An Yeong Yi, Kim Sung Hun, Kang Bong Joo
Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93, Jungbu-daero, Paldal-gu, Suwon-si, Gyeonggi-do, Republic of Korea.
Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, Republic of Korea.
PLoS One. 2017 Mar 30;12(3):e0174681. doi: 10.1371/journal.pone.0174681. eCollection 2017.
To determine the added value of qualitative analysis as an adjunct to quantitative analysis for the discrimination of benign and malignant lesions in patients with breast cancer using diffusion-weighted imaging (DWI) with readout-segmented echo-planar imaging (rs-EPI).
A total of 99 patients with 144 lesions were reviewed from our prospectively collected database. DWI data were obtained using rs-EPI acquired at 3.0 T. The diagnostic performances of DWI in the qualitative, quantitative, and combination analyses were compared with that of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Additionally, the effect of lesion size on the diagnostic performance of the DWI combination analysis was evaluated.
The strongest indicators of malignancy on DWI were a heterogeneous pattern (P = 0.005) and an apparent diffusion coefficient (ADC) value <1.0 × 10-3 mm2/sec (P = 0.002). The area under the curve (AUC) values for the qualitative analysis, quantitative analysis, and combination analysis on DWI were 0.732 (95% CI, 0.651-0.803), 0.780 (95% CI, 0.703-0.846), and 0.826 (95% CI, 0.754-0.885), respectively (P<0.0001). The AUC for the combination analysis on DWI was superior to that for DCE-MRI alone (0.651, P = 0.003) but inferior to that for DCE-MRI plus the ADC value (0.883, P = 0.03). For the DWI combination analysis, the sensitivity was significantly lower in the size ≤1 cm group than in the size >1 cm group (80% vs. 95.6%, P = 0.034).
Qualitative analysis of tumor morphology was diagnostically applicable on DWI using rs-EPI. This qualitative analysis adds value to quantitative analyses for lesion characterization in patients with breast cancer.
利用读出分段回波平面成像（rs-EPI）的扩散加权成像（DWI），确定定性分析作为定量分析辅助手段在鉴别乳腺癌患者良性和恶性病变中的附加价值。
从我们前瞻性收集的数据库中回顾了99例有144个病变的患者。使用在3.0 T下采集的rs-EPI获得DWI数据。将DWI在定性、定量和联合分析中的诊断性能与动态对比增强磁共振成像（DCE-MRI）进行比较。此外，评估了病变大小对DWI联合分析诊断性能的影响。
DWI上恶性肿瘤的最强指标是不均匀模式（P = 0.005）和表观扩散系数（ADC）值<1.0×10-3 mm2/秒（P = 0.002）。DWI定性分析、定量分析和联合分析的曲线下面积（AUC）值分别为0.732（95% CI，0.651-0.803）、0.780（95% CI，0.703-0.846）和0.826（95% CI，0.754-0.885）（P<0.0001）。DWI联合分析的AUC优于单独的DCE-MRI（0.651，P = 0.003），但低于DCE-MRI加ADC值（0.883，P = 0.03）。对于DWI联合分析，大小≤1 cm组的敏感性显著低于大小>1 cm组（80%对95.6%，P = 0.034）。
使用rs-EPI对DWI进行肿瘤形态的定性分析在诊断上是适用的。这种定性分析为乳腺癌患者病变特征的定量分析增加了价值。
