Breast Lesions: Diagnosis Using Diffusion Weighted Imaging at 1.5T and 3.0T—Systematic Review and Meta-analysis

Shi, Rong; Yao, Qing; Wu, Lian‐Ming; Xu, Jianrong

doi:10.1016/j.clbc.2017.06.011

Cited by 70 publications

(51 citation statements)

References 110 publications

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“…Whereas other metaanalyses assessed the diagnostic performance of the apparent diffusion coefficient (ADC) model (11)(12)(13), to our knowledge, ours is the first study to systematically compare all relevant advanced non-Gaussian diffusion techniques with standard diffusion-weighted imaging (DWI) for quantitatively distinguishing benign and malignant lesions. The pooled estimates of sensitivity, specificity, and area under the receiver operating characteristic curve were found to be comparable for ADC, intravoxel incoherent motion (IVIM), and diffusion-tensor imaging (DTI).…”

Section: Discussionmentioning

confidence: 99%

“…It was first used in the breast by Sigmund et al (10) to measure the differences in contribution of the microvasculature between malignant lesions and normal fibroglandular tissue. Whereas previous meta-analyses have assessed the performance of the ADC model in differentiating between benign and malignant lesions (11)(12)(13), more advanced diffusion techniques aim to improve on the results of quantitative DWI. Our metaanalysis compares the diagnostic performance of these advanced diffusion techniques, including DWI, DTI, and IVIM to assess whether they achieve an improvement in diagnostic performance that justifies their higher computational complexity and longer imaging time, which are needed to acquire the range of b values or diffusion directions.…”

Section: Key Pointsmentioning

confidence: 99%

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A Meta-analysis of the Diagnostic Performance of Diffusion MRI for Breast Lesion Characterization

et al. 2019

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Radiology 2019; 00:1-11 • https://doi.org/10.1148/radiol.2019182510 • Content code:Background: Various techniques are available to assess diffusion properties of breast lesions as a marker of malignancy at MRI. The diagnostic performance of these diffusion markers has not been comprehensively assessed. Purpose:To compare by meta-analysis the diagnostic performance of parameters from diffusion-weighted imaging (DWI), diffusion-tensor imaging (DTI), and intravoxel incoherent motion (IVIM) in the differential diagnosis of malignant and benign breast lesions. Materials and Methods:PubMed and Embase databases were searched from January to March 2018 for studies in English that assessed the diagnostic performance of DWI, DTI, and IVIM in the breast. Studies were reviewed according to eligibility and exclusion criteria. Publication bias and heterogeneity between studies were assessed. Pooled summary estimates for sensitivity, specificity, and area under the curve were obtained for each parameter by using a bivariate model. A subanalysis investigated the effect of MRI parameters on diagnostic performance by using a Student t test or a one-way analysis of variance. Results:From 73 eligible studies, 6791 lesions (3930 malignant and 2861 benign) were included. Publication bias was evident for studies that evaluated apparent diffusion coefficient (ADC). Significant heterogeneity (P , .05) was present for all parameters except the perfusion fraction (f ). The pooled sensitivity, specificity, and area under the curve for ADC was 89%, 82%, and 0.92, respectively. The highest performing parameter for DTI was the prime diffusion coefficient (l 1 ), and pooled sensitivity, specificity, and area under the curve was 93%, 90%, and 0.94, respectively. The highest performing parameter for IVIM was tissue diffusivity (D), and the pooled sensitivity, specificity, and area under the curve was 88%, 79%, and 0.90. Choice of MRI parameters had no significant effect on diagnostic performance. Conclusion:Diffusion-weighted imaging, diffusion-tensor imaging, and intravoxel incoherent motion have comparable diagnostic accuracy with high sensitivity and specificity. Intravoxel incoherent motion is comparable to apparent diffusion coefficient. Diffusion-tensor imaging is potentially promising but to date the number of studies is limited.

