DIFFUSION-WEIGHTED IMAGING IN MR MAMMOGRAPHY AS AN ALTERNATIVE TO BIOPSY IN THE EVALUATION OF INTERMEDIATE NON-MASS BREAST LESIONS

Background: Dynamic contrast-enhanced MRI is a sensitive tool for the diagnosis of breast cancer, however, its value is limited in cases of non-mass enhancement. Diffusion-weighted imaging (DWI) is promising in the diagnosis of non-mass breast lesions. Purpose: The aim of this study is to determine the value of diffusion-weighted imaging in the evaluation of intermediate non-mass breast lesions, as an alternative to biopsy. Materials and Methods: Thirty-three female patients between the ages of 38-56 years (mean age, 45 years) with non-mass lesions on MR mammography were included in this study. The lowest ADC values were obtained for the non-mass breast lesions. MR-guided core-needle biopsies were performed for 20 patients, while the other patients who refused biopsy, had yearly mammography and ultrasound every six months for two years. They also had at least one follow up MR mammography within the two years’ interval. Results: This study included 33 non-mass breast lesions detected on MR mammography. The lesion siz¬es ranged from 0.2 to 1.4 cm. The morphological characteristics of the lesions and their signal intensity curves on dynamic MR Mammography were recorded. For differentiation of benign and malignant lesions, a threshold ADC value of 1.03×10–3 mm2/s was used. The ADC values for all the lesions ranged from 1.3 x 10–3 mm2/s to 2.6 x 10–3 mm2/s. Conclusion: Diffusion-weighted imaging is effective in the evaluation of intermediate non-mass breast lesions on MR mammography and can be used as an alternative to biopsy.

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

Tumori Journal ◽

10.1177/0300891620914144 ◽

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.

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Diffusion-weighted imaging of suspicious (BI-RADS 4) breast lesions: stratification based on histopathology

Radiologia Brasileira ◽

10.1590/0100-3984.2015.0224 ◽

2017 ◽

Vol 50 (3) ◽

pp. 154-161 ◽

Cited By ~ 6

Author(s):

João Ricardo Maltez de Almeida ◽

André Boechat Gomes ◽

Thomas Pitangueira Barros ◽

Paulo Eduardo Fahel ◽

Mario de Souza Rocha

Keyword(s):

High Risk ◽

Coefficient Of Variation ◽

Diffusion Weighted Imaging ◽

Roc Curves ◽

Sampling Period ◽

Breast Lesions ◽

Real Difference ◽

Diffusion Weighted ◽

Adc Values ◽

Mass Lesions

Abstract Objective: To test the use of diffusion-weighted imaging (DWI) in stratifying suspicious breast lesions (BI-RADS 4), correlating them with histopathology. We also investigated the performance of DWI related to the main enhancement patterns (mass and non-mass) and tested its reproducibility. Materials and Methods: Seventy-six patients presented 92 lesions during the sampling period. Two independent examiners reviewed magnetic resonance imaging studies, described the lesions, and determined the apparent diffusion coefficient (ADC) values. Differences among benign, indeterminate- to high-risk, and malignant findings, in terms of the ADCs, were assessed by analysis of variance. Using receiver operating characteristic (ROC) curves, we compared the performance of ADC values in masses and non-mass lesions, and tested the reproducibility of measurements by determining the coefficient of variation and smallest real difference. Results: Among the 92 lesions evaluated, the histopathology showed that 37 were benign, 11 were indeterminate- to high-risk, and 44 were malignant. The mean ADC differed significantly among those histopathological groups, the value obtained for the malignant lesions (1.10 × 10-3 mm2/s) being significantly lower than that obtained for the other groups (p < 0.001). ROC curves demonstrated that DWI performed better when applied to masses than when applied to non-mass lesions (area under the curve, 0.88 vs. 0.67). Reproducibility was good (coefficient of variation, 7.03%; and smallest real difference, ± 0.242 × 10-3 mm2/s). Conclusion: DWI can differentiate between malignant and nonmalignant (benign or indeterminate- to high-risk) lesions, showing better performance for masses. Nevertheless, stratification based on histopathological criteria that are more refined has yet to be achieved.

