Enhanced mass on contrast‐enhanced breast MR imaging: Lesion characterization using combination of dynamic contrast‐enhanced and diffusion‐weighted MR images

Abstract

Purpose:To evaluate the diagnostic accuracy of a combination of dynamic contrast-enhanced MR imaging (DCE-MRI) and diffusion-weighted MR imaging (DWI) in characterization of enhanced mass on breast MR imaging and to find the strongest discriminators between carcinoma and benignancy. Materials and Methods:We analyzed consecutive breast MR images in 270 patients; however, 13 lesions in 93 patients were excluded based on our criteria. We analyzed tumor size, shape, margin, internal mass enhancement, kinetic curve pattern, and apparent diffusion coefficient (ADC) values. We applied univariate and multivariate analyses to find the strongest indicators of malignancy and calculate a predictive probability for malignancy. We added the corresponding categories to these prediction probabilities for malignancy and calculated diagnostic accuracy when we consider category 4b, 4c, and 5 lesions as malignant and category 4a, 3, and 2 lesions as benign. In a validation study, 75 enhancing lesions in 71 patients were examined consecutively.Results: Irregular margin, heterogeneous internal enhancement, rim enhancement, plateau time-intensity curve (TIC) pattern, and washout TIC pattern were the strongest indicators of malignancy as well as past studies, and ADC values less than 1.1 ϫ 10 Ϫ3 mm 2 /s were also the strongest indicators of malignancy. In a validation study, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 92% (56/61), 86% (12/14), 97% (56/58), 71% (12/17), and 91% (68/75), respectively. Conclusion:The combination of DWI and DCE-MRI could produce high diagnostic accuracy in the characterization of enhanced mass on breast MR imaging.

Value of Apparent Diffusion Coefficient Values in Differentiating Malignant and Benign Breast Lesions

“…Conversely, higher ADC values are usually associated with well-differentiated tumors or benign conditions. In keeping with our findings, in previous studies, lower ADC values were reported to be associated with malignant breast tumors rather than benign conditions (35,36). Constantini et al (37) reported an inverse correlation between the tumor grade and ADC values.…”

Correlation of the apparent diffusion coefficiency values on diffusion-weighted imaging with prognostic factors for breast cancer

“…Breast MRI is an established supplemental technique to mammography and ultrasonography for evaluation of suspicious breast lesions. Diffusion-weighted MRI (DWI) has recently been integrated into the standard breast MRI for discrimination of benign and malignant breast lesions obtained with dynamic contrast-enhanced MRI [1][2][3][4][5][6][7][8][9][10][11][12][13]. DWI is a non-invasive technique that represents the biological character of the mainly Brownian movement of protons in bulk water molecules in vivo.…”

MRI in the differential diagnosis of primary architectural distortion detected by mammography

“…Ei Khouli et al (17) showed that ADC values significantly improved the ability of DCE-MRI to discriminate between benign and malignant lesions. Yabuuchi et al (21,22) concluded that the application of DWI together with DCE-MRI contributes to an improved diagnostic accuracy of breast MRI. We found that DCE-MRI combined with ADC values provides a higher specificity than DCE-MRI in AD lesions detected by FFDM, independent of whether calcification is present or absent in the lesion.…”

“…One possible solution to improve this is to use apparent diffusion coefficient (ADC) values derived from diffusion-weighted imaging (DWI) to characterize breast tumors, and promising results have been reported by studies that combined ADC values and DCE-MRI in data analysis (17)(18)(19)(20)(21)(22). Nevertheless, few investigations have specifically evaluated MRI findings of AD detected by mammography, and moreover, the standard MRI scanning techniques have evolved since publication of these studies (23,24).…”