Keum Won Kim MD, Presenter: Nothing to Disclose

Jae Young Seo, Abstract Co-Author: Nothing to Disclose

Young Joong Kim MD, Abstract Co-Author: Nothing to Disclose

Cheol Mog Hwang MD, Abstract Co-Author: Nothing to Disclose

Young Jun Cho MD, Abstract Co-Author: Nothing to Disclose

Dae Ho Kim, Abstract Co-Author: Nothing to Disclose

You Mi Ra, Abstract Co-Author: Nothing to Disclose

The purpose of our study was to compare the accuracy and diagnostic values among diffusion-weighted imaging (DWI), dynamic contrast enhanced (DCE) MRI, and combination of DWI and DCE MRI in patients with suspicious breast lesions.

65 breast lesions of 35 patients who underwent subsequent biopsy or operation, were enrolled. They underwent DCE-MRI and DWI (b values of 1000 s/mm2). Morphologic and kinetic analyses on DCE-MRI were classified according to the BIRADS lexicon. The ADC values were calculated from the DWI. On DWI set, we were sorted according to the confidence levels for lesion characterization into five grades by comparing DWI and T2WI (confidence level 1, 2-benign, Confidence level 3, 4, 5-malignant). For the combined analysis, morphologic, kinetic features and DWI set confidence levels were evaluated together. Diagnostic values of DCE-MRI assessment, DWI set and combined analysis were calculated.

Of the 65 breast lesions, 27 were benign and 38 were malignant (8 DCIS, and 30 IDC). The mean ADCs of the invasive ductal carcinoma (0.86± 0.19 x 10-3 mm2/s) and DCIS (1.04 ± 0.27 x 10-3 mm2/s) were significantly lower than those of the benign lesions (1.35± 0.23x10-3 mm2/s). An ADC cutoff value of 1.1875x 10-3 mm2/s allowed discrimination between malignant and benign lesions (sensitivity: 85.2%, specificity: 87.9%). DCE-MRI assessment showed 94.74% sensitivity, 51.85% specificity and 73.5% positive predictive value (PPV). DWI set showed 93.51% sensitivity, 77.78% specificity and 85.1% PPV. Combined analysis provided 97.37% sensitivity, 81.4% specificity and 88.1% PPV. The specificity and PPV of combined analysis improved significantly (p< 0.05). The characterization accuracy on combined analysis (Az = 0.894) and the DWI set (Az=0.863) were higher than that on the DCE-MRI assessment (Az=0.733) for the breast lesions (p< 0.05).

The DWI set provided a higher accuracy for differentiation between benign and malignant breast lesions than DCE-MRI. The combination of DWI and DCE-MRI has the potential to increased specificity and accuracy of breast MRI.

The DWI set provides a higher accuracy than the DCE-MRI for differentiation between benign and malignant lesions. ADC value is useful to differentiate the malignant breast lesion from that of the bengn lesion. The combined analysis of DCE MR and DWI is important for the differentiation between benign and malignant lesions.  

Kim, K, Seo, J, Kim, Y, Hwang, C, Cho, Y, Kim, D, Ra, Y, Diagnostic Performance of Diffusion-weighted Imaging in Breast Lesions: Comparison Among Diffusion-weighted Imaging, Dynamic Contrast Enhanced MRI, and Combination of DWI and DCE MRI.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14017078.html