrospectively studied images of 17 patients with BCA who had undergone preoperative MRI and 6 patients with pathologically proven BTB who underwent DCE-MRI during January 2014 to January 2015.Results: All patients were female, with the age range of BTB patients being 23–43 years and the BCA patients being 31–74 years. Breast cancer patients had a statistically significant lower mean apparent diffusion coefficient (ADC) value (1072.10 +/- 365.14), compared to the BTB group (1690.77 +/- 624.05, p = 0.006). The mean T2-weighted signal intensity (T2SI) was lower for the BCA group (521.56 +/- 233.73) than the BTB group (787.74 +/- 196.04, p = 0.020). An ADC mean cut-off value of 1558.79 yielded 66% sensitivity and 94% specificity, whilst the T2SI cut-off value of 790.20 yielded 83% sensitivity and 83% specificity for differentiating between BTB and BCA. The homogeneous internal enhancement for focal mass was seen in BCA patients only.Conclusion: Multi-parametric MRI incorporating the DWI, T2W and DCE-MRI may be a useful tool to differentiate BCA from BTB.

scholarly journals Breast dynamic contrast enhanced MRI: fibrocystic changes presenting as a non-mass enhancement mimicking malignancy

2017 ◽  
Vol 51 (2) ◽  
pp. 130-136 ◽  
Author(s):  
Zorica C. Milosevic ◽  
Mirjan M. Nadrljanski ◽  
Zorka M. Milovanovic ◽  
Nina Z. Gusic ◽  
Slavko S. Vucicevic ◽  
...  
Keyword(s):  
Breast Imaging ◽  
Time Intensity Curve ◽  
Dce Mri ◽  
Dynamic Contrast Enhanced ◽  
Mri Examination ◽  
Contrast Enhanced ◽  
Significant Difference ◽  
Plateau Time ◽  
Diffuse Distribution ◽  
Mass Enhancement

Abstract Background We aimed to analyse the morphokinetic features of breast fibrocystic changes (nonproliferative lesions, proliferative lesions without atypia and proliferative lesions with atypia) presenting as a non-mass enhancement (NME)in dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) examination. Patients and methods Forty-six patients with histologically proven fibrocystic changes (FCCs) were retrospectively reviewed, according to Breast Imaging Reporting and Data System (BI-RADS) lexicon. Prior to DCE-MRI examination, a unilateral breast lesion suspicious of malignancy was detected clinically, on mammography or breast ultrasonography. Results The predominant features of FCCs presenting as NME in DCE-MRI examination were: unilateral regional or diffuse distribution (in 35 patients or 76.1%), heterogeneous or clumped internal pattern of enhancement (in 36 patients or 78.3%), plateau time-intensity curve (in 25 patients or 54.3%), moderate or fast wash-in (in 31 patients or 67.4%).Nonproliferative lesions were found in 11 patients (24%), proliferative lesions without atypia in 29 patients (63%) and lesions with atypia in six patients (13%), without statistically significant difference of morphokinetic features, except of the association of clustered microcysts with proliferative dysplasia without atypia. Conclusions FCCs presenting as NME in DCE-MRI examination have several morphokinetic features suspicious of malignancy, therefore requiring biopsy (BI-RADS 4). Nonproliferative lesions, proliferative lesions without atypia and proliferative lesions with atypia predominantly share the same predefined DCE-MRI morphokinetic features.

The value of dynamic contrast-enhanced magnetic resonance imaging combined with apparent diffusion coefficient in the differentiation of benign and malignant diseases of the breast

2021 ◽  
pp. 028418512110240
Author(s):  
Feng Ao ◽  
Yi Yan ◽  
Zi-Li Zhang ◽  
Sheng Li ◽  
Wen-Jing Li ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Lesion Group ◽  
Breast Lesions ◽  
Resonance Imaging ◽  
Dce Mri ◽  
Dynamic Contrast Enhanced ◽  
Contrast Enhanced ◽  
Apparent Diffusion ◽  
Malignant Breast ◽  
Diagnostic Criterion