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Section: Discussionmentioning

confidence: 99%

Section: Key Pointsmentioning

confidence: 99%

A Meta-analysis of the Diagnostic Performance of Diffusion MRI for Breast Lesion Characterization

et al. 2019

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“…Values are usually expressed in 10 23 mm 2 /sec. Because of the hindered diffusion in cancers, mean ADCs are generally low (range, 0.8-1.3 3 10 23 mm 2 /sec) compared with those in benign lesions (range, 1.2-2.0 3 10 23 mm 2 /sec) (43). Consequently, cancers have a low signal intensity on the derived ADC maps.…”

Section: Dwi Sequencesmentioning

confidence: 99%

Breast MRI: State of the Art

Mann¹,

Cho²,

Moy³

2019

Radiology

522

325

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reast MRI is an indispensable modality, along with mammography and US. Its main indications are staging of known cancer, screening for breast cancer in women at increased risk, and evaluation of response to neoadjuvant chemotherapy (1-3). As opposed to mammography and US, MRI is a functional technique. Heywang et al (4) and Kaiser and Zeitler (5) independently introduced this technique in the 1980s. Contrast material-enhanced MRI evaluates the permeability of blood vessels by using an intravenous contrast agent (gadolinium chelate) that shortens the local T1 time, leading to a higher signal on T1-weighted images (6). The underlying principle is that neoangiogenesis leads to formation of leaky vessels that allow for faster extravasation of contrast agents (7), thus leading to rapid local enhancement. Despite improvements in the technique of breast MRI, this principle is still the basis of all clinical MRI protocols. However, most MRI protocols nowadays are multiparametric (8,9). This review describes the current state of the art in breast MRI, with a focus on the major indications and the potential indication-based adaptations to the imaging protocol to maximize its value. Requirements for Breast MRI Breast MRI studies should be interpreted by radiologists with expertise in breast imaging, including mammographic and US studies, as these examinations are often complementary. Although empirical data on the learning curve for breast MRI are lacking, some studies showed improved performance of radiologists over time (10), and reporting breast MRI studies requires sufficient exposure to the technique. It is best practice to use a field strength of at least 1.5 T to acquire images at a sufficiently high spatial resolution (1-3). Utilization of a dedicated breast coil is mandatory to obtain images of diagnostic quality. Women lie in the prone position with the breasts hanging free in the recesses of the coil. This design allows the breast tissue to spread, which facilitates detection of abnormalities and prevents motion artifacts induced by respiration (11,12). A breast coil should have at least four channels, but modern designs

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“…By the time a primary cancer mass is clinically detectable, it contains a minimum of 10 7 -10 8 cells (approximately the size of 0.5 cm 3 ) [4,5]. Tumors may only reach this size and continue their growth by promoting new and incorporating current vasculature via angiogenesis [6].…”

Section: Ctcs and Metastatic Efficiencymentioning

confidence: 99%

Gauging the Impact of Cancer Treatment Modalities on Circulating Tumor Cells (CTCs)

Mathias

Chang

Martin

et al. 2020

Cancers

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The metastatic cascade consists of multiple complex steps, but the belief that it is a linear process is diminishing. In order to metastasize, cells must enter the blood vessels or body cavities (depending on the cancer type) via active or passive mechanisms. Once in the bloodstream and/or lymphatics, these cancer cells are now termed circulating tumor cells (CTCs). CTC numbers as well as CTC clusters have been used as a prognostic marker with higher numbers of CTCs and/or CTC clusters correlating with an unfavorable prognosis. However, we have very limited knowledge about CTC biology, including which of these cells are ultimately responsible for overt metastatic growth, but due to the fact that higher numbers of CTCs correlate with a worse prognosis; it would seem appropriate to either limit CTCs and/or their dissemination. Here, we will discuss the different cancer treatments which may inadvertently promote the mobilization of CTCs and potential CTC therapies to decrease metastasis.

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Breast Lesions: Diagnosis Using Diffusion Weighted Imaging at 1.5T and 3.0T—Systematic Review and Meta-analysis

Cited by 70 publications

References 110 publications

A Meta-analysis of the Diagnostic Performance of Diffusion MRI for Breast Lesion Characterization

A Meta-analysis of the Diagnostic Performance of Diffusion MRI for Breast Lesion Characterization

Breast MRI: State of the Art

Gauging the Impact of Cancer Treatment Modalities on Circulating Tumor Cells (CTCs)

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