Koru Hospital, Kızılırmak Mah, Cukurambar, Ankara, Turkey.
Radiology Department, Baskent University Hospital, Bahcelievler, Ankara, Turkey.
Can Assoc Radiol J. 2021 Aug;72(3):460-469. doi: 10.1177/0846537120907098. Epub 2020 Mar 11.
The aim of this study is to evaluate the diagnostic performance of combined breast magnetic resonance imaging (MRI) protocol including dynamic contrast-enhanced MRI (DCE-MRI) and diffusion-weighted imaging (DWI) in patients with enhancing lesions that demonstrated washout curve and to determine whether applying apparent diffusion coefficient (ADC) cutoff value could improve the diagnostic value of breast MRI.
The retrospective study included 116 patients with 116 suspicious breast lesions, which showed washout curve on DCE-MRI, who underwent subsequent biopsy. Morphologic characteristics on DCE-MRI and ADC values on DWI were evaluated. Apparent diffusion coefficient values and morphologic features of benign and malignant lesions were compared. Diagnostic values of DCE-MRI and combined MRI, including DCE-MRI and DWI (applying an ADC cutoff value) for distinguishing malignancy from benign lesions, were calculated.
Of the 116 breast lesions, 79 were malignant and 37 were benign. The ADC value of malignant tumors (median ADC, 0.72 × 10 mm/s) was significantly lower than that of benign lesions (median ADC, 1.03 × 10 mm/s; < .000). The sensitivity and specificity of an ADC cutoff value of 0.89 × 10 mm/s were 92% and 95%, respectively. Dynamic contrast-enhanced MRI alone presented 100% sensitivity and 59.4% specificity. Adding an ADC cutoff value of 0.89 × 10 mm/s provided 100% sensitivity and 81% specificity, which would have prevented biopsy for 21.6% of benign lesions without missing any malignancies.
Applying an ADC cutoff value to DCE-MRI provides an improvement in the diagnostic value of breast MRI for differentiating among lesions presenting washout curve.
本研究旨在评估包括动态对比增强磁共振成像（DCE-MRI）和弥散加权成像（DWI）的联合乳腺磁共振成像（MRI）方案在表现为洗脱曲线的强化病变患者中的诊断性能，并确定应用表观扩散系数（ADC）截断值是否可以提高乳腺 MRI 的诊断价值。
这项回顾性研究纳入了 116 例 116 个可疑乳腺病变患者，这些病变在 DCE-MRI 上显示洗脱曲线，并随后进行了活检。评估 DCE-MRI 的形态特征和 DWI 的 ADC 值。比较良性和恶性病变的 ADC 值和形态特征。计算 DCE-MRI 和联合 MRI（应用 ADC 截断值）对鉴别良恶性病变的诊断价值。
在 116 个乳腺病变中，79 个为恶性，37 个为良性。恶性肿瘤的 ADC 值（中位数 ADC，0.72×10 mm/s）明显低于良性病变（中位数 ADC，1.03×10 mm/s；<.000）。ADC 截断值为 0.89×10 mm/s 的灵敏度和特异度分别为 92%和 95%。单独进行 DCE-MRI 的灵敏度为 100%，特异度为 59.4%。加入 ADC 截断值为 0.89×10 mm/s 可提供 100%的灵敏度和 81%的特异度，这将使 21.6%的良性病变无需活检而不会漏诊任何恶性病变。
在 DCE-MRI 中应用 ADC 截断值可提高乳腺 MRI 鉴别洗脱曲线病变的诊断价值。
