Correlation of Peri-Tumoral Edema Determined in T2 Weighted Imaging with Apparent Diffusion Coefficient of Peritumoral Area in Patients with Breast Carcinoma

Abstract

Background: Breast cancer may result in remodeling of adjacent normal appearing breast tissues. Magnetic resonance imaging (MRI) is increasingly used in the diagnosis and follow-up of breast cancer by means of diffusion weighted imaging, which is based on thermal motion of water molecules in the extracellular fluid. Objectives: We investigated the correlation of visual assessment of peri-tumoral edema with peri-tumoral and tumoral apparent diffusion coefficient (ADC) values. Patients and Methods: In this cross-sectional study, from 2016 to 2018, 78 patients with 89 malignant breast lesions (mean age, 47 years) were examined by 1.5-T breast MRI. The lesions were categorized based on the visual assessment of peri-tumoral edema on T2 weighted imaging (T2WI) into two groups: (A) with edema (36 lesions) and (B) without edema (53 lesions). Measuring ADC values in the contralateral normal breast tissue, peri-tumoral tissue and peri-tumoral-normal tissue ADC ratio were compared between the two groups for all lesions. Results: The number of in situ lesions was higher in group B (7.5% vs 2.7%) with the p value of 0.01. The mean of ADC values in the normal breast tissue was 1.76 × 10-3mm2/s. Tumor ADCs were significantly lower in group A compared to group B (0.95 × 10-3mm2/s vs. 1.11 × 10-3mm2/s) with the P value of 0.003. However, peri-tumoral ADCs were significantly higher in group A (1.82 × 10-3mm2/s vs. 1.53 × 10-3mm2/s) with the p value of 0.005. The peri-tumoral-normal tissue ADC ratio was 0.87 in group B and about 1 in group A. However, the difference between normal tissue ADCs and peri-tumoral ADCs was only significant (P value of 0.005) in group B. The cut-off point value for differentiating normal tissue ADCs and peri-tumoral ADCs was 1.61 × 10-3mm2/s with the sensitivity of 65% and specificity of 70%. Conclusion: Breast cancer with peri-tumoral edema has lower tumoral ADC values, higher peri-tumoral ADC values and lower prevalence of in situ lesions. Visual assessment of peri-tumoral edema on T2WI could predict the tumoral characteristic on diffusion-weighted imaging.

Restriction spectrum imaging with elastic image registration for automated evaluation of response to neoadjuvant therapy in breast cancer

“…The performance, indicating prediction of response, was present already at the early treatment time point and is probably due to the RSI 3C classifier’s quantification reflecting tumor cellularity, rather than tumor vascular perfusion as in DCE. The RSI 3C classifier is based on the first two components of the RSI 3C model (C 1 and C 2 ), which have previously demonstrated discrimination of cancer from healthy breast tissue in the pre-treatment setting ( 16 ). This is likely due to these two components corresponding to cancer while simultaneously accounting for varying degrees of fatty tissue and fibroglandular tissue.…”

“…To create a global RSI 3C tissue classifier applicable across patients and time points, the first two components of RSI 3C (C 1 and C 2 ) were selected, as these have previously demonstrated excellent discrimination of cancer from healthy breast tissue ( 16 ). Joint C 1 and C 2 probability density functions (PDFs) for voxels in cancer and control ROIs were calculated for all patients simultaneously at the pre-treatment time point.…”

The Breast Edema Enigma: Features, Diagnosis, Treatment, and Recommendations

“…Currently, magnetic resonance imaging (MRI), with its high sensitivity, plays a crucial role in diagnosing breast cancer and characterizing tumor stage, morphology, margins, and neoangiogenesis [16], particularly when performed with contrast enhancement [17]. Its use to evaluate breast edema is optimized by T2 diffusion-weighted imaging in which thermal movement of water molecules in extracellular fluid is detected as a high-intensity signal [18,19]. The edema may be focal (including subcutaneous and peritumoral subtypes) or diffuse.…”