Department of Radiology, Konyang University Hospital, College of Medicine, Myunggok Medical Research Center, Daejeon, Republic of Korea.
Department of Radiology, University of North Carolina, CB #7510, Physicians' Office Building, Rm #118, 170 Manning Drive, Chapel Hill, NC 27599.
Acad Radiol. 2018 May;25(5):643-652. doi: 10.1016/j.acra.2017.11.011. Epub 2018 Jan 12.
This study aimed to compare the diagnostic values of a combination of diffusion-weighted imaging and T2-weighted imaging (DWI-T2WI) with dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), and to evaluate the correlation of DWI with the histologic grade in breast cancer.
This study evaluated a total of 169 breast lesions from 136 patients who underwent both DCE-MRI and DWI (b value, 1000s/mm). Morphologic and kinetic analyses for DCE-MRI were classified according to the Breast Imaging-Reporting and Data System. For the DWI-T2WI set, a DWI-T2WI score for lesion characterization that compared signal intensity of DWI and T2WI (benign: DWI-T2WI score of 1, 2; malignant: DWI-T2WI score of 3, 4, 5) was used. The diagnostic values of DCE-MRI, DWI-T2WI set, and combined assessment of DCE and DWI-T2WI were calculated.
Of 169 breast lesions, 48 were benign and 121 were malignant (89 invasive ductal carcinoma, 24 ductal carcinoma in situ, 4 invasive lobular carcinoma, 4 mucinous carcinoma). The mean apparent diffusion coefficient (ADC) of invasive ductal carcinoma (0.92 ± 0.19 × 10 mm/s) and ductal carcinoma in situ (1.11 ± 0.13 × 10 mm/s) was significantly lower than the value seen in benign lesions (1.36 ± 0.22 × 10 mm/s). The specificity, positive predictive value (PPV), and accuracy of DWI-T2WI set and combined assessment of DCE and DWI-T2WI (specificity, 87.5% and 91.7%; PPV, 94.3% and 96.2%; accuracy, Az = 0.876 and 0.922) were significantly higher than those of the DCE-MRI (specificity, 45.8%; PPV, 81.7%; accuracy, Az = 0.854; P < .05). A low ADC value and the presence of rim enhancement were associated with a higher histologic grade cancer (P < .05).
Combining DWI, T2WI, and ADC values provides increased accuracy for differentiation between benign and malignant lesions, compared with DCE-MRI. A lower ADC value was associated with a higher histologic grade cancer.
本研究旨在比较弥散加权成像和 T2 加权成像（DWI-T2WI）联合动态对比增强磁共振成像（DCE-MRI）的诊断价值，并评估 DWI 与乳腺癌组织学分级的相关性。
本研究共纳入 136 例患者的 169 个乳腺病变，这些患者均同时接受了 DCE-MRI 和 DWI（b 值为 1000s/mm）检查。DCE-MRI 的形态学和动力学分析根据乳腺影像报告和数据系统进行分类。对于 DWI-T2WI 组，使用一种用于病变特征描述的 DWI-T2WI 评分，该评分比较了 DWI 和 T2WI 的信号强度（良性：DWI-T2WI 评分为 1、2；恶性：DWI-T2WI 评分为 3、4、5）。计算了 DCE-MRI、DWI-T2WI 组以及 DCE 和 DWI-T2WI 联合评估的诊断价值。
169 个乳腺病变中，48 个为良性，121 个为恶性（89 个浸润性导管癌、24 个导管原位癌、4 个浸润性小叶癌、4 个黏液癌）。浸润性导管癌（0.92±0.19×10 mm/s）和导管原位癌（1.11±0.13×10 mm/s）的表观扩散系数（ADC）均值明显低于良性病变（1.36±0.22×10 mm/s）。DWI-T2WI 组和 DCE 和 DWI-T2WI 联合评估的特异性、阳性预测值（PPV）和准确性（特异性，87.5%和 91.7%；PPV，94.3%和 96.2%；准确性，Az = 0.876 和 0.922）明显高于 DCE-MRI（特异性，45.8%；PPV，81.7%；准确性，Az = 0.854；P<.05）。低 ADC 值和边缘强化的存在与较高的组织学分级癌症相关（P<.05）。
与 DCE-MRI 相比，联合使用 DWI、T2WI 和 ADC 值可提高良恶性病变的鉴别准确性。较低的 ADC 值与较高的组织学分级癌症相关。
