Department of Radiology and Imaging Sciences, National Institutes of Health/Clinical Center and the National Institute of Biomedical Imaging and Bioengineering, Bethesda, Md, USA.
Radiology. 2010 Jul;256(1):64-73. doi: 10.1148/radiol.10091367.
To evaluate the incremental value of diffusion-weighted (DW) imaging and apparent diffusion coefficient (ADC) mapping in relation to conventional breast magnetic resonance (MR) imaging in the characterization of benign versus malignant breast lesions at 3.0 T.
This retrospective HIPAA-compliant study was approved by the institutional review board, with the requirement for informed patient consent waived. Of 550 consecutive patients who underwent bilateral breast MR imaging over a 10-month period, 93 women with 101 lesions met the following study inclusion criteria: They had undergone three-dimensional (3D) high-spatial-resolution T1-weighted contrast material-enhanced MR imaging, dynamic contrast-enhanced MR imaging, and DW imaging examinations at 3.0 T and either had received a pathologic analysis-proven diagnosis (96 lesions) or had lesion stability confirmed at more than 2 years of follow-up (five lesions). DW images were acquired with b values of 0 and 600 sec/mm(2). Regions of interest were drawn on ADC maps of breast lesions and normal glandular tissue. Morphologic features (margin, enhancement pattern), dynamic contrast-enhanced MR results (semiquantitative kinetic curve data), absolute ADCs, and glandular tissue-normalized ADCs were included in multivariate models to predict a diagnosis of benign versus malignant lesion.
Forty-one (44%) of the 93 patients were premenopausal, and 52 (56%) were postmenopausal. Thirty-three (32.7%) of the 101 lesions were benign, and 68 (67.3%) were malignant. Normalized ADCs were significantly different between the benign (mean ADC, 1.1 x 10(-3) mm(2)/sec +/- 0.4 [standard deviation]) and malignant (mean ADC, 0.55 x 10(-3) mm(2)/sec +/- 0.16) lesions (P < .001). Adding normalized ADCs to the 3D T1-weighted and dynamic contrast-enhanced MR data improved the diagnostic performance of MR imaging: The area under the receiver operating characteristic curve improved from 0.89 to 0.98, and the false-positive rate decreased from 36% (nine of 25 lesions) to 24% (six of 25 lesions).
DW imaging with glandular tissue-normalized ADC assessment improves the characterization of breast lesions beyond the characterization achieved with conventional 3D T1-weighted and dynamic contrast-enhanced MR imaging at 3.0 T.
在 3.0T 磁共振成像（MR）中，评估扩散加权（DW）成像和表观扩散系数（ADC）图相对于常规乳腺 MR 成像在良、恶性乳腺病变鉴别中的附加价值。
本回顾性研究符合 HIPAA 规定，经机构审查委员会批准，无需患者知情同意。在 10 个月期间，对 550 例连续行双侧乳腺 MR 成像的患者进行研究，其中 93 例女性的 101 个病灶符合以下研究纳入标准：均行三维（3D）高空间分辨率 T1 加权对比增强 MR 成像、动态对比增强 MR 成像和 DW 成像检查，且均行病理分析证实（96 个病灶）或 2 年以上随访证实病变稳定（5 个病灶）。DW 成像采用 b 值为 0 和 600 sec/mm(2)。在 ADC 图上绘制乳腺病变和正常腺体组织的感兴趣区。形态特征（边缘、强化模式）、动态对比增强 MR 结果（半定量动力学曲线数据）、绝对 ADC 值和腺体组织归一化 ADC 值均纳入多变量模型以预测良性或恶性病变。
93 例患者中，41 例（44%）为绝经前，52 例（56%）为绝经后。101 个病灶中，33 个（32.7%）为良性，68 个（67.3%）为恶性。良性病变的 ADC 值（平均值 1.1 x 10(-3) mm(2)/sec +/- 0.4 [标准差]）与恶性病变（平均值 0.55 x 10(-3) mm(2)/sec +/- 0.16）之间存在显著差异（P <.001）。将 ADC 值归一化后纳入 3D T1 加权和动态对比增强 MR 数据可提高 MR 成像的诊断效能：受试者工作特征曲线下面积从 0.89 提高至 0.98，假阳性率从 36%（25 个病灶中的 9 个）降至 24%（25 个病灶中的 6 个）。
在 3.0T，与常规 3D T1 加权和动态对比增强 MR 成像相比，DW 成像联合腺体组织 ADC 值评估可提高乳腺病变的特征性表现。
