Application of Diffusion Weighted Imaging Techniques for Differentiating Benign and Malignant Breast Lesions

To explore the value of apparent diffusion coefficient (ADC), intravoxel incoherent motion (IVIM), and diffusional kurtosis imaging (DKI) based on diffusion weighted magnetic resonance imaging (DW-MRI) in differentiating benign and malignant breast lesions. A total of 215 patients with breast lesions were prospectively collected for breast MR examination. Single exponential, IVIM, and DKI models were calculated using a series of b values. Parameters including ADC, perfusion fraction (f), tissue diffusion coefficient (D), perfusion-related incoherent microcirculation (D*), average kurtosis (MK), and average diffusivity (MD) were compared between benign and malignant lesions. ROC curves were used to analyze the optimal diagnostic threshold of each parameter, and to evaluate the diagnostic efficacy of single and combined parameters. ADC, D, MK, and MD values were significantly different between benign and malignant breast lesions (P<0.001). Among the single parameters, ADC had the highest diagnostic efficiency (sensitivity 91.45%, specificity 82.54%, accuracy 88.84%, AUC 0.915) and the best diagnostic threshold (0.983 μm2/ms). The combination of ADC and MK offered high diagnostic performance (sensitivity 90.79%, specificity 85.71%, accuracy 89.30%, AUC 0.923), but no statistically significant difference in diagnostic performance as compared with single-parameter ADC (P=0.268). The ADC, D, MK, and MD parameters have high diagnostic value in differentiating benign and malignant breast lesions, and of these individual parameters the ADC has the best diagnostic performance. Therefore, our study revealed that the use of ADC alone should be useful for differentiating between benign and malignant breast lesions, whereas the combination of MK and ADC might improve the diagnostic performance to some extent.

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Does contrast-enhanced ultrasound (CEUS) play a better role in diagnosis of breast lesions with calcification? A comparison with MRI

British Journal of Radiology ◽

10.1259/bjr.20200195 ◽

2020 ◽

Vol 93 (1112) ◽

pp. 20200195

Author(s):

Jiamin Pan ◽

Wenjuan Tong ◽

Jia Luo ◽

Jinyu Liang ◽

Fushun Pan ◽

...

Keyword(s):

Breast Imaging ◽

Breast Lesions ◽

Diagnostic Efficiency ◽

Contrast Enhanced Ultrasound ◽

Roc Curve Analysis ◽

Diagnostic Efficacy ◽

Score System ◽

Contrast Enhanced ◽

Significant Difference

Objective: To compare the efficacy of contrast-enhanced ultrasound enabled reclassification of Breast Imaging Reporting and Data System (CEUS-BI-RADS) with MRI in the diagnosis of breast lesions with calcification. Methods: A total of 52 breast lesions with calcification from 51 patients were detected by ultrasound as hyperechoic foci and categorized as BI-RADS 3–5. The 51 patients further underwent CEUS scan and MRI. The ultrasound-BI-RADS combined with CEUS 5-point score system redefined the classification of BI-RADS which was called CEUS-BI-RADS. The diagnostic efficacy of three methods was assessed by receiver operating characteristic (ROC) curve analysis. Histopathological assessment used as the gold-standard. Results: The sensitivities of Ultrasound-BI-RADS, MRI classification of BI-RADS (MRI-BI-RADS) and CEUS-BI-RADS were 85%, 90% and 95% without significant difference among the three modalities (p > 0.05). The diagnostic specificities of ultrasound-BI-RADS, MRI-BI-RADS and CEUS-BI-RADS were 78.1%, 78.1% and 96.8%, respectively (p < 0.05); and the accuracy were 80.7%, 82.6% and 96.1% for ultrasound-BI-RADS, MRI-BI-RADS and CEUS-BI-RADS, respectively (p < 0.05). The area under ROC (AUROC) in differentiation of breast lesions with calcification was 0.945 for CEUS-BI-RADS, 0.907 for MRI-BI-RADS and 0.853 for ultrasound-BI-RADS, with no significant difference among the three modalities (p > 0.05). Conclusion: The CEUS-BI-RADS has a better diagnostic efficiency than MRI-BI-RADS in the differentiation of the breast lesions with calcification. Advances in knowledge: •CEUS is a better method in differentiation of breast lesions with calcification. •CEUS-BI-RADS increases the efficiency of diagnosis compared to MRI.

