05Sep 2019

ROLE OF DIFFUSION WEIGHTED MRI IN EVALUATION OF BIRADS3 AND BIRADS4 BREAST LESIONS.

  • Department of Radiology, Faculty of Medicine, Benisuef University, Egypt.
  • Department of Radiology, Faculty of Medicine, Cairo University, Egypt.
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Background: Precise diagnosis of suspicious breast lesions helps in better assessment and management. The aim of this study is to explore the role of DCE-MRI and DWI in evaluation of suspicious breast lesions (BI-RADS 3 and 4). Subjects and Methods: A total of 50 patients with suspicious breast lesions (BI-RADS 3 and 4) participated in the study. After giving informed consent, all patients were subjected to DWI and DCE-MRI, and their findings were compared to histopathology results. DCE-MRI curves, borders, and enhancement were described, and DWI findings were also extracted. Factors predicting distinction of cancerous tissue from benign tissue by DCE-MRI and DWI according to histopathology reference have been analyzed. Results:Using DCE-MRI, out of 19 patients proven by histopathology to have benign lesions, 12 (63.2%) showed mass lesions and out of 29 patients with malignant lesions 21 (72.4%) had mass lesions (p<0.001).Curves of benign lesions were mostly persistent (83.3%) whenever malignant curves were either plateau or wash out;(47.6%) each (p<0.001).ADC brightness was more frequent in benign lesions (p<0.05). The best cut-off of ADC that can differentiate between malignant and benign lesions was 1.19 (sensitivity 94.7% and specificity 67.7%).DCE-MRI had a sensitivity of 75.8% and specificity of 73.7%, while DWI had a sensitivity of 82.8% and specificity of 73.7%. No statistically significant differences have been noticed between benign and malignant breast non-mass lesions regarding any of the studied measures (p>0.05). Conclusion: DCE-MRI and DWI are crucial in distinction of suspicious breast mass lesions. The sensitivity and specificity of DCE-MRI and DWI as diagnostics have been determined.