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Utility of diffusion weighted mr in diffrentation between benign and malgnant breast lesions

QJM ◽

10.1093/qjmed/hcaa068.019 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

A E E Rady ◽

H M Sakr ◽

Y I Abdelkhalie ◽

A S M Sadek

Keyword(s):

Diffusion Weighted Imaging ◽

Breast Lesions ◽

Adc Value ◽

Breast Masses ◽

Conventional Mri ◽

Diffusion Weighted ◽

Apparent Diffusion ◽

Malignant Breast ◽

Adc Values ◽

Value Measurement

Abstract Purpose of this Study is To evaluate the role of DWI MRI in the differentiation between benign and malignant breast lesions. Methods The study included 40 patients all of them were females with positive breast lesion detected by ultrasound or mammography (between 25 and 66 years of age) referred from surgery and oncology departments. Each patient included in the study was subjected to full history taking, mammography, ultrasonography and conventional MRI sequences and Diffusion Weighted imaging and ADC value measurement. Technique was performed using a standard 1.5 Tesla unit (Acheiva, Philips). Results The study showed significant results were obtained between ADC values of benign and malignant lesions (p < 0.001). Conclusion According to the results of this study we concluded that the addition of DW-MRI and ADC value measurements to the conventional MRI of the breast increased the accuracy of diagnosis and characterization of different breast masses. Also, the use of DW-MRI with ADC value measurements was found to be a valuable quantitative analysis. Keywords Breast masses– MRI – Diffusion weighted imaging Apparent diffusion coefficient.

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Quantitative Evaluation for Differential Diagnosis of Breast Lesions in Diffusion-Weighted MR Imaging

Health and Technology ◽

10.1007/s12553-021-00604-z ◽

2021 ◽

Author(s):

Winniecia Dkhar ◽

Rajagopal Kadavigere ◽

Samir Paruthikunnan Mustaffa

Keyword(s):

Differential Diagnosis ◽

Mr Imaging ◽

B Value ◽

Breast Lesions ◽

Benign Lesions ◽

Adc Value ◽

B Values ◽

Diffusion Weighted ◽

Adc Values ◽

Malignant Lesions

AbstractDiffusion-weighted MR Imaging is a rapidly emerging technique, that allows in-vivo mapping processes of the water diffusion in tissues. It has the potential capabilities for clinical application in breast imaging. The aim of this study was to find out the optimal b-value for calculation of ADC value for differential diagnosis of breast lesions. A total of 124 subjects (mean age 46 years) with 141 lesions were included. The protocol consists of axial T2 sequence for lesion localization and measurement and DW sequence with three sets of b-values of 0, 300, 600, and 1000 s/mm2. The mean ADC values of the breast lesions for b-values (0, 300, 600, and 1000) were 1.75 ± 0.18 × 10−3mm2/sec, 1.66 ± 0.12 × 10−3mm2/sec and 1.57 ± 0.15 × 10−3mm2/sec for the benign lesions and 1.26 ± 0.048 × 10−3mm2/sec, 1.14 ± 0.11 × 10−3mm2/sec and 0.93 ± 0.14 × 10−3mm2/sec for malignant lesions respectively. Statistical significant differences were noted on the ADC value of benign and malignant lesions among the three sets of b values (p = 0.001). ADC values of malignant lesion was significantly lower compared to benign lesions. The AUC (0.998) was substantially large for b-value of 0,600 s/mm2 with a threshold ADC cut off value of 1.28 × 10−3mm2/sec with 98.4% sensitivity, 93.2% specificity and 98.5% positive predictive value(PPV). In conclusion, diffusion weighted imaging has the ability for differential diagnosis of breast lesions with the optimal b value of 0,600 s/ mm2. DWI is a reliable tool for characterising breast lesions and may increase the overall specificity of breast MRI.

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Addition of Diffusion-Weighted Imaging to Dynamic Contrast Enhanced MRI: can it help differentiate benign from malignant jaw lesions?