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Effects of contrast-enhancement on diffusion weighted imaging and apparent diffusion coefficient measurements in 3-T magnetic resonance imaging of breast lesions

Acta Radiologica ◽

10.1177/0284185117740759 ◽

2017 ◽

Vol 59 (8) ◽

pp. 902-908

Author(s):

Valentina Cipolla ◽

Daniele Guerrieri ◽

Giacomo Bonito ◽

Simone Celsa ◽

Carlo de Felice

Keyword(s):

Diffusion Coefficient ◽

Apparent Diffusion Coefficient ◽

Diffusion Weighted Imaging ◽

Breast Lesions ◽

Post Contrast ◽

Diffusion Weighted ◽

Signed Rank ◽

Apparent Diffusion ◽

Malignant Breast ◽

Adc Values

Background The effect of gadolinium-based contrast agents on diffusion-weighted imaging (DWI) measurements of breast lesions is still not clear. Purpose To investigate gadolinium effects on DWI and apparent diffusion coefficient (ADC) in breast lesions and normal parenchyma with 3 Tesla contrast-enhanced MRI. Material and Methods Pre- and post-contrast DWI (b = 0 and b = 1000 s/mm2) were acquired in 47 patients. Measured ADC values, pre- and post-contrast T2 signal intensity (T2 SI) and contrast-to-noise ratio (CNR) were compared with Wilcoxon signed-rank and rank-sum test ( P < 0.05). Results Post-contrast ADC was reduced only in malignant lesions (−34%), T2 SI was reduced both in malignant (−50%) and benign (−36%) lesions. Post-contrast CNR was reduced in all groups except for benign lesions. Conclusion Gadolinium-based contrast agent causes a significant reduction in ADC values of malignant breast lesions.

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Diagnostic value of various vascular features of breast cancer by age

Clinical Hemorheology and Microcirculation ◽

10.3233/ch-211258 ◽

2021 ◽

pp. 1-9

Author(s):

Jia Lin ◽

Wenqiang Lin ◽

Liang Xu ◽

Teng Lin

Keyword(s):

Breast Cancer ◽

Breast Imaging ◽

Critical Role ◽

Added Value ◽

Breast Lesions ◽

Diagnostic Efficiency ◽

Complex Flow ◽

Diagnostic Efficacy ◽

Breast Masses ◽

Malignant Breast

BACKGROUND: Tumor angiogenesis plays a critical role in the growth and metastasis of breast cancer and evaluating the added value of vascular features to Breast Imaging Reporting and Data System (BI-RADS) in differentiating malignant nodules from benign ones is essential. Micro-flow Imaging (MFI) is a promising noninvasive diagnostic method for the microvessels in breast tumors, but its precise value is still uncertain. OBJECTIVES: Understanding whether malignant tumor vascular characteristics by MFI are associated with breast cancer and whether the diagnostic efficiency varies by age. MATERIALS AND METHODS: We used B-mode Ultrasound and MFI to detect the characteristics of 153 solid breast lesions. Two investigators reviewed the vessels images by MFI and assessed the vascular features, respectively. Evaluating diagnostic efficacy of different vascular features combined with BI-RADS in different age groups. RESULTS: The mean size of lesions is 19.4 (range 18–78) mm. There were 94 breast masses in benign, while 59 breast masses in malignant by pathology. III Adler classification, penetrating vessels, and complex flow pattern showed a positive association with a high risk of malignant breast lesions (p < 0.05). BI-RADS combined with vessel characteristics show better improvement of diagnostic performance of breast lesions in the elderly group than in the young group. CONCLUSIONS: Vascular features by MFI contribute to malignant breast masses’ diagnosis, and the association might be modified by age.

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Role of diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) in differentiating between benign and malignant breast lesions

The Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1016/j.ejrnm.2013.09.009 ◽

2013 ◽

Vol 44 (4) ◽

pp. 945-951 ◽

Cited By ~ 8

Author(s):

Wael Abdulghaffar ◽

Magdy M. Tag-Aldeen

Keyword(s):

Diffusion Coefficient ◽

Apparent Diffusion Coefficient ◽

Diffusion Weighted Imaging ◽

Breast Lesions ◽

Diffusion Weighted ◽

Apparent Diffusion ◽

Malignant Breast

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Diffusion-weighted MRI combined with susceptibility-weighted MRI: added diagnostic value for four common lateral ventricular tumors

Acta Radiologica ◽

10.1177/0284185117738562 ◽

2017 ◽

Vol 59 (8) ◽

pp. 980-987 ◽

Cited By ~ 2

Author(s):

Yuanlin Yu ◽

Hua Zhang ◽

Zebin Xiao ◽

Dejun She ◽

Zhen Xing ◽

...