  1. Saslow D, Boetes C, Burke W, Harms S, Leach MO, Lehman CD, et al.American Cancer Society guidelines for breast screening with MRI as anadjunct to mammography. Cancer J Clin. 2007; 57:75?89.
  2. Boyd NF, Martin LJ, Yaffe MJ, Minkin S. Mammographic density and breastcancer risk: current understanding and future prospects. Breast Cancer Res.2011; 13(6):223.
  3. Weinstein S, Rosen M. Breast MR imaging: current indications and advancedimaging techniques. RadiolClin N Am. 2010; 48(5):1013?42.
  4. Hylton N. Dynamic contrast-enhanced magnetic resonance imaging as animaging biomarker. J ClinOncol. 2006; 24(20):3293?8.
  5. Kuhl CK, Mielcareck P, Klaschik S, Leutner C, Wardelmann E, Gieseke J, et al.Dynamic breast MR imaging: are signal intensity time course data useful fordifferential diagnosis of enhancing lesions? Radiology.1999; 211(1):101?10.
  6. El Khouli RH, Macura KJ, Jacobs MA, Khalil TH, Kamel IR, Dwyer A, et al.Dynamic contrast-enhanced MRI of the breast: quantitative method forkinetic curve type assessment. Am J Roentgenol. 2009; 193(4):295?300.
  7. Partridge SC, Rahbar H, Murthy R, Chai X, Kurland BF, DeMartini WB, et al.Improved diagnostic accuracy of breast MRI through combined apparentdiffusion coefficients and dynamic contrast-enhanced kinetics. MagnResonMed. 2011; 65(6):1759?67.
  8. Krammer J, Pinker-Domenig K, Robson ME, Gonen M, Bernard-Davila B, Morris EA, et al. Breast cancer detection and tumor characteristics in BRCA1 and BRCA2 mutation carriers. Breast Cancer Res Treat. 2017; 163:565?71.
  9. Mann RM., Kuhl CK, Kinkel K, Boetes C. Breast MRI: guidelines from the European society of breast imaging. EurRadiol 2008; 18, 1307?18.
  10. Ashraf AB, Gavenonis SC, Daye D, Mies C, Rosen MA, Kontos D. A multichannelMarkov random field framework for tumor segmentation with an applicationto classification of gene expression-based breast cancer recurrence risk. IEEETrans Med Imaging. 2013; 32(4):637?48.
  11. Fusco R, Sansone M, Filice S, Carone G, Amato DM, Sansone C , et al.Pattern Recognition Approaches for Breast Cancer DCE-MRI Classification: A Systematic Review.J. Med. Biol. Eng. 2016; 36:449?59.
  12. Wu S, Berg WA, Zuley ML, Kurland BF, Jankowitz RC, Nishikawa R, et al.Breast MRI contrast enhancement kinetics of normal parenchyma correlate with presence of breast cancer.Breast Cancer Research 2016; 18:76.
  13. Lee CH. Problem solving MR imaging of the breast. RadiolClin North Am 2004; 42:919?934.
  14. Nunes LW, Schnall MD, Orel SG. Update of breast MR imaging architectural interpretation model. Radiology 2001; 219:484?494.
  15. Sardanelli F, Melani E, Ottonello C. Magnetic resonance imaging of the breast in characterizing positive or uncertain mammographic findings. Cancer Detect Prev 1998; 22(1):39?42.
  16. Lee CH, Smith RC, Levine JA, Troiano RN, Tocino I. Clini?cal usefulness of MR imaging of the breast in the evaluation of the problematic mammogram. AJR Am J Roentgenol 1999; 173(5):1323?9.
  17. Spick C, Szolar DHM, Preidler KW, Tillich M, Reittner P, Baltzer PA. Breast MRI used as a problem-solving tool reli?ably excludes malignancy. Eur J Radiol 2015; 84(1):61?4.
  18. Oztekin PS, Kosar PN. Magnetic resonance imaging of the breast as a problem-solving method: to be or not to be? Breast J 2014;20 (6):622?31.
  19. Strobel K, Schrading S, Hansen NL, Barabasch A, Kuhl CK. Assessment of BI-RADS category 4 lesions detected with screening mammography and screening US: utility of MR imaging. Radiology 2015;274 (2):343?51.
  20. Milosevic ZC, NadrljanskiMM,Milovanovic ZM, Gusic NZ,Vucicevic SS, RadulovicOS.Breast dynamic contrast enhanced MRI:fibrocystic changes presenting as a non-mass enhancement mimicking malignancyRadiolOncol 2017; 51(2): 130-6.
  21. Ochi M, Kuroiwa T, Sunami S, Murakami J, Murakami J, Miyahara S, Nagaie T, et al. Diffusion-weighted imaging (b value = 1500 s/mm (2)) is useful to decrease false-positive breast cancer cases due to fibrocystic changes. Breast Cancer 2013; 20: 137-44.
  22. Sinha?S, Lucas-Quesada?FA, Sinha?U, DeBruhl?N, Bassett?LW.?In vivo diffusion-weighted MRI of the breast: potential for lesion characterization.?J MagnReson Imaging?2002; 15(6):693?704.

[Heba Ahmed Mostafa, Sahar Mansour, Sahar M abd Elsalam and Soha.t.Hamed. (2019); ROLE OF DIFFUSION WEIGHTED MRI IN EVALUATION OF BIRADS3 AND BIRADS4 BREAST LESIONS. Int. J. of Adv. Res. 7 (9). 178-184] (ISSN 2320-5407). www.journalijar.com


Heba Ahmed Mostafa
Heba ahmed mostafa

DOI:


Article DOI: 10.21474/IJAR01/9645       DOI URL: http://dx.doi.org/10.21474/IJAR01/9645


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