Erkin Aribal1, Ruslan Asadov2, Abdullah Ramazan3, Mustafa Ümit Ugurlu4, Handan Kaya5. 1. Marmara University, Faculty of Medicine, Department of Radiology, Mimar Sinan cad 41, Pendik, 34890 Istanbul, Turkey. Electronic address: earibal@marmara.edu.tr. 2. Marmara University, Faculty of Medicine, Department of Radiology, Mimar Sinan cad 41, Pendik, 34890 Istanbul, Turkey. Electronic address: dr.esedov@gmail.com. 3. TC SB Marmara University Pendik Training and Research Hospital, Radiology Department, Mimar Sinan cad 41, Pendik, 34890 Istanbul, Turkey. Electronic address: abdramazan@gmail.com. 4. Marmara University, Faculty of Medicine, Department of General Surgery, Mimar Sinan cad 41, Pendik, 34890 Istanbul, Turkey. Electronic address: umitugurlu@gmail.com. 5. Marmara University, Faculty of Medicine, Department of Pathology, Mimar Sinan cad 41, Pendik, 34890 Istanbul, Turkey. Electronic address: hkaya@marmara.edu.tr.
Abstract
OBJECTIVES: To evaluate the diagnostic accuracy of dynamic contrast enhanced breast MRI (DCE-MRI) combined with diffusion weighted imaging (DWI) and 1H single-voxel magnetic resonance spectroscopy (1HMRS) in differentiating malignant from benign breast lesions. METHODS: One hundred twenty-nine patients with 138 lesions were included in the study. Multiparametric MRI of the breast was performed with a 3T unit. A DWI is followed by DCE-MRI and 1HMRS. All lesions were biopsied within one week after MRI. Histopathologic findings were accepted as the standard of reference. Probability of malignancy was assessed according to BI-RADS for DCE-MRI. ADC values were measured for DWI and choline peaks were assessed using a semi-quantitative method in 1HMRS. Two blinded radiologists evaluated findings in consensus. Diagnostic performance of DCE-MRI, DWI and 1HMRS alone or in combination for multiparametric imaging were statistically evaluated. RESULTS: Histopathology revealed malignancy in 54.4% of lesions (75/138). DCE-MRI showed the highest AUC (0.978), sensitivity (97.33%) and specificity (88.89%) compared to DWI and 1HMRS. Sensitivity was 100% when a positive result from any one of three techniques was accepted as malignancy, albeit with a trade-off for 65.1% specificity. Highest specificity (98.4%) was attained when all three techniques were required to be positive, though with a lower sensitivity (82.7%) as trade-off. Logistic regression analysis confirmed significant association with DCE-MRI (p<0.001) and 1H MRS (p=0.009) but not with DWI (p=0.127). There was one case of fat necrosis which was false positive in all three techniques. CONCLUSIONS: Multiparametric imaging with combination of DCE-MRI, DWI and 1HMRS does not improve, and may even reduce the diagnostic accuracy of breast MRI. Although, the specificity may be improved with a trade-off for lower sensitivity, we have not set a convenient algorithm for the combined use of these techniques.
OBJECTIVES: To evaluate the diagnostic accuracy of dynamic contrast enhanced breast MRI (DCE-MRI) combined with diffusion weighted imaging (DWI) and 1H single-voxel magnetic resonance spectroscopy (1HMRS) in differentiating malignant from benign breast lesions. METHODS: One hundred twenty-nine patients with 138 lesions were included in the study. Multiparametric MRI of the breast was performed with a 3T unit. A DWI is followed by DCE-MRI and 1HMRS. All lesions were biopsied within one week after MRI. Histopathologic findings were accepted as the standard of reference. Probability of malignancy was assessed according to BI-RADS for DCE-MRI. ADC values were measured for DWI and choline peaks were assessed using a semi-quantitative method in 1HMRS. Two blinded radiologists evaluated findings in consensus. Diagnostic performance of DCE-MRI, DWI and 1HMRS alone or in combination for multiparametric imaging were statistically evaluated. RESULTS: Histopathology revealed malignancy in 54.4% of lesions (75/138). DCE-MRI showed the highest AUC (0.978), sensitivity (97.33%) and specificity (88.89%) compared to DWI and 1HMRS. Sensitivity was 100% when a positive result from any one of three techniques was accepted as malignancy, albeit with a trade-off for 65.1% specificity. Highest specificity (98.4%) was attained when all three techniques were required to be positive, though with a lower sensitivity (82.7%) as trade-off. Logistic regression analysis confirmed significant association with DCE-MRI (p<0.001) and 1H MRS (p=0.009) but not with DWI (p=0.127). There was one case of fat necrosis which was false positive in all three techniques. CONCLUSIONS: Multiparametric imaging with combination of DCE-MRI, DWI and 1HMRS does not improve, and may even reduce the diagnostic accuracy of breast MRI. Although, the specificity may be improved with a trade-off for lower sensitivity, we have not set a convenient algorithm for the combined use of these techniques.
Authors: D Leithner; G J Wengert; T H Helbich; S Thakur; R E Ochoa-Albiztegui; E A Morris; K Pinker Journal: Clin Radiol Date: 2017-12-09 Impact factor: 2.350
Authors: Kiaran P McGee; Ken-Pin Hwang; Daniel C Sullivan; John Kurhanewicz; Yanle Hu; Jihong Wang; Wen Li; Josef Debbins; Eric Paulson; Jeffrey R Olsen; Chia-Ho Hua; Lizette Warner; Daniel Ma; Eduardo Moros; Neelam Tyagi; Caroline Chung Journal: Med Phys Date: 2021-05-20 Impact factor: 4.071