Independent value of image fusion in unenhanced breast MRI using diffusion-weighted and morphological T2-weighted images for lesion characterization in patients with recently detected BI-RADS 4/5 x-ray mammography findings

Abstract

• Unenhanced breast MRI with additional DWIBS/T2w-image fusion allows reliable lesion characterization. • Abbreviated reading of fused DWIBS/T2w-images alone decreases diagnostic confidence and accuracy. • Reading fused DWIBS/T2w-images as the sole diagnostic method should be avoided.

Prediction of malignancy by a radiomic signature from contrast agent‐free diffusion MRI in suspicious breast lesions found on screening mammography.

“…Prior to MRI, all women underwent the regular screening work‐up process including ultrasound, clinical examination, and, if necessary, a magnification mammography for further characterization of the lesions. The examined cohort was subject to a prior study focusing on diagnostic performance of unenhanced MRM in the hands of expert radiologists and the added benefit of maximum intensity projections (MIPs) and image fusion techniques; however, radiomic analyses in this group have not been previously performed. Baseline epidemiological and clinical characteristics including tumor location, pathological findings, and BI‐RADS assessment are shown in Supplementary Table 1.…”

“…Recently, contrast‐free breast MRI protocols with high‐quality diffusion‐weighted imaging (DWI) have shown promise in the diagnostic decision‐making of breast lesions . The combination of DWI with morphological T 2 ‐weighted imaging sequences has been reported to provide reliable characterization of breast lesions . Recently, DWI is increasingly being incorporated into breast MRI, as it has shown promise in improved differentiation of benign and malignant lesions and noncontrast detection of breast cancer …”

“…[7][8][9][10][11] The combination of DWI with morphological T 2 -weighted imaging sequences has been reported to provide reliable characterization of breast lesions. [7][8][9]11,12 Recently, DWI is increasingly being incorporated into breast MRI, as it has shown promise in improved differentiation of benign and malignant lesions and noncontrast detection of breast cancer. 13 A further measure to improve this methodic approach may lie in its combination with a radiomic approach.…”

Assessment of breast mass morphology with diffusion‐weighted MRI: Beyond apparent diffusion coefficient

“…On the other hand, abbreviated breast MRI protocols have gained significant popularity due to their shorter acquisition time, lower cost, and comparable diagnostic accuracy to DCE‐MRI . However, there are some recent concerns about nephrogenic systemic fibrosis and gadolinium deposition in neural tissues, which provoked the search for noncontrast‐enhanced breast MRI protocols . The results of those and our present study show that DWI is highly effective in the detection and characterization of breast tumors, and it may be potentially used as an abbreviated MRI for screening or even for some diagnostic purposes.…”

“…In the literature, 78–94% sensitivity and 79–94% specificity were reported for unenhanced MRI combining DWI with T 1 and/or T 2 ‐weighted sequences . On the other hand, 89–91% sensitivity and 91–94% specificity were reported for contrast‐enhanced abbreviated MRI .…”