Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
Eur J Radiol. 2022 Sep;154:110439. doi: 10.1016/j.ejrad.2022.110439. Epub 2022 Jul 14.
To investigate the diagnostic value of multi-model high-resolution diffusion-weighted MR imaging (DWI) in breast lesions, with a comparison of simultaneous multi-slice readout-segmented echo-planar imaging (SMS rs-EPI) and single-shot EPI (ss-EPI).
This retrospective study was approved by the institutional ethics committee and included 120 patients with 122 breast lesions (25 benign and 97 malignant). All patients underwent breast DWI with multi-b values (0, 50, 100, 200, 400, 800, 1200, and 2000 s/mm) based on both SMS rs-EPI and ss-EPI on a 3.0 T MR scanner. Quantitative DWI-derived parameters including ADC, MK, MD, D, D*, and f were calculated based on mono-exponential (Mono), intravoxel incoherent motion (IVIM), diffusion kurtosis (DKI) models. Meanwhile, both DWI sequences were qualitatively evaluated with respect to overall image quality, lesion conspicuity, image artifact, geometric distortion, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and lesion contrast. The differences in DW-derived parameters, image quality, and diagnostic performance were statistically compared between SMS rs-EPI and ss-EPI groups.
The SMS rs-EPI produced higher Contrast, CNR and lower SNR than ss-EPI (p < 0.01). The image quality of SMS rs-EPI was superior to ss-EPI either in subjective or objective evaluation. There was no significant difference between the SMS rs-EPI and ss-EPI for either MD or the D* (p > 0.05). However, the MK and f between the two sequences showed significant differences (p < 0.05). Spearman's correlation coefficient displayed good linear correlation for MK values (r = 0.73, 95% CI 0.617-0.857), MD values (r = 0.88, 95% CI 0.814-0.926), ADC values (r = 0.93, 95% CI 0.869-0.948) and D values (r = 0.93, 95% CI 0.856-0.948) between SMS rs-EPI and ss-EPI. Spearman's correlation coefficient for f values (r = 0.25, 95% CI 0.226-0.559) and D* values (r = 0.22, 95% CI 0.025-0.348) were fair and no correlation between the two sequences. MK values have the highest diagnostic value in differentiating benign and malignant breast lesions.
High-resolution multi-model DWI based on SMS rs-EPI technique can provide superior image quality and lesion characterization, with comparable diagnostic performance as compared with ss-EPI DWI in differentiating benign and malignant breast lesions. Of different DWI-derived parameters, MK values showed the best diagnostic performance.
探讨多模态高分辨率磁共振扩散加权成像（DWI）在乳腺病变中的诊断价值，并比较同时多片层读出分段回波平面成像（SMS rs-EPI）和单次激发 EPI（ss-EPI）的应用效果。
本回顾性研究经机构伦理委员会批准，纳入 120 例 122 个乳腺病变患者（25 个良性病变，97 个恶性病变）。所有患者均在 3.0T 磁共振扫描仪上接受基于 SMS rs-EPI 和 ss-EPI 的多 b 值（0、50、100、200、400、800、1200 和 2000 s/mm）DWI 检查。基于单指数（Mono）、体素内不相干运动（IVIM）和扩散峰度（DKI）模型，计算定量 DWI 衍生参数，包括 ADC、MK、MD、D、D*和 f。同时，从整体图像质量、病变显示度、图像伪影、几何变形、信噪比（SNR）、对比噪声比（CNR）和病变对比等方面，对两种 DWI 序列进行定性评估。统计分析 SMS rs-EPI 组和 ss-EPI 组之间 DW 衍生参数、图像质量和诊断性能的差异。
SMS rs-EPI 产生的对比度、CNR 高于 ss-EPI，SNR 低于 ss-EPI（p<0.01）。SMS rs-EPI 的图像质量在主观和客观评估中均优于 ss-EPI。MD 或 D在 SMS rs-EPI 和 ss-EPI 之间无显著差异（p>0.05）。然而，MK 和 f 在两种序列之间有显著差异（p<0.05）。Spearman 相关系数显示，MK 值（r=0.73，95%CI：0.617-0.857）、MD 值（r=0.88，95%CI：0.814-0.926）、ADC 值（r=0.93，95%CI：0.869-0.948）和 D 值（r=0.93，95%CI：0.856-0.948）在 SMS rs-EPI 和 ss-EPI 之间具有良好的线性相关性。f 值（r=0.25，95%CI：0.226-0.559）和 D值（r=0.22，95%CI：0.025-0.348）的 Spearman 相关系数为中等，SMS rs-EPI 和 ss-EPI 之间无相关性。MK 值在鉴别良恶性乳腺病变方面具有最高的诊断价值。
基于 SMS rs-EPI 技术的高分辨率多模态 DWI 可提供更高的图像质量和病变特征，在鉴别良恶性乳腺病变方面与 ss-EPI DWI 具有可比的诊断性能。在不同的 DWI 衍生参数中，MK 值具有最佳的诊断性能。
