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01-02-2017 | Breast

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

Authors: Sebastian Bickelhaupt, Jana Tesdorff, Frederik Bernd Laun, Tristan Anselm Kuder, Wolfgang Lederer, Susanne Teiner, Klaus Maier-Hein, Heidi Daniel, Anne Stieber, Stefan Delorme, Heinz-Peter Schlemmer

Published in: European Radiology | Issue 2/2017

Abstract

Objectives

The aim of this study was to evaluate the accuracy and applicability of solitarily reading fused image series of T2-weighted and high-b-value diffusion-weighted sequences for lesion characterization as compared to sequential or combined image analysis of these unenhanced sequences and to contrast- enhanced breast MRI.

Methods

This IRB-approved study included 50 female participants with suspicious breast lesions detected in screening X-ray mammograms, all of which provided written informed consent. Prior to biopsy, all women underwent MRI including diffusion-weighted imaging (DWIBS, b = 1500s/mm²). Images were analyzed as follows: prospective image fusion of DWIBS and T2-weighted images (FU), side-by-side analysis of DWIBS and T2-weighted series (CO), combination of the first two methods (CO+FU), and full contrast-enhanced diagnostic protocol (FDP). Diagnostic indices, confidence, and image quality of the protocols were compared by two blinded readers.

Results

Reading the CO+FU (accuracy 0.92; NPV 96.1 %; PPV 87.6 %) and the CO series (0.90; 96.1 %; 83.7 %) provided a diagnostic performance similar to the FDP (0.95; 96.1 %; 91.3 %; p > 0.05). FU reading alone significantly reduced the diagnostic accuracy (0.82; 93.3 %; 73.4 %; p = 0.023).

Conclusions

MR evaluation of suspicious BI-RADS 4 and 5 lesions detected on mammography by using a non-contrast-enhanced T2-weighted and DWIBS sequence protocol is most accurate if MR images were read using the CO+FU protocol.

Key Points

• 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.

Thomassin-Naggara I, De Bazelaire C, Chopier J, Bazot M, Marsault C, Trop I (2013) Diffusion-weighted MR imaging of the breast: advantages and pitfalls. Eur J Radiol 82:435–443CrossRefPubMed

Cipolla V, Santucci D, Guerrieri D, Drudi FM, Meggiorini ML, de Felice C (2014) Correlation between 3T apparent diffusion coefficient values and grading of invasive breast carcinoma. Eur J Radiol 83:2144–2150CrossRefPubMed

Choi S, Chang Y, Park H, Kim H, Hong S, Seo D (2012) Correlation of the apparent diffusion coefficiency values on diffusion-weighted imaging with prognostic factors for breast cancer. Br J Radiol 85:e474–e479CrossRefPubMedPubMedCentral

Stadlbauer A, Bernt R, Gruber S et al (2009) Diffusion-weighted MR imaging with background body signal suppression (DWIBS) for the diagnosis of malignant and benign breast lesions. Eur Radiol 19:2349–2356CrossRefPubMed

Kuhl CK, Schrading S, Strobel K, Schild HH, Hilgers R-D, Bieling HB (2014) Abbreviated breast magnetic resonance imaging (MRI): first postcontrast subtracted images and maximum-intensity projection—a novel approach to breast cancer screening with MRI. J Clin Oncol 32:2304–2310CrossRefPubMed

Kuhl CK (2006) MR Imaging for surveillance of women at high familial risk for breast cancer. Magn Reson Imaging Clin N Am 14:391–402CrossRefPubMed

Takahara T, Imai Y, Yamashita T, Yasuda S, Nasu S, Van Cauteren M (2004) Diffusion weighted whole body imaging with background body signal suppression (DWIBS): technical improvement using free breathing, STIR and high resolution 3D display. Radiat Med 22:275–282PubMed

Fathi Kazerooni A, Mohseni M, Rezaei S, Bakhshandehpour G, Saligheh Rad H (2014) Multi-parametric (ADC/PWI/T2-w) image fusion approach for accurate semi-automatic segmentation of tumorous regions in glioblastoma multiforme. Magn Reson Mater Phys Biol Med. doi:10.1007/s10334-014-0442-7:1-10

Mir N, Sohaib SA, Collins D, Koh DM (2010) Technical article: fusion of high b-value diffusion-weighted and T2-weighted MR images improves identification of lymph nodes in the pelvis. J Med Imaging Radiat Oncol 54:358–364CrossRefPubMed

10.

