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Comparative Study
. 2014 Sep;40(3):674-81.
doi: 10.1002/jmri.24416. Epub 2013 Nov 8.

High-resolution diffusion-weighted imaging for the separation of benign from malignant BI-RADS 4/5 lesions found on breast MRI at 3T

Dorota J Wisner  1 , Nathan Rogers, Vibhas S Deshpande, David N Newitt, Gerhard A Laub, David A Porter, John Kornak, Bonnie N Joe, Nola M Hylton
Affiliations
Comparative Study

High-resolution diffusion-weighted imaging for the separation of benign from malignant BI-RADS 4/5 lesions found on breast MRI at 3T

Dorota J Wisner et al. J Magn Reson Imaging. 2014 Sep.

Abstract

Purpose: To determine whether readout-segmented echo-planar diffusion imaging (RESOLVE) improves separation of malignant versus benign lesions compared to standard single-shot echo-planar imaging (ss-EPI) on BI-RADS 4/5 lesions detected on breast magnetic resonance imaging (MRI).

Materials and methods: Consecutive 3T breast MRI studies with BI-RADS 4/5 designation and subsequent biopsy or benign mastectomy were retrospectively identified. Freehand regions of interest (ROIs) were drawn on lesions and also on normal background fibroglandular tissue for comparison. Lesion-to-background contrast was evaluated by normalizing signal intensity of the lesion ROI by the normal background tissue ROI at b = 800. Statistical analysis used the Mann-Whitney/Wilcoxon rank-sum test for unpaired and Wilcoxon signed-rank for paired comparisons.

Results: Of 38 lesions in 32 patients, 10 were malignant. Lesion-to-background contrast was higher on RESOLVE than ss-EPI (1.80 ± 0.71 vs. 1.62 ± 0.63, P = 0.03). Mean apparent diffusion coefficient (ADC) was the same or lower on RESOLVE than ss-EPI, and this effect was largest in malignant lesions (RESOLVE 0.90 ± 0.13; ss-EPI 1.00 ± 0.13; median difference -0.10 (95% confidence interval [CI]: -0.17, -0.02) × 10(-3) mm(2) /sec; P = 0.014). By either diffusion method, there was a statistically significant difference between benign and malignant mean ADC (P < 0.001).

Conclusion: Increased lesion-to-background contrast and improved separation of benign from malignant lesions by RESOLVE compared to standard diffusion suggests that RESOLVE may show promise as an adjunct to clinical breast MRI.

Keywords: DWI; benign; breast MRI; diffusion; malignant; screening.

