A survey by the European Society of Breast Imaging on the implementation of breast diffusion-weighted imaging in clinical practice

Abstract

Objectives To perform a survey among all European Society of Breast Imaging (EUSOBI) radiologist members to gather representative data regarding the clinical use of breast DWI. Methods An online questionnaire was developed by two board-certified radiologists, reviewed by the EUSOBI board and committees, and finally distributed among EUSOBI active and associated (not based in Europe) radiologist members. The questionnaire included 20 questions pertaining to technical preferences (acquisition time, magnet strength, breast coils, number of b values), clinical indications, imaging evaluation, and reporting. Data were analyzed using descriptive statistics, the Chisquare test of independence, and Fisher's exact test. Results Of 1411 EUSOBI radiologist members, 275/1411 (19.5%) responded. Most (222/275, 81%) reported using DWI as part of their routine protocol. Common indications for DWI include lesion characterization (using an ADC threshold of 1.2-1.3 × 10 −3 mm 2 /s) and prediction of response to chemotherapy. Members most commonly acquire two separate b values (114/217, 53%), with b value = 800 s/mm 2 being the preferred value for appraisal among those acquiring more than two b values (71/171, 42%). Most did not use synthetic b values (169/217, 78%). While most mention hindered diffusion in the MRI report (161/213, 76%), only 142/217 (57%) report ADC values. ConclusionThe utilization of DWI in clinical practice among EUSOBI radiologists who responded to the survey is generally in line with international recommendations, with the main application being the differentiation of benign and malignant enhancing lesions, treatment response assessment, and prediction of response to chemotherapy. Report integration of qualitative and quantitative DWI data is not uniform. Key Points• Clinical performance of breast DWI is in good agreement with the current recommendations of the EUSOBI International Breast DWI working group. • Breast DWI applications in clinical practice include the differentiation of benign and malignant enhancing, treatment response assessment, and prediction of response to chemotherapy. • Report integration of DWI results is not uniform.

Breast DWI Analyzed Before and After Gadolinium Contrast Administration—An Intrapatient Analysis on 1.5 T and 3.0 T

“…Previously, a range of ADC thresholds 1.0 Â 10 −3 mm 2 /s-1.6 Â 10 −3 mm 2 /s was already proposed for labeling high-risk malignant lesions by several studies. 1,28,34,37,38 All these thresholds may also apply for postcontrast DWI using our MRI protocol. Based on our data, we determined an ADC threshold with a sensitivity of approximately 0.98 (benign was positively labeled) and found values of 1.0 Â 10 −3 mm 2 /s-1.1 Â 10 −3 mm 2 /s.…”

The road to breast cancer screening with diffusion MRI

“…Many more details can be found in ( 10 ). In addition, a survey of the implementation of breast DWI in clinical practice from the EUSOBI has recently been published ( 52 ).…”

“…This is an important point, considering that repeated use of GBCA would be a problem for screening. Not only does DWI remain more sensitive than MMG across studies ( 52 , 92 , 95 , 96 ), but mammography-occluded breast cancers are better represented with DWI than with ultrasound ( 94 ).…”

“…Despite this good clinical performance, it may seem surprising that DWI has not yet been recommended to be used as a stand-alone modality for breast cancer evaluation, let alone for breast cancer screening. Diffusion MRI is not even included in the BI-RADS lexicon used to assess breast lesions from GBCA MRI ( 97 ), although it is considered useful ( 52 ). The main reason is likely the high variability of the results found in the literature, especially with regard to ADC values ( 13 , 98 ).…”

“…The EUSOBI international committee on breast DWI has provided guidelines for obtaining optimized and consistent results (13). This report, along with the EUSOBI survey (52) have pointed out to an urgent need for standardization of DWI acquisition and processing protocols to achieve consistent results among breast DWI users.…”