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. 2019 Jul;20(7):142-150.
doi: 10.1002/acm2.12624. Epub 2019 May 23.

Combined application of pharamcokinetic DCE-MRI and IVIM-DWI could improve detection efficiency in early diagnosis of ductal carcinoma in situ

Wei-Jing Tao  1 , Hui-Xin Zhang  2 , Lian-Mei Zhang  3 , Feng Gao  4 , Wei Huang  5 , Yan Liu  5 , Yan Zhu  5 , Gen-Ji Bai  5
Affiliations

Combined application of pharamcokinetic DCE-MRI and IVIM-DWI could improve detection efficiency in early diagnosis of ductal carcinoma in situ

Wei-Jing Tao et al. J Appl Clin Med Phys. 2019 Jul.

Abstract

Purpose: Ductal carcinoma in situ (DCIS) is a precursor of invasive ductal breast carcinoma (IDC). This study aimed to use pharamcokinetic dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) for the early diagnosis of DCIS.

Methods: Forty-seven patients, including 25 with DCIS (age: 28-70 yr, mean age: 48.7 yr) and 22 with benign disease (age: 25-67 yr, mean age: 43.1 yr) confirmed by pathology, underwent pharamcokinetic DCE-MRI and IVIM-DWI in this study. The quantitative parameters Ktrans , Kep , Ve , Vp , and D, f, D* were obtained by processing of DCE-MRI and IVIM-DWI images with Omni-Kinetics and MITK-Diffusion softwares, respectively. Parameters were analyzed statistically using GraphPad Prism and MedCalc softwares.

Results: All low-grade DCIS lesions demonstrated mass enhancement with clear boundaries, while most middle-grade and high-grade DCIS lesions showed non-mass-like enhancement (NMLE). DCIS lesions were significantly different from benign lesions in terms of Ktrans , Kep , and D (t = 5.959, P < 0.0001; t = 5.679, P < 0.0001; and t = 5.629, P < 0.0001, respectively). The AUC of Ktrans , Kep , D and the combined indicator of Ktrans , Kep, and D were 0.936, 0.902, 0.860, and 0.976, respectively. There was a significant difference in diagnostic efficacy only between D and the combined indicator (Z = 2.408, P = 0.016).

Conclusion: DCE-MRI and IVIM-DWI could make for the early diagnosis of DCIS, and reduce the misdiagnosis of DCIS and over-treatment of benign lesions.

Keywords: diffusion-weighted imaging; ductal carcinoma in situ; dynamic contrast-enhanced magnetic resonance imaging; intravoxel incoherent motion.

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Conflict of interest statement

The authors declare no competing financial interests.

Figures

Figure 1
Figure 1
A 49‐year‐old woman had bilateral breast tumors for >7 months, without pain and fever. (a–c) T2WI, T1WI, and T1WI‐FS scans showed bilateral breast lesions with hypointensity on T1WI and hyperintensity on T2WI. (d) Enhanced T1WI‐FS showed bilateral breast lesions that were significantly enhanced, in mass enhancement. (e–h) Bilateral breast tumors are shown in Ktrans, Kep, Ve, and Vp maps, respectively, by postprocessing of dynamic contrast‐enhanced magnetic resonance imaging. (i–k) The D, f, and D* maps were obtained, respectively, by postprocessing of intravoxel incoherent motion diffusion‐weighted imaging images. (l–m) Hematoxylin and eosin‐stained (×200) images showed that the left lesion was a fibroadenoma and the right lesion was ductal carcinoma in situ.
Figure 2
Figure 2
A 51‐yr‐old female exhibited a left breast mass for 1 month. (a–c) T2WI, T1WI, and T1WI‐FS scans showed the left breast lesion was hypointense on T1WI and hyperintense on T2WI without boundaries. (d) Enhanced T1WI‐FS showed that the left breast lesion exhibited non‐mass‐like enhancement. (e–h) The Ktrans, Kep, Ve, and Vp maps with the left breast lesion were obtained respectively by postprocessing of dynamic contrast‐enhanced magnetic resonance imaging. (i–k) The D, f, and D* maps were obtained by postprocessing of intravoxel incoherent motion diffusion‐weighted imaging images. (l) Hematoxylin and eosin‐stained (×200) images showed that the left lesion was ductal carcinoma in situ.
Figure 3
Figure 3
A 61‐yr‐old woman reported a left breast nodule for 5 days. (a–c) T2WI, T1WI, and T1WI‐FS scans showed the left breast lesion was hypointense on T1WI and hyperintense on T2WI. (d) Enhanced T1WI‐FS showed that the left breast lesion exhibited mass enhancement. (e–h) The Ktrans, Kep, Ve, and Vp maps obtained for the left breast lesion, by postprocessing of dynamic contrast‐enhanced magnetic resonance imaging. (i–k) The D, f, and D* maps were obtained by postprocessing of intravoxel incoherent motion diffusion‐weighted imaging images. (l) Hematoxylin and eosin‐stained (×200) image showed that the left lesion was fibroadenoma.
Figure 4
Figure 4
A 26‐yr‐old female reported a right breast lesion for 2 months that gradually enlarged, without pain and fever. (a–c) T2WI, T1WI, and T1WI‐FS scans showed that the left breast lesion was hypointense on T1WI and hyperintense on T2WI without boundaries. (d) Enhanced T1WI‐FS showed that the right breast lesion exhibited non‐mass‐like enhancement. (e–h) The Ktrans, Kep, Ve, and Vp maps obtained for the right breast lesion, by postprocessing of dynamic contrast‐enhanced magnetic resonance imaging. (i–k) The D, f, and D* maps were obtained by postprocessing of intravoxel incoherent motion diffusion‐weighted imaging images. (l) Hematoxylin and eosin (×200) image showed that the right lesion was inflammatory.
Figure 5
Figure 5
(a) The box and whiskers of dynamic contrast‐enhanced magnetic resonance imaging parameters of ductal carcinoma in situ (DCIS) and benign lesions. (b) The box and whiskers of intravoxel incoherent motion diffusion‐weighted imaging parameters of ductal carcinoma in situ (DCIS) and benign lesions.
Figure 6
Figure 6
Receiver operating characteristic curves of the parameters Ktrans, Kep, D, and the combined indicator of Ktrans, Kep, and D to diagnosis DCIS and benign lesions.
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