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Figures

Figure 1
Figure 1. Comparison of ADC values obtained by standard (ss-EPI) versus RESOLVE
Box plot demonstrating mean ADC distribution for normal, benign, and malignant breast tissue using the ss-EPI and RESOLVE diffusion methods. The whiskers extend to the most extreme values inside the range defined as 1.5 times the interquartile range. All data points outside this range are plotted as outliers, but were included in the standard deviation calculations of Table 3. For both ss-EPI and RESOLVE diffusion, normal breast tissue demonstrates the highest ADC values. Benign lesions had intermediate ADC values. Malignant lesions had the lowest ADC values, and demonstrated the largest paired differences between RESOLVE and ss-EPI.
Figure 2
Figure 2. Example of suspicious lesion, found to be malignant
Malignant lesion as identified on the axial post-contrast T1 images (a), and on b800 maps using RESOLVE (b) and standard diffusion (ss-EPI) (d). T2 images (not shown) did not demonstrate evidence of T2 shine-through. Window-leveling between RESOLVE and ss-EPI images is equalized on both b800 and ADC images. The lesion-to-background contrast is higher on RESOLVE than ss-EPI b800. Resulting ADC maps reveal a mean ADC of 0.861 × 10−3 mm2/sec by RESOLVE (c) and 1.038 × 10−3 mm2/sec by ss-EPI (e). Pathology demonstrated 6-mm grade 2 invasive ductal carcinoma.
Figure 2
Figure 2. Example of suspicious lesion, found to be malignant
Malignant lesion as identified on the axial post-contrast T1 images (a), and on b800 maps using RESOLVE (b) and standard diffusion (ss-EPI) (d). T2 images (not shown) did not demonstrate evidence of T2 shine-through. Window-leveling between RESOLVE and ss-EPI images is equalized on both b800 and ADC images. The lesion-to-background contrast is higher on RESOLVE than ss-EPI b800. Resulting ADC maps reveal a mean ADC of 0.861 × 10−3 mm2/sec by RESOLVE (c) and 1.038 × 10−3 mm2/sec by ss-EPI (e). Pathology demonstrated 6-mm grade 2 invasive ductal carcinoma.
Figure 2
Figure 2. Example of suspicious lesion, found to be malignant
Malignant lesion as identified on the axial post-contrast T1 images (a), and on b800 maps using RESOLVE (b) and standard diffusion (ss-EPI) (d). T2 images (not shown) did not demonstrate evidence of T2 shine-through. Window-leveling between RESOLVE and ss-EPI images is equalized on both b800 and ADC images. The lesion-to-background contrast is higher on RESOLVE than ss-EPI b800. Resulting ADC maps reveal a mean ADC of 0.861 × 10−3 mm2/sec by RESOLVE (c) and 1.038 × 10−3 mm2/sec by ss-EPI (e). Pathology demonstrated 6-mm grade 2 invasive ductal carcinoma.
Figure 2
Figure 2. Example of suspicious lesion, found to be malignant
Malignant lesion as identified on the axial post-contrast T1 images (a), and on b800 maps using RESOLVE (b) and standard diffusion (ss-EPI) (d). T2 images (not shown) did not demonstrate evidence of T2 shine-through. Window-leveling between RESOLVE and ss-EPI images is equalized on both b800 and ADC images. The lesion-to-background contrast is higher on RESOLVE than ss-EPI b800. Resulting ADC maps reveal a mean ADC of 0.861 × 10−3 mm2/sec by RESOLVE (c) and 1.038 × 10−3 mm2/sec by ss-EPI (e). Pathology demonstrated 6-mm grade 2 invasive ductal carcinoma.
Figure 2
Figure 2. Example of suspicious lesion, found to be malignant
Malignant lesion as identified on the axial post-contrast T1 images (a), and on b800 maps using RESOLVE (b) and standard diffusion (ss-EPI) (d). T2 images (not shown) did not demonstrate evidence of T2 shine-through. Window-leveling between RESOLVE and ss-EPI images is equalized on both b800 and ADC images. The lesion-to-background contrast is higher on RESOLVE than ss-EPI b800. Resulting ADC maps reveal a mean ADC of 0.861 × 10−3 mm2/sec by RESOLVE (c) and 1.038 × 10−3 mm2/sec by ss-EPI (e). Pathology demonstrated 6-mm grade 2 invasive ductal carcinoma.
Figure 3
Figure 3. Example of suspicious lesion, found to be benign
Benign lesion as identified on the axial post-contrast T1 images (a), and on b800 maps using RESOLVE (b) and standard diffusion (ss-EPI) (d). T2 images (not shown) did not demonstrate evidence of T2 shine-through. Window-leveling between RESOLVE and ss-EPI images is equalized on both b800 and ADC images. RESOLVE demonstrates slightly less banding at fibroglandular-fat interfaces. Resulting ADC maps reveal a mean ADC of 1.241 × 10−3 mm2/sec by RESOLVE (c) and 1.413 × 10−3 mm2/sec by ss-EPI (e). Pathology demonstrated usual ductal hyperplasia.
Figure 3
Figure 3. Example of suspicious lesion, found to be benign
Benign lesion as identified on the axial post-contrast T1 images (a), and on b800 maps using RESOLVE (b) and standard diffusion (ss-EPI) (d). T2 images (not shown) did not demonstrate evidence of T2 shine-through. Window-leveling between RESOLVE and ss-EPI images is equalized on both b800 and ADC images. RESOLVE demonstrates slightly less banding at fibroglandular-fat interfaces. Resulting ADC maps reveal a mean ADC of 1.241 × 10−3 mm2/sec by RESOLVE (c) and 1.413 × 10−3 mm2/sec by ss-EPI (e). Pathology demonstrated usual ductal hyperplasia.
Figure 3
Figure 3. Example of suspicious lesion, found to be benign
Benign lesion as identified on the axial post-contrast T1 images (a), and on b800 maps using RESOLVE (b) and standard diffusion (ss-EPI) (d). T2 images (not shown) did not demonstrate evidence of T2 shine-through. Window-leveling between RESOLVE and ss-EPI images is equalized on both b800 and ADC images. RESOLVE demonstrates slightly less banding at fibroglandular-fat interfaces. Resulting ADC maps reveal a mean ADC of 1.241 × 10−3 mm2/sec by RESOLVE (c) and 1.413 × 10−3 mm2/sec by ss-EPI (e). Pathology demonstrated usual ductal hyperplasia.
Figure 3
Figure 3. Example of suspicious lesion, found to be benign
Benign lesion as identified on the axial post-contrast T1 images (a), and on b800 maps using RESOLVE (b) and standard diffusion (ss-EPI) (d). T2 images (not shown) did not demonstrate evidence of T2 shine-through. Window-leveling between RESOLVE and ss-EPI images is equalized on both b800 and ADC images. RESOLVE demonstrates slightly less banding at fibroglandular-fat interfaces. Resulting ADC maps reveal a mean ADC of 1.241 × 10−3 mm2/sec by RESOLVE (c) and 1.413 × 10−3 mm2/sec by ss-EPI (e). Pathology demonstrated usual ductal hyperplasia.
Figure 3
Figure 3. Example of suspicious lesion, found to be benign
Benign lesion as identified on the axial post-contrast T1 images (a), and on b800 maps using RESOLVE (b) and standard diffusion (ss-EPI) (d). T2 images (not shown) did not demonstrate evidence of T2 shine-through. Window-leveling between RESOLVE and ss-EPI images is equalized on both b800 and ADC images. RESOLVE demonstrates slightly less banding at fibroglandular-fat interfaces. Resulting ADC maps reveal a mean ADC of 1.241 × 10−3 mm2/sec by RESOLVE (c) and 1.413 × 10−3 mm2/sec by ss-EPI (e). Pathology demonstrated usual ductal hyperplasia.
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