10.21203/rs.2.21207/v1 ◽

2020 ◽

Author(s):

Xue Zhao

Keyword(s):

Diffusion Weighted Imaging ◽

Adc Value ◽

Dce Mri ◽

Dynamic Contrast Enhanced Mri ◽

Dynamic Contrast Enhanced ◽

Enhanced Mri ◽

Diffusion Weighted ◽

Contrast Enhanced ◽

Adc Values ◽

Contrast Enhanced Mri

Abstract Objective: To explore the diagnosis value of adding diffusion-weighted imaging (DWI) to dynamic contrast enhanced MRI (DCE-MRI) in distinguishing benign from malignant jaw lesions.Materials and Methods: This retrospective study was involved 53 patients (23 benign, 30 malignant) with jaw lesions confirmed by pathology were analyzed. DWI and DCE-MRI were performed in all patients. The Apparent Diffusion Coefficient (ADC) value as well as the DCE-MRI parameters [time to peak (Tpeak), wash in rate (WIR), wash out rate (WOR), relative enhancement, and maximum enhancement] were measured for each patient. The optimal cut-off value of ADC values and DCE-MRI parameters were determined by using a receiver operating characteristics (ROCs), and the area under ROC curve (AUC) was evaluated. P < 0.05 was considered to indicate a significant difference. Results: Among the five parameters of DCE-MRI, the WOR displayed the most significantly difference with a threshold value of 4.90 l/s between benign and malignant group (P<0.05). When only WOR was used as the basis for diagnosis, the sensitivity, specificity, and AUC were 77.20%, 78.00%, and 0.800, respectively (Fig.3, 4). However, sensitivity (77.20% vs 83.30%), specificity (78.00% vs 87.20%) and accuracy (0.80 vs 0.85) significantly improved with the addition of ADC values in the evaluation of jaw lesions, which manifested better than that by using WOR alone.Conclusion: The high WOR of DCE-MRI may have a malignant tendency, but in the evaluation of jaw disease, the addition of ADC value can improve the diagnostic value.

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Breast Lesion Characterisation with Diffusion Weighted Imaging Versus Dynamic Contrast Enhanced-MRI: A Prospective Observational Study in a Tertiary Care Hospital

EMJ Radiology ◽

10.33590/emjradiol/21-00053 ◽

2021 ◽

pp. 75-82

Author(s):

Amandeep Singh ◽

Jasmin Purewal ◽

Kamlesh Gupta ◽

Gauravdeep Singh

Keyword(s):

Predictive Value ◽

Diffusion Weighted Imaging ◽

Histopathological Diagnosis ◽

Breast Lesions ◽

Dce Mri ◽

Dynamic Contrast Enhanced ◽

Diffusion Weighted ◽

Contrast Enhanced ◽

Malignant Lesions ◽

Lesion Characterisation

Purpose: Dynamic contrast-enhanced (DCE)-MRI has a promising role in breast cancer detection and lesion characterisation. Diffusion-weighted imaging (DWI) acts as an adjunct in the differentiation between benign and malignant lesions. The purpose of the study was to evaluate the efficacy of DCE-MRI and DWI in differentiating benign and malignant lesions. Methods: In a prospective study conducted between March 2019 and February 2020, 60 patients with breast lesions underwent DWI combined with DCE-MRI of the breast. The time–intensity curves were plotted. Lesions were classified according to the latest American College of Radiology Breast Imaging Reporting and Data System (ACR BI-RADS; 5th edition). The results were compared with the histopathological diagnosis. The sensitivity and specificity of DWI, DCE-MRI, and combined DWI and DCE-MRI were calculated for detection of benign and malignant breast lesions. Results: Sixty patients underwent breast MRI in which 78 lesions were detected, out of which 28 were benign and 50 were malignant. Quantitative apparent diffusion coefficient measurement revealed 96% sensitivity and 82% specificity, with a positive predictive value of 92% and negative predictive value of 96%, for differentiating benign from malignant lesions. DCE-MRI findings showed 96% sensitivity and 78.5% specificity. The sensitivity of combined DWI and DCE-MRI was 98% and specificity was 86%, which was higher than DWI and DCE-MRI alone. Conclusion: Multiparametric MRI of the breast has very high sensitivity for detecting and characterising breast lesions as benign or malignant lesions. DWI had higher specificity than DCE-MRI, and the combined use of DWI and DCE-MRI had greater efficacy than DWI and DCE-MRI alone.