Park JJ, Kim CK, Park SY, Park BK (2014) Parametrial invasion in cervical cancer: fused T2-weighted imaging and high-b-value diffusion-weighted imaging with background body signal suppression at 3 T. Radiology. doi:10.1148/radiol.14140920:140920

11.

Telegrafo M, Rella L, Stabile Ianora AA, Angelelli G, Moschetta M (2015) Unenhanced breast MRI (STIR, T2-weighted TSE, DWIBS): an accurate and alternative strategy for detecting and differentiating breast lesions. Magn Reson Imaging 33:951–955CrossRefPubMed

12.

Trimboli RM, Verardi N, Cartia F, Carbonaro LA, Sardanelli F (2014) Breast cancer detection using double reading of unenhanced MRI Including T1-weighted, T2-weighted STIR, and diffusion-weighted imaging: a proof of concept study. Am J Roentgenol 203:674–681CrossRef

13.

McDonald ES, Hammersley JA, Chou SS et al (2016) Performance of DWI as a rapid unenhanced technique for detecting mammographically occult breast cancer in elevated-risk women with dense breasts. AJR Am J Roentgenol 14:W1–W12

14.

Kul S, Oguz S, Eyuboglu I, Komurcuoglu O (2015) Can unenhanced breast MRI be used to decrease negative biopsy rates? Diagn Interv Radiol 21:287–292CrossRefPubMedPubMedCentral

15.

Bickelhaupt S, Laun FB, Tesdorff J, Lederer W, Daniel H, Stieber A, Delorme S, Schlemmer HP (2016) Fast and noninvasive characterization of suspicious lesions detected at breast cancer x-ray screening: capability of diffusion-weighted MR imaging with MIPs. Radiology 278(3):689–697

16.

Morsbach F, Bickelhaupt S, Wanner GA, Krauss A, Schmidt B, Alkadhi H (2013) Reduction of metal artifacts from hip prostheses on CT images of the pelvis: value of iterative reconstructions. Radiology 268:237–244CrossRefPubMed

17.

Yiang Y, Metz CE (2010) BI-RADS data should not be used to estimate ROC curves. Radiology 256:29–31CrossRef

18.

Nechifor-Boila IA, Bancu S, Buruian M et al (2013) Diffusion weighted imaging with background body signal suppression / T2 image fusion in magnetic resonance mammography for breast cancer diagnosis. Chirur (Bucur) 108:199–205

19.

Golatta M, Schweitzer-Martin M, Harcos A et al (2014) Evaluation of virtual touch tissue imaging quantification, a new shear wave velocity imaging method, for breast lesion assessment by ultrasound. Biomed Res Int 960262:31

20.

Molinari C, Clauser P, Girometti R et al (2015) MR mammography using diffusion-weighted imaging in evaluating breast cancer: a correlation with proliferation index. Radiol Med 120:911–918CrossRefPubMed

Title: 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
Authors: Sebastian Bickelhaupt
Jana Tesdorff
Frederik Bernd Laun
Tristan Anselm Kuder
Wolfgang Lederer
Susanne Teiner
Klaus Maier-Hein
Heidi Daniel
Anne Stieber
Stefan Delorme
Heinz-Peter Schlemmer
Publication date: 01-02-2017
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 2/2017
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-016-4400-9

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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

Objectives

Methods

Results

Conclusions

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Key Points

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