Keyword(s):

Diffusion Coefficient ◽

Apparent Diffusion Coefficient ◽

Diagnostic Performance ◽

The Other ◽

High Grade ◽

Diffusion Weighted ◽

Significant Difference ◽

Apparent Diffusion ◽

Ventricular Tumors ◽

High Grade Gliomas

Background Diffusion-weighted imaging (DWI) and susceptibility-weighted imaging (SWI) are reliable imaging modalities for brain tumors. However, the role of DWI and SWI in the diagnosis of common lateral ventricular tumors has not been systematically evaluated. Purpose To evaluate the diagnostic performance of DWI and SWI in common lateral ventricular tumors. Material and Methods Fifty-two patients with histopathologically confirmed lateral ventricular tumors were included in this study (18 with central neurocytomas, nine with ependymomas, seven with high-grade gliomas, and 18 with meningiomas). The relative minimum apparent diffusion coefficient (rADCmin) and relative average apparent diffusion coefficient (rADCave) measured by DWI and the intratumoral susceptibility signal intensity (ITSS) of hemorrhage acquired by SWI were calculated. These quantitative parameters were evaluated using the Mann–Whitney U test, receiver operating characteristic curve, and logistic regression analyses. Results The rADCmin and rADCave ratios of central neurocytomas were significantly lower than those of the other neoplasms. The rADCmin and rADCave ratios of ependymomas and the rADCave ratio of high-grade gliomas were significantly higher than those of meningiomas. The ITSS score of meningiomas was significantly lower than those of the other tumors, while the score of central neurocytomas was obviously lower than those of ependymomas and high-grade gliomas. The combination of the rADC ratio with the ITSS showed no significant difference, except in discriminating between meningiomas and high-grade glioma-ependymomas. Conclusion The rADC ratios and ITSS may be useful for differentiating common lateral ventricular tumors. The diagnostic performance may be improved with the use of the rADC ratios and ITSS scores.

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Whole-tumor histogram analysis of apparent diffusion coefficient maps in grading diagnosis of ependymoma

Chinese Journal of Academic Radiology ◽

10.1007/s42058-019-00019-w ◽

2020 ◽

Vol 2 (3-4) ◽

pp. 41-46

Author(s):

Huiyu Huang ◽

Yong Zhang ◽

Jingliang Cheng ◽

Mengmeng Wen

Keyword(s):

Diffusion Coefficient ◽

Apparent Diffusion Coefficient ◽

Sensitivity And Specificity ◽

Histogram Analysis ◽

Diagnostic Efficiency ◽

Diagnostic Efficacy ◽

Who Grade ◽

Significant Difference ◽

Apparent Diffusion ◽

Apparent Diffusion Coefficient Maps

Abstract Objective To study the value of whole-tumor histogram analysis which is based on apparent diffusion coefficient maps in grading diagnosis of ependymoma. Methods 71 patients with ependymal tumors were retrospectively analyzed, including 13 cases of WHO grade I, 28 cases of WHO grade II, and 30 cases of WHO grade III. Mazda software was used to draw the region of interest (ROI) in the apparent diffusion coefficient maps of three groups on every layer of tumor level. The whole-tumor gray histogram analysis was carried to obtained nine characteristic parameters, including mean, variance, kurtosis, skewness, Perc.01%, Perc.10%, Perc.50%, Perc.90%, and Perc.99%. When the parameters satisfy the test of normal distribution and homogeneity of variance, single factor analysis of variance (ANOVA) was carried to compare the three groups and LSD t test was performed to compare the two groups. Besides, the ROC curve was used to analyze the diagnostic efficacy of the parameters. Results Variance, Perc.01%, and Perc.10% had significant differences among the three groups (all P < 0.05). The remaining six parameters had no significant difference among the three groups (all P > 0.05). And, between WHO I and WHO II, the sensitivity and specificity of the Perc.10% were 85.7% and 100.0%, the AUC was 0.872, and the cut-off was 126.5. Between WHO I and WHO III, the sensitivity and specificity of the Perc.10% were 85.7% and 87.7%, the AUC was 0.835, and the optimum critical value was 131.33. Besides, the sensitivity, specificity, and AUC of variance between WHO II and WHO III are 68.4%, 76.9%, 0.794, and 2645.7, respectively. They had higher identification efficiency. Conclusion Whole-tumor histogram analysis of apparent diffusion coefficient (ADC) maps could provide ancillary diagnostic value in grading diagnosis of ependymoma. Perc.10% had a high diagnostic efficiency.