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Role of Quantitative Diffusion-Weighted Imaging in Differentiating Benign and Malignant Orbital Masses

Indian Journal of Radiology and Imaging ◽

10.1055/s-0041-1730120 ◽

2021 ◽

Author(s):

Preeti Mundhada ◽

Sudarshan Rawat ◽

Ullas Acharya ◽

Dhananjay Raje

Keyword(s):

Roc Curve ◽

Diffusion Weighted Imaging ◽

Care Hospital ◽

Adc Value ◽

Diffusion Weighted ◽

Significant Difference ◽

Orbital Masses ◽

Adc Values ◽

Orbital Lesions

Abstract Aim To determine the role of diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) values in differentiating benign and malignant orbital masses. Materials and Methods After obtaining institutional ethical board approval and informed consent from all patients, an observational study was done for a period of 24 months in the radiology department of a tertiary care hospital in South India. Conventional magnetic resonance imaging and DWI using a 3T scanner was done for all patients with suspected orbital mass lesion. ADC value and clinicohistopathological correlation were studied for every patient. Chi-square test was used to compare the signal characteristics of DWI and ADC maps between benign and malignant lesions. A comparison of mean ADC values for benign and malignant masses was performed using Student’s t-test for independent samples. The cut-off value for ADC was obtained using the receiver operating characteristic (ROC) curve. Results Of 44 patients with orbital lesions, 70% were benign and 30% were malignant. There was a significant difference in the mean ADC values of benign and malignant orbital masses. Using ROC curve analysis, an optimal ADC threshold of 1.26 × 10−3 mm2/s was calculated for the prediction of malignancy with 100% sensitivity, 80.65% specificity, and 86.36% accuracy (95% confidence interval: 0.872, 1.00, p < 0.0001). Two ADC thresholds were used to characterize the orbital masses with more than 90% confidence. Conclusion Quantitative assessment of ADC is a useful noninvasive diagnostic tool for differentiating benign and malignant orbital masses. Malignant orbital lesions demonstrate significantly lower ADC values as compared with benign lesions.

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Predicting axillary response to neoadjuvant chemotherapy: the role of diffusion weighted imaging

British Journal of Radiology ◽

10.1259/bjr.20210511 ◽

2021 ◽

Author(s):

Lucia Graña-López ◽

Tania Pérez-Ramos ◽

Fiz Andrés Maciñeira ◽

Ángeles Villares ◽

Manuel Vázquez-Caruncho

Keyword(s):

Neoadjuvant Chemotherapy ◽

Diffusion Weighted Imaging ◽

Primary Tumour ◽

Pathologic Complete Response ◽

Tumour Response ◽

Complete Response ◽

Adc Value ◽

Diffusion Weighted ◽

Adc Values ◽

Response To Neoadjuvant Chemotherapy

Objective: The aim of this study is to investigate whether the primary tumour response to neoadjuvant chemotherapy (NAC), based on the increase in the ADC-values (apparent diffusion coefficient) within the breast lesion, could help to predict axillary complete response. Methods: We retrospectively included 74 patients who were treated with NAC followed by surgery at Lucus Augusti Hospital between January 2015 and September 2020. Simple logistic regression was used to evaluate the factors associated with axillary pathological complete response, including the changes in breast tumour ADC-values due to the treatment. Results: Axillary complete response was correlated with negative oestrogen receptor status, Her2 positivity and response of primary tumour. It was achieved in 31% of the patients. In addition, the increase in the tumour ADC-values with NAC was higher for responders. Among the tumours that demonstrated an increase in ADC-value >0.92 ×10−3 mm2/s, 42.8% (15/35) showed axillary complete response. Eight (20.5%) breast cancers with an increase in ADC below the cut-off value were found to have no metastatic nodes after treatment (p = 0.038). Conclusion: Our results suggest that the performance of models predicting axillary response to NAC can be improved by adding the tumour response determined also using diffusion-weighted imaging. Advances in knowledge: For the fist time, we investigate the relation between tumour response to NAC, assessed using diffusion-weighted imaging, and axillary pathologic complete response.

