Diffusion-weighted imaging with apparent diffusion coefficient mapping for breast cancer detection as a stand-alone parameter: Comparison with dynamic contrast-enhanced and multiparametric magnetic resonance imaging Journal Article

   

Authors:	Pinker, K.; Moy, L.; Sutton, E. J.; Mann, R. M.; Weber, M.; Thakur, S. B.; Jochelson, M. S.; Bago-Horvath, Z.; Morris, E. A.; Baltzer, P. A.; Helbich, T. H.
Article Title:	Diffusion-weighted imaging with apparent diffusion coefficient mapping for breast cancer detection as a stand-alone parameter: Comparison with dynamic contrast-enhanced and multiparametric magnetic resonance imaging
Abstract:	Purpose The aims of this study were to compare dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) with apparent diffusion coefficient mapping as a stand-alone parameter without any other supportive sequence for breast cancer detection and to assess its combination as multiparametric MRI (mpMRI) of the breast. Materials and Methods In this institutional review board-approved single-center study, prospectively acquired data of 106 patients who underwent breast MRI from 12/2010 to 09/2014 for an imaging abnormality (Breast Imaging Reporting and Data System 0, 4/5) were retrospectively analyzed. Four readers independently assessed DWI and DCE as well as combined as mpMRI. Breast Imaging Reporting and Data System categories, lesion size, and mean apparent diffusion coefficient values were recorded. Histopathology was used as the gold standard. Appropriate statistical tests were used to compare diagnostic values. Results There were 69 malignant and 41 benign tumors in 106 patients. Four patients presented with bilateral lesions. Dynamic contrast-enhanced MRI was the most sensitive test for breast cancer detection, with an average sensitivity of 100%. Diffusion-weighted imaging alone was less sensitive (82%; P < 0.001) but more specific than DCE-MRI (86.8% vs 76.6%; P = 0.002). Diagnostic accuracy was 83.7% for DWI and 90.6% for DCE-MRI. Multiparametric MRI achieved a sensitivity of 96.8%, not statistically different from DCE-MRI (P = 0.12) and with a similar specificity as DWI (83.8%; P = 0.195), maximizing diagnostic accuracy to 91.9%. There was almost perfect interreader agreement for DWI (κ = 0.864) and DCE-MRI (κ = 0.875) for differentiation of benign and malignant lesions. Conclusion Dynamic contrast-enhanced MRI is most sensitive for breast cancer detection and thus still indispensable. Multiparametric MRI using DCE-MRI and DWI maintains a high sensitivity, increases specificity, and maximizes diagnostic accuracy, often preventing unnecessary breast biopsies. Diffusion-weighted imaging should not be used as a stand-alone parameter because it detects significantly fewer cancers in comparison with DCE-MRI and mpMRI. © Wolters Kluwer Health, Inc. All rights reserved.
Keywords:	breast cancer; dynamic contrast-enhanced mri; diffusion-weighted imaging; multiparametric mri
Journal Title:	Investigative Radiology
Volume:	53
Issue:	10
ISSN:	0020-9996
Publisher:	Lippincott Williams & Wilkins
Date Published:	2018-10-01
Start Page:	587
End Page:	595
Language:	English
DOI:	10.1097/rli.0000000000000465
PROVIDER:	scopus
PMCID:	PMC6123254
PUBMED:	29620604
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85053387709&doi=10.1097%2fRLI.0000000000000465&partnerID=40&md5=6d57b08f5090cfa27c0670e0cef54f81
Notes:	Article -- Export Date: 1 October 2018 -- Source: Scopus

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