Background The value of combined dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and apparent diffusion coefficient (ADC) histogram analysis for the diagnosis of breast cancer has not been evaluated in previous studies. Purpose To investigate the diagnostic value of DCE-MRI combined with ADC in benign and malignant breast lesions. Material and Methods The clinicopathological imaging data included 168 patients (177 lesions) with breast lesions who underwent convention breast MRI, DCE-MRI, and diffusion-weighted imaging (DWI); they were divided into the benign lesion group (n = 39) and malignant lesion group (n = 129) based on pathology. Results Using the type III outflow curve as a diagnostic criterion for malignant breast lesions, the diagnostic sensitivity was 76.9%, the specificity was 80%, the correct rate was 72.2%, and its area under the curve (AUC) was 0.823. Using an enhancement ratio > 100% as a diagnostic criterion for malignant breast lesions, the sensitivity was 61.5%, specificity was 80%, and AUC was 0.723. Using > 3 ipsilateral vessels as a diagnostic criterion for malignant lesions in the breast resulted in a diagnostic sensitivity of 81.6%, a specificity of 80.8%, and an AUC of 0.805. Conclusion The type of time intensity curve DCE-MRI, the early enhancement rate in the first phase, the number of ipsilateral vessels, and the ADC full volume histogram of the blood supply score and DWI are valuable in the diagnosis of benign and malignant breast lesions.

scholarly journals Unenhanced breast MRI: could it replace dynamic breast MRI in detecting and characterizing breast lesions?

2020 ◽  
Vol 51 (1) ◽  
Author(s):  
Reham Khalil ◽  
Noha Mohamed Osman ◽  
Nivine Chalabi ◽  
Enas Abdel Ghany
Keyword(s):  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Breast Mri ◽  
Breast Lesions ◽  
Dce Mri ◽  
Contrast Enhanced ◽  
Mri Protocol ◽  
Sensitivity Specificity

Abstract Background We aimed to evaluate the unenhanced MRI of the breast (UE-MRI) as an effective substitute for dynamic contrast-enhanced breast MRI (DCE-MRI) in both detecting and characterizing breast lesions. We enrolled in our retrospective study 125 females (232 breasts, as 18 patients had unilateral mastectomy) with breast mass at MRI of variable pathologies. Routine DCE-MRI protocol of the breast was conducted. We compared the conventional unenhanced images including STIR, T2, and DWIs to the DCE-MRI by two blinded radiologists, to detect and characterize breast lesions, and then we compared their results with the final reference diagnoses supplied by the histopathology or serial negative follow-ups. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy for UE-MRI and DCE-MRI were calculated. UE-MRI results of each observer were also compared with DCE- MRI. Results The calculated UE-MRI sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for the first observer were 95%, 80%, 83%, 94%, and 89% respectively, and for the second observer, they were 94%, 79%, 81%, 93%, and 86%. On the other hand, those for the DCE-MRI by the first observer were 98%, 82%, 84%, 98%, and 90% and were 97%, 81%, 84%, 97%, and 89% by the second observer. The intraobserver agreement between the UE-MRI and DCE-MRI results of each observer was 94% and 95%, while the interobserver agreement for each section was 97.4% for UE-MRI and 98.3% for DCE-MRI. Conclusion UE-MRI of the breast can be a reliable and effective substitute for breast DCE-MRI. It can be used with comparable accuracy to DCE-MRI whenever contrast administration is not feasible or contraindicated.

scholarly journals Kinetic information from dynamic contrast-enhanced MRI enables prediction of residual cancer burden and prognosis in triple-negative breast cancer: a retrospective study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ayane Yamaguchi ◽  
Maya Honda ◽  
Hiroshi Ishiguro ◽  
Masako Kataoka ◽  
Tatsuki R. Kataoka ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Preoperative Chemotherapy ◽  
Triple Negative Breast Cancer ◽  
Signal Intensity ◽  
Triple Negative ◽  
Lesion Size ◽  
Mri Findings ◽  
Dce Mri ◽  
Dynamic Contrast Enhanced ◽  
Contrast Enhanced

AbstractThis study aimed to evaluate the predictions of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for prognosis of triple-negative breast cancer (TNBC), especially with residual disease (RD) after preoperative chemotherapy. This retrospective analysis included 74 TNBC patients who received preoperative chemotherapy. DCE-MRI findings from three timepoints were examined: at diagnosis (MRIpre), at midpoint (MRImid) and after chemotherapy (MRIpost). These findings included cancer lesion size, washout index (WI) as a kinetic parameter using the difference in signal intensity between early and delayed phases, and time-signal intensity curve types. Distant disease-free survival was analysed using the log-rank test to compare RD group with and without a fast-washout curve. The diagnostic performance of DCE-MRI findings, including positive predictive value (PPV) for pathological responses, was also calculated. RD without fast washout curve was a significantly better prognostic factor, both at MRImid and MRIpost (hazard ratio = 0.092, 0.098, p < 0.05). PPV for pathological complete remission at MRImid was 76.7% by the cut-off point at negative WI value or lesion size = 0, and 66.7% at lesion size = 0. WI and curve types derived from DCE-MRI at the midpoint of preoperative chemotherapy can help not only assess tumour response but also predict prognosis.

Sign in / Sign up

Export Citation Format

Share Document