Diffusion-weighted MR for Differentiation of Breast Lesions at 3.0 T: How Does Selection of Diffusion Protocols Affect Diagnosis?

Bogner, Wolfgang; Gruber, Stephan; Pinker, Katja; Gräβner, G.; Stadlbauer, Andreas; Weber, Michael; Moser, Ewald; Helbich, Thomas H.; Trattnig, Siegfried

doi:10.1148/radiol.2532081718

Cited by 259 publications

(244 citation statements)

References 36 publications

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“…Furthermore, the choice of b-values is important to reduce effects from blood flow. In the present study the b-values chosen (50 to 800 mm 2 /s) were similar to values defined as optimal for breast cancer in a recent publication (26). A subjective determination of tumor ROIs may also affect the results, although in the present study this was done with careful reference to areas with contrast enhancement.…”

Section: Discussionmentioning

confidence: 63%

Diffusion‐weighted and dynamic contrast‐enhanced MRI in evaluation of early treatment effects during neoadjuvant chemotherapy in breast cancer patients

Jensen¹,

Garzón²,

Heldahl³

et al. 2011

Magnetic Resonance Imaging

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Purpose: To use dynamic contrast-enhanced (DCE) and diffusion-weighted (DW) MRI at 3 Tesla (T) for early evaluation of treatment effects in breast cancer patients undergoing neoadjuvant chemotherapy (NAC), and assess the reliability of DW-MRI.Materials and Methods: DW-and DCE-MRI acquisitions of 15 breast cancer patients were performed before and after one cycle of NAC. MRI tumor diameter and volume, apparent diffusion coefficient (ADC) and kinetic parameters (K trans , v e ) were derived. The reliability of ADC before NAC was assessed. Changes in MRI parameters after NAC were analyzed, and logistic regression analysis was used to find the best predictors for pathologic response. Results:The reliability for ADC values was high, with intraclass correlation coefficient of 0.84 (P ¼ 0.001). After one cycle of NAC, MRI tumor diameter (8%, P ¼ 0.005) and tumor volume (30%, P ¼ 0.008) was reduced for all patients, while ADC mean values increased (0.12 mm 2 /s, P ¼ 0.008). The best predictor for treatment response was a change in MRI tumor diameter with mean error rate of 0.167 (13% for responders, 5% for nonresponders, P ¼ 0.291).Conclusion: Changes in MRI derived tumor diameter and ADC after only one cycle of NAC could provide a valuable tool for early evaluation of treatment effects in breast cancer patients.

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Section: Discussionmentioning

confidence: 63%

Diffusion‐weighted and dynamic contrast‐enhanced MRI in evaluation of early treatment effects during neoadjuvant chemotherapy in breast cancer patients

Jensen¹,

Garzón²,

Heldahl³

et al. 2011

Magnetic Resonance Imaging

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“…Furtheremore, it provides extensive information without contrast medium. An ADC threshold level between malignant and benign lesions with a diagnostic accuracy is around 95 % (49,52,53). MRI s main disadvantages are: it has a long scan time and it is a relatively expensive examination.…”

Section: Resultsmentioning

confidence: 99%

“…However, it is also well known that higher b values result in reduced signal to noise ratio (SNR) and therefore lower image quality. If the lesion is not visible in the b 800 images, the location of the lesion can be identified at least b in the 50 image, otherwise the ADC value can not be evaluated (44,47,50,51,53,55). Lesions smaller than 5 mm and lesions with central necrosis and an enhancing rim smaller than 5 mm are often harder to delineate in the DWI or lead to wrong ADC values (44,47).…”

Section: Diffusion-weighted Mri (Dw Mri)mentioning

confidence: 99%

Nuclear Magnetic Resonance as a Diagnostic Tool in Breast Cancer

Hnilicová¹,

Dobrota²

2012

Acta Medica Martiniana

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A b s t r a c tThe early detection and treatment of breast cancer is of direct benefit to patients. Magnetic resonance imaging (MRI) is a promising modality for detection, diagnosis, and staging of breast cancer. MRI enables two methods: the diffusion-weighted MRI (DW MRI) and the dynamic contrast enhanced MRI (DCE MRI). DW MRI reflects the diffusion of water molecules in the extracellular fluid space and allows the estimation of cellularity and tissue structure. The value of the diffusion of water in tissue is called the apparent diffusion coefficient (ADC). ADC values in malignant lesions are smaller than in benign tissue. DCE MRI yields appropriate pharmacokinetic data of physiological parameters that relate to tissue perfusion, microvascular vessel wall permeability and extracellular volume fraction. Gadolinium based contrast agent is usually used in breast DCE MRI diagnostics. Changes in the post-contrast signal intensity help to distinguish lesions according to characteristically enhanced accumulation of contrast agent. Malignant lesions are characterized by a faster and stronger signal enhancement than benign lesions which relate to their neoangiogenesis. Over the last few years, there has been appreciable interest in the use of magnetic resonance spectroscopy (MRS) for the non-invasive analysis of breast tisue metabolites. One of the spectroscopic hallmarks of the neoplastic process appears to be the presence of total choline signal in the in vivo spectrum. Despite the fact that MRI and MRS achieve excellent results, they are still not so frequently used in comparison to mammography and breast ultrasound.

