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. 2024 Jul;34(7):4730-4737.
doi: 10.1007/s00330-023-10321-y. Epub 2023 Nov 27.

Image quality of DWI at breast MRI depends on the amount of fibroglandular tissue: implications for unenhanced screening

Mirjam Wielema  1   2 , Paul E Sijens  1 , Ruud M Pijnappel  3 , Geertruida H De Bock  2 , Marcel Zorgdrager  1 , Marius G J Kok  4 , Eva Rainer  5 , Raoul Varga  5 , Paola Clauser  5 , Matthijs Oudkerk  6 , Monique D Dorrius  1   2 , Pascal A T Baltzer  7
Affiliations

Image quality of DWI at breast MRI depends on the amount of fibroglandular tissue: implications for unenhanced screening

Mirjam Wielema et al. Eur Radiol. 2024 Jul.

Abstract

Objectives: To compare image quality of diffusion-weighted imaging (DWI) and contrast-enhanced breast MRI (DCE-T1) stratified by the amount of fibroglandular tissue (FGT) as a measure of breast density.

Methods: Retrospective, multi-reader, bicentric visual grading analysis study on breast density (A-D) and overall image and fat suppression quality of DWI and DCE-T1, scored on a standard 5-point Likert scale. Cross tabulations and visual grading characteristic (VGC) curves were calculated for fatty breasts (A/B) versus dense breasts (C/D).

Results: Image quality of DWI was higher in the case of increased breast density, with good scores (score 3-5) in 85.9% (D) and 88.4% (C), compared to 61.6% (B) and 53.5% (A). Overall image quality of DWI was in favor of dense breasts (C/D), with an area under the VGC curve of 0.659 (p < 0.001). Quality of DWI and DCE-T1 fat suppression increased with higher breast density, with good scores (score 3-5) for 86.9% and 45.7% of density D, and 90.2% and 42.9% of density C cases, compared to 76.0% and 33.6% for density B and 54.7% and 29.6% for density A (DWI and DCE-T1 respectively).

Conclusions: Dense breasts show excellent fat suppression and substantially higher image quality in DWI images compared with non-dense breasts. These results support the setup of studies exploring DWI-based MR imaging without IV contrast for additional screening of women with dense breasts.

Clinical relevance statement: Our findings demonstrate that image quality of DWI is robust in women with an increased amount of fibroglandular tissue, technically supporting the feasibility of exploring applications such as screening of women with mammographically dense breasts.

Key points: • Image and fat suppression quality of diffusion-weighted imaging are dependent on the amount of fibroglandular tissue (FGT) which is closely connected to breast density. • Fat suppression quality in diffusion-weighted imaging of the breast is best in women with a high amount of fibroglandular tissue. • High image quality of diffusion-weighted imaging in women with a high amount of FGT in MRI supports that the technical feasibility of DWI can be explored in the additional screening of women with mammographically dense breasts.

Keywords: Area under the curve; Breast density; Diffusion magnetic resonance imaging; Early detection of cancer; Neoplasms.

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Conflict of interest statement

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Figures

Fig. 1
Fig. 1
Stacked bar chart of the quality of fat suppression of diffusion-weighted imaging for each amount of fibroglandular tissue category
Fig. 2
Fig. 2
Visual grading characteristics (VGC) curve comparing the fat suppression quality of DWI images and T1 early post-contrast images between breast with a low and a high amount of fibroglandular tissue
Fig. 3
Fig. 3
Stacked bar chart of the quality of fat suppression of DCE-T1 for each amount of fibroglandular tissue category
Fig. 4
Fig. 4
Stacked bar chart showing the quality of fat suppression of DCE-T1 for DIXON and SPAIR fat suppression, displayed per amount of fibroglandular tissue category
See this image and copyright information in PMC

Comment in

References

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