Isaac Daimiel Naranjo1, Roberto Lo Gullo1,2, Carolina Saccarelli1, Sunitha B Thakur1,3, Almir Bitencourt1,4, Elizabeth A Morris1, Maxine S Jochelson1, Varadan Sevilimedu5, Danny F Martinez1, Katja Pinker-Domenig6,7. 1. Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA. 2. Department of Radiology, Breast Imaging Division, Istituto Europeo di Oncologia, Via Giuseppe Ripamonti, 435, 20141, Milano, Italy. 3. Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA. 4. Department of Imaging, A.C.Camargo Cancer Center, SP, São Paulo, Brazil. 5. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA. 6. Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA. pinkerdk@mskcc.org. 7. Department of Biomedical Imaging and Image-guided Therapy Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. pinkerdk@mskcc.org.
Abstract
OBJECTIVES: To assess DWI for tumor visibility and breast cancer detection by the addition of different synthetic b-values. METHODS: Eighty-four consecutive women who underwent a breast-multiparametric-MRI (mpMRI) with enhancing lesions on DCE-MRI (BI-RADS 2-5) were included in this IRB-approved retrospective study from September 2018 to March 2019. Three readers evaluated DW acquired b-800 and synthetic b-1000, b-1200, b-1500, and b-1800 s/mm2 images for lesion visibility and preferred b-value based on lesion conspicuity. Image quality (1-3 scores) and breast composition (BI-RADS) were also recorded. Diagnostic parameters for DWI were determined using a 1-5 malignancy score based on qualitative imaging parameters (acquired + preferred synthetic b-values) and ADC values. BI-RADS classification was used for DCE-MRI and quantitative ADC values + BI-RADS were used for mpMRI. RESULTS: Sixty-four malignant (average = 23 mm) and 39 benign (average = 8 mm) lesions were found in 80 women. Although b-800 achieved the best image quality score, synthetic b-values 1200-1500 s/mm2 were preferred for lesion conspicuity, especially in dense breast. b-800 and synthetic b-1000/b-1200 s/mm2 values allowed the visualization of 84-90% of cancers visible with DCE-MRI performing better than b-1500/b-1800 s/mm2. DWI was more specific (86.3% vs 65.7%, p < 0.001) but less sensitive (62.8% vs 90%, p < 0.001) and accurate (71% vs 80.7%, p = 0.003) than DCE-MRI for breast cancer detection, where mpMRI was the most accurate modality accounting for less false positive cases. CONCLUSION: The addition of synthetic b-values enhances tumor conspicuity and could potentially improve tumor visualization particularly in dense breast. However, its supportive role for DWI breast cancer detection is still not definite. KEY POINTS: • The addition of synthetic b-values (1200-1500 s/mm2) to acquired DWI afforded a better lesion conspicuity without increasing acquisition time and was particularly useful in dense breasts. • Despite the use of synthetic b-values, DWI was less sensitive and accurate than DCE-MRI for breast cancer detection. • A multiparametric MRI modality still remains the best approach having the highest accuracy for breast cancer detection and thus reducing the number of unnecessary biopsies.