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“…The range of b values reported in the literature for breast DWI is 0-1000. Two studies have investigated multiple combinations of b values to determine their effect on image quality and the calculated ADC value (42,43). The first study found no significant difference in the diagnostic performance of ADC (42).…”

Section: Breast Applicationsmentioning

confidence: 99%

“…Two studies have investigated multiple combinations of b values to determine their effect on image quality and the calculated ADC value (42,43). The first study found no significant difference in the diagnostic performance of ADC (42). The optimum cut-off values varied in these studies, which was likely a result of different calculation methods and differences in patient populations (43)(44)(45).…”

Section: Breast Applicationsmentioning

confidence: 99%

Diffusion weighted MRI for detecting and monitoring cancer: a review of current applications in body imaging

Türkbey

Aras

Karabulut

et al. 2011

Diagn Interv Radiol

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Imaging is used to detect, characterize, and monitor cancer. Recently, diffusion-weighted magnetic resonance imaging (DWI) has become a useful adjunct for assessing tumors with magnetic resonance imaging (MRI). DWI involves the acquisition of a magnetic resonance signal related to random thermal motion (Brownian motion) or the "diffusion" of water protons in tissue. The signal obtained with DWI is a measure of the net displacement of water molecules, e.g., the water path length in the extracellular, intracellular and intravascular spaces. This motion is largely random and can be reduced by structural barriers, such as cell membranes and collagen. Restricted diffusion in biological tissues is inversely proportional to tissue cellularity and the integrity of cell membranes, and it can be quantified with apparent diffusion coefficient (ADC) measurements (1). Depending on the microarchitecture, either restricted or increased diffusion can occur in malignant tumors. For instance, diffusion is restricted in cellular portions of the tumor, but it may be increased in necrotic portions (2, 3). Other causes of enhanced diffusion include increased water content arising from intratumoral edema and cystic tumor components (4-6).Although initially used to evaluate neurological diseases, the applications of DWI have been extended to oncologic imaging throughout the body made possible by improvements in MRI hardware and new sequences. The use of DWI as a complement to conventional MRI methods has led to improvements in the detection and characterization of tumors, treatment response monitoring, and detection of recurrence in oncology patients. Basic concepts of DWIIn 1965, Stejskal and Tanner (7) proposed the application of a symmetric pair of additional gradients on either side of the 180˚ refocusing radiofrequency pulse. The Stejskal-Tanner sequence is still the basis of modern DWI. For static water molecules, the phasing effect caused by the first gradient will be reversed by the second gradient, leading to no signal loss; however, this phasing effect will not be completely reversed if the water molecules are not stationary, which results in the observed well-known diffusion signal decay. The amount of diffusion weighting is determined by the b value, which describes the amplitude, duration of the applied gradient, and time interval between the two diffusion gradients (4). The degree of signal attenuation from water molecules is cor- ABSTRACT Diffusion-weighted magnetic resonance imaging (MRI), which involves the acquisition of a magnetic resonance signal related to the Brownian motion of water protons in tissue, has become a useful technique for assessing tumors. In this article, we review the basic concepts, imaging strategies, and body applications of diffusion-weighted MRI in detecting and monitoring cancer.

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Diffusion-weighted MR for Differentiation of Breast Lesions at 3.0 T: How Does Selection of Diffusion Protocols Affect Diagnosis?

Abstract: Optimum ADC determination and DW imaging quality at 3.0 T was found with a combined b value protocol of 50 and 850 sec/mm(2). This provided a high accuracy for differentiation of benign and malignant breast tumors.

Cited by 259 publications

References 36 publications

Diffusion‐weighted and dynamic contrast‐enhanced MRI in evaluation of early treatment effects during neoadjuvant chemotherapy in breast cancer patients

Diffusion‐weighted and dynamic contrast‐enhanced MRI in evaluation of early treatment effects during neoadjuvant chemotherapy in breast cancer patients

Nuclear Magnetic Resonance as a Diagnostic Tool in Breast Cancer

Diffusion weighted MRI for detecting and monitoring cancer: a review of current applications in body imaging

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