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Incorporating diffusion-weighted imaging in a diagnostic algorithm for multiparametric MR mammography

Acta Radiologica ◽

10.1177/02841851211041822 ◽

2021 ◽

pp. 028418512110418

Author(s):

Katerina Vassiou ◽

Michael Fanariotis ◽

Ioannis Tsougos ◽

Ioannis Fezoulidis

Keyword(s):

Sensitivity And Specificity ◽

Predictive Value ◽

Region Of Interest ◽

Diagnostic Algorithm ◽

Breast Lesions ◽

Adc Value ◽

Diffusion Weighted ◽

Adc Values ◽

Single Formula ◽

Sensitivity Specificity

Background Apparent diffusion coefficient (ADC) measurements are not incorporated in BI-RADS classification. Purpose To assess the probability of malignancy of breast lesions at magnetic resonance mammography (MRM) at 3 T, by combining ADC measurements with the BI-RADS score, in order to improve the specificity of MRM. Material and Methods A total of 296 biopsy-proven breast lesions were included in this prospective study. MRM was performed at 3 T, using a standard protocol with dynamic sequence (DCE-MRI) and an extra echo-planar diffusion-weighted sequence. A freehand region of interest was drawn inside the lesion, and ADC values were calculated. Each lesion was categorized according to the BI-RADS classification. Logistic regression analysis was employed to predict the probability of malignancy of a lesion. The model combined the BI-RADS classification and the ADC value. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were calculated. Results In total, 153 malignant and 143 benign lesions were analyzed; 257 lesions were masses and 39 lesions were non-mass-like enhancements. The sensitivity and specificity of the combined method were 96% and 86%, respectively, in contrast to 95% and 81% with BI-RADS classification alone. Conclusion We propose a method of assessing the probability of malignancy in breast lesions by combining BI-RADS score and ADC values into a single formula, increasing sensitivity and specificity compared to BI-RADS classification alone.

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Clinical suspicion of spondylodiscitis with equivocal MRI findings: does diffusion-weighted imaging prove helpful here?

Acta Radiologica ◽

10.1177/0284185120927905 ◽

2020 ◽

pp. 028418512092790

Author(s):

Jeanette Henkelmann ◽

Kristina Bremicker ◽

Timm Denecke ◽

Karl-Titus Hoffmann ◽

Ralf Henkelmann ◽

...

Keyword(s):

Diffusion Weighted Imaging ◽

Characteristic Curve ◽

Area Under The Curve ◽

Region Of Interest ◽

High Sensitivity ◽

Diagnostic Value ◽

Mri Findings ◽

Adc Value ◽

Diffusion Weighted ◽

Adc Values

Background Despite the high sensitivity of magnetic resonance imaging (MRI), early detection of spondylodiscitis (SpD) remains challenging due to its low specificity. Purpose To assess the diagnostic value of diffusion-weighted imaging (DWI) in suspected cases of SpD with ambiguous early MRI findings in the differentiation of degenerative disorders (DD). Material and Methods In this prospective study, 52 patients suspected of having SpD underwent a whole-spine 3-T MRI scan comprising sagittal DWI. Of 58 conspicuous, T2-weighted, signal increased discs, 39 were successfully evaluated using DWI. Apparent diffusion coefficient (ADC) values and ADC maps were blindly analyzed using the region of interest of the conspicuous disc and a normal adjacent reference disc. Intraindividual ratios (conspicuous disc: reference disc) were calculated. Results All conspicuous discs showed increased absolute ADC values, which did not differ significantly between SpD (n = 22) and DD (n = 17). However, ADC ratio was significantly higher in SpD vs. DD ( P < 0.05). In receiver operating characteristic curve analysis, an ADC ratio threshold of 1.6 resulted in 45% sensitivity and 88% specificity (area under the curve = 0.69) for SpD diagnosis. Conclusion The absolute ADC value does not provide a reliable diagnosis of SpD. Increased diffusivity can be an indication of infection but should always be discussed in the context of existing disc degeneration.

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