OBJECTIVES: To assess DWI for tumor visibility and breast cancer detection by the addition of different synthetic b-values. METHODS: Eighty-four consecutive women who underwent a breast-multiparametric-MRI (mpMRI) with enhancing lesions on DCE-MRI (BI-RADS 2-5) were included in this IRB-approved retrospective study from September 2018 to March 2019. Three readers evaluated DW acquired b-800 and synthetic b-1000, b-1200, b-1500, and b-1800 s/mm2 images for lesion visibility and preferred b-value based on lesion conspicuity. Image quality (1-3 scores) and breast composition (BI-RADS) were also recorded. Diagnostic parameters for DWI were determined using a 1-5 malignancy score based on qualitative imaging parameters (acquired + preferred synthetic b-values) and ADC values. BI-RADS classification was used for DCE-MRI and quantitative ADC values + BI-RADS were used for mpMRI. RESULTS: Sixty-four malignant (average = 23 mm) and 39 benign (average = 8 mm) lesions were found in 80 women. Although b-800 achieved the best image quality score, synthetic b-values 1200-1500 s/mm2 were preferred for lesion conspicuity, especially in dense breast. b-800 and synthetic b-1000/b-1200 s/mm2 values allowed the visualization of 84-90% of cancers visible with DCE-MRI performing better than b-1500/b-1800 s/mm2. DWI was more specific (86.3% vs 65.7%, p < 0.001) but less sensitive (62.8% vs 90%, p < 0.001) and accurate (71% vs 80.7%, p = 0.003) than DCE-MRI for breast cancer detection, where mpMRI was the most accurate modality accounting for less false positive cases. CONCLUSION: The addition of synthetic b-values enhances tumor conspicuity and could potentially improve tumor visualization particularly in dense breast. However, its supportive role for DWI breast cancer detection is still not definite. KEY POINTS: • The addition of synthetic b-values (1200-1500 s/mm2) to acquired DWI afforded a better lesion conspicuity without increasing acquisition time and was particularly useful in dense breasts. • Despite the use of synthetic b-values, DWI was less sensitive and accurate than DCE-MRI for breast cancer detection. • A multiparametric MRI modality still remains the best approach having the highest accuracy for breast cancer detection and thus reducing the number of unnecessary biopsies.
Entities:
Keywords:
Breast tumors; Diagnostic imaging; Diffusion magnetic resonance imaging; Echo-planar imaging; Image analysis
Authors: Savannah C Partridge; David C Newitt; Thomas L Chenevert; Mark A Rosen; Nola M Hylton Journal: Radiology Date: 2019-04-02 Impact factor: 11.105
Authors: Rubina M Trimboli; Nicola Verardi; Francesco Cartia; Luca A Carbonaro; Francesco Sardanelli Journal: AJR Am J Roentgenol Date: 2014-09 Impact factor: 3.959
Authors: Vikas Gulani; Fernando Calamante; Frank G Shellock; Emanuel Kanal; Scott B Reeder Journal: Lancet Neurol Date: 2017-06-13 Impact factor: 44.182
Authors: Elizabeth S McDonald; Jill A Hammersley; Shinn-Huey S Chou; Habib Rahbar; John R Scheel; Christoph I Lee; Cheng-Liang Liu; Constance D Lehman; Savannah C Partridge Journal: AJR Am J Roentgenol Date: 2016-04-14 Impact factor: 3.959
Authors: Yabo Fu; Hao Zhang; Eric D Morris; Carri K Glide-Hurst; Suraj Pai; Alberto Traverso; Leonard Wee; Ibrahim Hadzic; Per-Ivar Lønne; Chenyang Shen; Tian Liu; Xiaofeng Yang Journal: IEEE Trans Radiat Plasma Med Sci Date: 2021-08-24
Authors: Laura Martincich; Katja Pinker; Roberto Lo Gullo; Varadan Sevilimedu; Pascal Baltzer; Denis Le Bihan; Julia Camps-Herrero; Paola Clauser; Fiona J Gilbert; Mami Iima; Ritse M Mann; Savannah C Partridge; Andrew Patterson; Eric E Sigmund; Sunitha Thakur; Fabienne E Thibault Journal: Eur Radiol Date: 2022-05-04 Impact factor: 7.034
Authors: M Wielema; P E Sijens; H Dijkstra; G H De Bock; I G van Bruggen; J E Siegersma; E Langius; R M Pijnappel; M D Dorrius; M Oudkerk Journal: PLoS One Date: 2021-01-25 Impact factor: 3.240
Authors: Isaac Daimiel Naranjo; Peter Gibbs; Jeffrey S Reiner; Roberto Lo Gullo; Sunitha B Thakur; Maxine S Jochelson; Nikita Thakur; Pascal A T Baltzer; Thomas H Helbich; Katja Pinker Journal: Cancers (Basel) Date: 2022-03-29 Impact factor: 6.575
Authors: V Romeo; P Clauser; S Rasul; P Kapetas; P Gibbs; P A T Baltzer; M Hacker; R Woitek; T H Helbich; K Pinker Journal: Eur J Nucl Med Mol Imaging Date: 2021-08-10 Impact factor: 10.057