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Qualitative and quantitative strain and shear wave elastography paradigm in differentiation of breast lesions

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-022-00697-0 ◽

2022 ◽

Vol 53 (1) ◽

Author(s):

Roaa M. A. Shehata ◽

Mostafa A. M. El-Sharkawy ◽

Omar M. Mahmoud ◽

Hosam M. Kamel

Keyword(s):

Shear Wave ◽

Diagnostic Performance ◽

Strain Ratio ◽

Breast Lesions ◽

Breast Masses ◽

Significant Difference ◽

Malignant Breast ◽

Malignant Lesions ◽

The Mean ◽

Sensitivity Specificity

Abstract Background Breast cancer is the most common life-threatening cancer in women worldwide. A high number of women are going through biopsy procedures for characterization of breast masses every day and yet 75% of the pathological results prove these masses to be benign. Ultrasound (US) elastography is a non-invasive technique that measures tissue stiffness. It is convenient for differentiating benign from malignant breast tumors. Our study aims to evaluate the role of qualitative ultrasound elastography scoring (ES), quantitative mass strain ratio (SR), and shear wave elasticity ratio (SWER) in differentiation between benign and malignant breast lesions. Results Among 51 female patients with 77 histopathologically proved breast lesions, 57 breast masses were malignant and 20 were benign. All patients were examined by B-mode ultrasound then strain and shear wave elastographic examinations using ultrasound machine (Logiq E9, GE Medical Systems) with 8.5–12 MHz high-frequency probes. Our study showed that ES best cut-off point > 3 with sensitivity, specificity, PPV, NPP, accuracy was 94.7%, 85%, 94.7%, 85%, 90.9%, respectively, and AUC = 0.926 at P < 0.001, mass SR the best cut-off point > 4.6 with sensitivity, specificity, PPV, NPP, accuracy was 96.5%, 80%, 93.2%, 88.9%, 92.2%, respectively, and AUC = 0.860 at P < 0.001, SWER the best cut-off value > 4.9 with sensitivity, specificity, PPV, NPP and accuracy was 91.2%, 80%, 92.9%, 76.2%, 93.5%, respectively, and AUC = 0.890 at P < 0.001. The mean mass strain ratio for malignant lesions is 10.1 ± 3.7 SD and for solid benign lesions 4.7 ± 4.3 SD (p value 0.001). The mean shear wave elasticity ratio for malignant lesions is 10.6 ± 5.4 SD and for benign (solid and cystic) lesions 3.6 ± 4.2 SD. Using ROC curve and Youden index, the difference in diagnostic performance between ES, SR and SWER was not significant in differentiation between benign and malignant breast lesions and also was non-significant difference when comparing them with conventional US alone. Conclusion ES, SR, and SWER have a high diagnostic performance in differentiating malignant from benign breast lesions with no statistically significant difference between them.

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Diagnostic performance of whole-lesion apparent diffusion coefficient histogram analysis metrics for differentiating benign and malignant breast lesions: a systematic review and diagnostic meta-analysis

Acta Radiologica ◽

10.1177/0284185119896520 ◽

2020 ◽

Vol 61 (9) ◽

pp. 1165-1175

Author(s):

Fan Xu ◽

Ying-ying Liang ◽

Yuan Guo ◽

Zhi-ping Liang ◽

Mei Wu ◽

...

Keyword(s):

Diffusion Coefficient ◽

Apparent Diffusion Coefficient ◽

Diagnostic Performance ◽

Meta Analysis ◽

Histogram Analysis ◽

Breast Lesions ◽

Adc Value ◽

Apparent Diffusion ◽

Malignant Breast ◽

Meta Regression

Background Although whole-lesion apparent diffusion coefficient (ADC) histogram has been increasingly used for breast lesions, it has not been routinely used in clinical practice as an emergent promising imaging tool. Purpose To evaluate the performance of whole-lesion ADC histogram analysis metrics for differentiating benign and malignant breast lesions. Material and Methods A systematic PubMed/EMBASE/Cochrane electronic database search was performed for original diagnostic studies from 1 January 1970 to 2 January 2019. Summary estimates of diagnostic accuracy were generated and meta-regression was performed to explore sources of heterogeneity according to study and magnetic resonance imaging characteristics. Results Five original articles involving 493 patients were included in the meta-analysis. The pooled sensitivity and specificity of whole-lesion ADC histogram analysis were 0.85 (95% confidence interval [CI] = 0.81–0.89) and 0.79 (95% CI = 0.72–0.84) for distinguishing benign and malignant breast lesions, respectively. The area under the curve (AUC) was 0.9178. No publication bias was detected ( P = 0.51). In subgroup analysis, the summary sensitivity and specificity of 50th percentile ADC value were 0.81 (95% CI = 0.71–0.88) and 0.86 (95% CI = 0.74–0.94), respectively. Meta-regression analysis indicated no covariates were sources of heterogeneity ( P > 0.05). Conclusion Whole-lesion ADC histogram analysis demonstrated good diagnostic performance for differentiating between benign and malignant breast lesions, with 50th percentile ADC value showing higher diagnostic accuracy than other histogram parameters. Given the limited number of studies included in the analysis, the findings from our meta-analysis will need further confirmation in future research.

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