评估乳腺肿块形态学的弥散加权 MRI：超越表观扩散系数。
Assessment of breast mass morphology with diffusion-weighted MRI: Beyond apparent diffusion coefficient.
机构信息
Karadeniz Technical University, School of Medicine, Department of Radiology, Trabzon, Turkey.
Recep Tayyib Erdoğan University, Faculty of Medicine, Department of Radiology, Rize, Turkey.
出版信息
J Magn Reson Imaging. 2018 Dec;48(6):1668-1677. doi: 10.1002/jmri.26175. Epub 2018 May 7.
BACKGROUND
Diffusion-weighted imaging (DWI) is a noncontrast-enhanced MRI technique. There are new promising studies on the use of DWI as a part of the enhanced or unenhanced abbreviated breast MRI protocols.
PURPOSE
To evaluate the ability of breast DWI in the assessment of mass morphology and determine the contribution of this morphologic evaluation in their characterization.
STUDY TYPE
Retrospective.
POPULATION
In all, 213 consecutive women were breast MR imaged and had a later confirmed diagnosis.
FIELD STRENGTH/SEQUENCE: Breast dynamic contrast-enhanced-MRI (DCE-MRI) and DWI at 1.5T.
ASSESSMENT
After Institutional Review Board approval, two radiologists first independently, and later in consensus, evaluated the visibility and morphology of the 143 malignant, 70 benign masses on DWI and DCE-MRI in separate sessions, blindly. Shape, margin, and internal pattern of the masses were evaluated according to BI-RADS lexicon. Apparent diffusion coefficient (ADC) and tumor size were measured by one radiologist.
STATISTICAL TESTS
Consistency between imaging methods and readers was evaluated with Cohen's kappa statistics. Multivariate analysis was applied to find the best predictors of malignancy.
RESULTS
Tumor visibility on DWI was high to moderate in at least 88% of cases. Consistency between DWI and DCE-MRI was substantial (kappa ≥0.757) for shape and margin and moderate (kappa = 0.505) for internal pattern. Interobserver agreement was substantial to moderate for all morphologic parameters (kappa ≥0.596). Morphology evaluated on DWI provided 83-84% accuracy in discriminating malignant from benign masses. ADC alone provided 90-91% accuracy. Both morphologic parameters and ADC were significantly associated with malignancy on multivariate analysis and provided 91-93% accuracy.
DATA CONCLUSION
DWI might be used not only for ADC evaluation but also for the morphological evaluation of breast masses to characterize them.
LEVEL OF EVIDENCE
3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;48:1668-1677.
背景
弥散加权成像（DWI）是一种非增强对比磁共振成像技术。目前有一些新的研究表明，DWI 可作为增强或非增强简化乳腺 MRI 方案的一部分来使用。
目的
评估乳腺 DWI 在评估肿块形态方面的能力，并确定这种形态学评估对其特征描述的贡献。
研究类型
回顾性研究。
人群
共有 213 例连续女性进行了乳腺 MRI 检查，并在后续得到了确诊。
磁场强度/序列：乳腺动态对比增强磁共振成像（DCE-MRI）和 1.5T 的 DWI。
评估
在获得机构审查委员会批准后，两位放射科医生首先在单独的会议中独立评估，之后进行了共识评估，对 143 个恶性和 70 个良性肿块在 DWI 和 DCE-MRI 上的可见性和形态进行评估。根据 BI-RADS 词典评估肿块的形状、边界和内部模式。一位放射科医生测量了表观扩散系数（ADC）和肿瘤大小。
统计检验
应用 Cohen's kappa 统计检验评估影像学方法和读者之间的一致性。应用多变量分析来寻找恶性肿瘤的最佳预测因素。
结果
在至少 88%的病例中，DWI 上的肿瘤可见度较高或为中度。DWI 与 DCE-MRI 的形状和边界具有显著一致性（kappa≥0.757），内部模式的一致性为中度（kappa=0.505）。所有形态学参数的观察者间一致性为中度至高度（kappa≥0.596）。在区分良恶性肿块方面，DWI 上的形态学评估的准确性为 83-84%。ADC 单独的准确性为 90-91%。多变量分析表明，形态学参数和 ADC 均与恶性肿瘤显著相关，其准确性为 91-93%。
数据结论
DWI 不仅可用于 ADC 评估，还可用于乳腺肿块的形态学评估，以对其进行特征描述。
证据水平
3 技术功效：2 级。JMRI 2018；48：1668-1677。
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