Role of diffusion weighted imaging and dynamic contrast enhanced magnetic resonance imaging in breast tumors

Gareer

Egypt J Radiol Nucl Med

et al. 2021

Background Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) has always been a problem solver in troublesome breast lesions. Despite its many advantages, the encountered low specificity results in unnecessary biopsies. Diffusion-weighted MRI (DW-MRI) is a well-established technique that helps in characterizing breast lesions according to their water diffusivity. So this work aimed to assess the diagnostic performance of DW-MRI in troublesome breast lesions and see if it can replace DCE-MRI study. Results In our prospective study, we included 86 patients with mammography and/or ultrasound-detected 90 probably benign or probably malignant (BIRADS 3 or 4) breast lesions. Among the studied cases, 49/90 lesions were benign, and 41/90 were malignant. Combined analysis of morphological and kinetic findings in DCE-MRI had achieved the highest sensitivity of 95.1%. DW-MRI alone was less sensitive (73.2%) yet more specific (83.7%) than DCE-MRI (77.6%). Diagnostic accuracy of DCE-MRI was higher (85.6%) as compared to DW-MRI which was (78.9%). Conclusion DCE-MRI is the cornerstone in the workup of troublesome breast lesions. DW-MRI should not be used as supplementary tool unless contrast administration is contraindicated. Combining both DCE-MRI and DW-MRI is the ultimate technique for better lesion evaluation.

Section: Discussionmentioning

confidence: 57%

Can DWI-MRI be an alternative to DCE-MRI in the diagnosis of troublesome breast lesions?

Gareer

Egypt J Radiol Nucl Med

et al. 2021

“…A further 103 studies were excluded for the study type (not articles), 40 studies were excluded for the language, and 111 studies were excluded for failure to meet the eligibility criteria after carefully reading the full text: failure to extract the number of true positives, false negatives, false negatives, and true negatives; no mp-MRI to diagnose breast cancer; and did not use 1.5-T or 3.0-T MRI machines. Finally, 22 studies were included in the meta-analysis (2–4,8–12,14–17,29–38).…”

Section: Resultsmentioning

confidence: 99%

“…Several authors have demonstrated that the number of benign breast lesions among the lesions with type I contrast enhancement kinetic was larger than that among lesions with type II or type III contrast kinetics. It means that the lesions with type I contrast kinetic tend to be benign (36,40–42). In addition, the number of malignant breast lesions was larger among the lesions with type III contrast enhancement kinetic than that among the lesions with type I or type II contrast enhancement kinetics (36,40–42).…”

Section: Discussionmentioning

confidence: 99%

Accuracy of multiparametric MRI in distinguishing the breast malignant lesions from benign lesions: a meta-analysis

et al. 2020

Background The sensitivity of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for detecting breast cancer was high and the specificity was relatively low. However, diffusion-weighted imaging (DWI) has a high specificity in the diagnosis of malignant lesions. Purpose To evaluate the accuracy of the multiparametric MRI (mp-MRI) in distinguishing the breast malignant lesions from the benign lesions. Material and Methods A comprehensive search of the PubMed, Embase, and Cochrane Library electronic databases was conducted up to March 2020. Data were analyzed for the following indexes: pooled sensitivity and specificity; positive likelihood ratio; negative likelihood ratio; diagnostic odds ratio; and the area under the curve. Results A total of 2356 patients with 1604 malignant and 967 benign breast lesions were included from 22 studies. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and area under the curve for mp-MRI were 0.93, 0.85, 6.3, 0.08, 81, and 0.96, respectively. The pooled sensitivity, specificity, and area under the curve for DCE-MRI alone were 0.95, 0.71, and 0.92, respectively. The pooled sensitivity, specificity, and area under the curve for DWI alone were 0.88, 0.84, and 0.93, respectively. Conclusion The mp-MRI did not improve the sensitivity but increased the specificity for the diagnosis of breast malignant lesions.

“…Another study done by Bakry et al . in 2015, to evaluate the role of DWI and DCE-MRI in characterisation of breast tumours, showed a sensitivity of 91.7% and a specificity of 84.2% for DCE-MRI alone [ 14 ]. The diffusion-weighted MRI showed a sensitivity of 94.4% and a specificity of 92.1%.…”

Section: Discussionmentioning

confidence: 99%

Effectivity of combined diffusion-weighted imaging and contrast-enhanced MRI in malignant and benign breast lesions

Yadav

Chauhan

2018

Pol J Radiol

PurposeMammography is the most commonly used diagnostic test for breast lesion detection and evaluation, but in dense breast parenchyma it lowers its sensitivity to detect small lesions. Sensitivity and specificity improves with combined use of contrast-enhanced magnetic resonance imaging (CE-MRI) and diffusion-weighted imaging (DWI) in differentiating benign and malignant breast lesions. The aim of the study was to evaluate the effectivity of combined dynamic CE-MRI and DWI in differentiating benign and malignant lesions, and to calculate the apparent diffusion coefficient (ADC) values of malignant and benign lesions of the breast.Material and methodsFifty-seven patients with 68 lesions were included in the study. MRI of breast using different sequences was acquired on 1.5 Tesla Machine with dedicated breast coils. Dynamic CE-MRI along with DWI was acquired for each patient. Histopathological reports were accepted as the standard of reference.ResultsOut of 68 lesions, 37 were malignant on biopsy (54.4%) and 31 were benign (45.5%). The sensitivity of CE-MRI was 92%, specificity 84.21%, positive predictive values (PPV) 88.46 %, and negative predictive values (NPP) 88.89%. The sensitivity of DWI-MRI was 91.6%, specificity was 90.6%, PPV 91.6%, and NPP 90.6%. The sensitivity of combined DWI-MRI and CE-MRI was 95.0%, specificity was 96.43%, PPV 97.44%, and NPP 93.10%. Mean ADCs of benign lesions (b = 800) was 1.905 ± 0.59 × 10–3 mm (2)/s, which was significantly higher than those of malignant lesions (b = 800) 1.014 ± 0.47 × 10–3 mm (2)/s.ConclusionMulti-parametric MRI is an excellent non-invasive modality with high sensitivity and specificity to differentiate malignant from benign breast lesions.