Jung Hyun Park1, Bo La Yun1, Mijung Jang1, Hye Shin Ahn2, Sun Mi Kim1, Soo Hyun Lee3, Eunyoung Kang4, Eun-Kyu Kim4, So Yeon Park5. 1. Department of Radiology, Seoul National University Bundang Hospital, Nam, Gyeongi-do, Republic of Korea. 2. Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea. 3. Department of Radiology, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea. 4. Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea. 5. Department of Pathology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Abstract
BACKGROUND: Acquired high b-value (>1000 s/mm2 ) diffusion-weighted imaging (DWI) has its strength in lesion detection. However, it is not easily used, due to a lower signal-to-noise ratio, eddy current distortions, and prolonged acquisition times. Synthetic DWI does not have these disadvantages because it is based on indirect acquisition, calculated in a voxel-wise manner. PURPOSE: To compare the diagnostic performance of synthetic and acquired high b-value (1500 s/mm2 ) DWI in women with breast cancer. STUDY TYPE: Retrospective. POPULATION: A total of 108 patients (median age 49 years [range 32-77]) with 133 breast cancers. FIELD STRENGTH/SEQUENCE: 3T, echo-planar imaging. ASSESSMENT: Three radiologists independently reviewed image sets of both synthetic (S-b1500) and acquired (A-b1500) high b-value DWI. Malignancy confidence of the lesion was scored using a 6-point Likert-type scale. STATISTICAL TEST: Jack-knife alternative free-response receiver-operating characteristic 1 (JAFROC1) analysis was used. Sensitivity and positive predictive value (PPV) were compared using generalized estimating equations. An independent t-test was used to compare the confidence. An intraclass correlation coefficient was calculated to compare interobserver agreement. RESULTS: The JAFROC1 figures of merit values were 0.816 and 0.808 in S-b1500 and A-b1500, respectively, with no statistically significant difference (P = 0.637). Sensitivity was higher in synthetic than in A-b1500 for readers 2 (P = 0.015) and 3 (P = 0.037). Although sensitivity was higher in S-b1500 than in A-b1500 for reader 1, the difference was not significant (P = 0.487). The PPV of S-b1500 was not significantly different from that of A-b1500 (P = 0.397). The malignancy confidence of true-positive tumors was higher in S-b1500 than in A-b1500 (P = 0.013). Interobserver agreement was good for both sequences. DATA CONCLUSIONS: The synthetic high b-value DWI may improve the diagnostic sensitivity for breast cancer detection without affecting PPV compared with acquired high b-value DWI. LEVEL OF EVIDENCE: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:857-863.
BACKGROUND: Acquired high b-value (>1000 s/mm2 ) diffusion-weighted imaging (DWI) has its strength in lesion detection. However, it is not easily used, due to a lower signal-to-noise ratio, eddy current distortions, and prolonged acquisition times. Synthetic DWI does not have these disadvantages because it is based on indirect acquisition, calculated in a voxel-wise manner. PURPOSE: To compare the diagnostic performance of synthetic and acquired high b-value (1500 s/mm2 ) DWI in women with breast cancer. STUDY TYPE: Retrospective. POPULATION: A total of 108 patients (median age 49 years [range 32-77]) with 133 breast cancers. FIELD STRENGTH/SEQUENCE: 3T, echo-planar imaging. ASSESSMENT: Three radiologists independently reviewed image sets of both synthetic (S-b1500) and acquired (A-b1500) high b-value DWI. Malignancy confidence of the lesion was scored using a 6-point Likert-type scale. STATISTICAL TEST: Jack-knife alternative free-response receiver-operating characteristic 1 (JAFROC1) analysis was used. Sensitivity and positive predictive value (PPV) were compared using generalized estimating equations. An independent t-test was used to compare the confidence. An intraclass correlation coefficient was calculated to compare interobserver agreement. RESULTS: The JAFROC1 figures of merit values were 0.816 and 0.808 in S-b1500 and A-b1500, respectively, with no statistically significant difference (P = 0.637). Sensitivity was higher in synthetic than in A-b1500 for readers 2 (P = 0.015) and 3 (P = 0.037). Although sensitivity was higher in S-b1500 than in A-b1500 for reader 1, the difference was not significant (P = 0.487). The PPV of S-b1500 was not significantly different from that of A-b1500 (P = 0.397). The malignancy confidence of true-positive tumors was higher in S-b1500 than in A-b1500 (P = 0.013). Interobserver agreement was good for both sequences. DATA CONCLUSIONS: The synthetic high b-value DWI may improve the diagnostic sensitivity for breast cancer detection without affecting PPV compared with acquired high b-value DWI. LEVEL OF EVIDENCE: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:857-863.
Keywords:
breast neoplasms; computer-assisted; diffusion magnetic resonance imaging; image interpretation; magnetic resonance imaging; predictive value of tests
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