仰卧位与俯卧位多体位弥散加权 MRI 乳腺成像。

Multishot Diffusion-Weighted MRI of the Breasts in the Supine vs. Prone Position.

机构信息

Department of Radiology, Stanford University, Stanford, California, USA.

Global MR Application and Workflow, GE Healthcare, Boston, Massachusetts, USA.

出版信息

J Magn Reson Imaging. 2023 Sep;58(3):951-962. doi: 10.1002/jmri.28582. Epub 2022 Dec 30.

DOI:10.1002/jmri.28582

PMID:36583628

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10310889/

Abstract

BACKGROUND

Diffusion-weighted imaging (DWI) may allow for breast cancer screening MRI without a contrast injection. Multishot methods improve prone DWI of the breasts but face different challenges in the supine position.

PURPOSE

To establish a multishot DWI (msDWI) protocol for supine breast MRI and to evaluate the performance of supine vs. prone msDWI.

STUDY TYPE

Prospective.

POPULATION

Protocol optimization: 10 healthy women (ages 22-56), supine vs. prone: 24 healthy women (ages 22-62) and five women (ages 29-61) with breast tumors.

FIELD STRENGTH/SEQUENCE: 3-T, protocol optimization msDWI: free-breathing (FB) 2-shots, FB 4-shots, respiratory-triggered (RT) 2-shots, RT 4-shots, supine vs. prone: RT 4-shot msDWI, T2-weighted fast-spin echo.

ASSESSMENT

Protocol optimization and supine vs. prone: three observers performed an image quality assessment of sharpness, aliasing, distortion (vs. T2), perceived SNR, and overall image quality (scale of 1-5). Apparent diffusion coefficients (ADCs) in fibroglandular tissue (FGT) and breast tumors were measured.

STATISTICAL TESTS

Effect of study variables on dichotomized ratings (4/5 vs. 1/2/3) and FGT ADCs were assessed with mixed-effects logistic regression. Interobserver agreement utilized Gwet's agreement coefficient (AC). Lesion ADCs were assessed by Bland-Altman analysis and concordance correlation (ρ ). P value <0.05 was considered statistically significant.

RESULTS

Protocol optimization: 4-shots significantly improved sharpness and distortion; RT significantly improved sharpness, aliasing, perceived SNR, and overall image quality. FGT ADCs were not significantly different between shots (P = 0.812), FB vs. RT (P = 0.591), or side (P = 0.574). Supine vs. prone: supine images were rated significantly higher for sharpness, aliasing, and overall image quality. FGT ADCs were significantly higher supine; lesion ADCs were highly correlated (ρ = 0.92).

DATA CONCLUSION

Based on image quality, supine msDWI outperformed prone msDWI. Lesion ADCs were highly correlated between the two positions, while FGT ADCs were higher in the supine position.

EVIDENCE LEVEL

TECHNICAL EFFICACY

Stage 1.

摘要

背景

扩散加权成像（DWI）可用于在不注射对比剂的情况下进行乳腺癌筛查 MRI。多 shot 方法可改善俯卧位乳房 DWI，但在仰卧位时面临不同的挑战。

目的

建立仰卧位乳腺 MRI 的多 shot DWI（msDWI）方案，并评估仰卧位与俯卧位 msDWI 的性能。

研究类型

前瞻性。

人群

方案优化：10 名健康女性（年龄 22-56 岁），仰卧位与俯卧位：24 名健康女性（年龄 22-62 岁）和 5 名患有乳腺肿瘤的女性（年龄 29-61 岁）。

磁场强度/序列：3T，方案优化 msDWI：自由呼吸（FB）2 shot、FB 4 shot、呼吸触发（RT）2 shot、RT 4 shot，仰卧位与俯卧位：RT 4 shot msDWI、T2 加权快速自旋回波。

评估

方案优化和仰卧位与俯卧位：三位观察者对清晰度、伪影、失真（与 T2 相比）、感知 SNR 和整体图像质量（1-5 分）进行了图像质量评估。测量纤维腺体组织（FGT）和乳腺肿瘤中的表观扩散系数（ADC）。

统计学检验

采用混合效应逻辑回归评估研究变量对二分评级（4/5 与 1/2/3）和 FGT ADC 的影响。观察者间一致性利用 Gwet 的一致性系数（AC）进行评估。采用 Bland-Altman 分析和一致性相关系数（ρ）评估病变 ADC。P 值<0.05 被认为具有统计学意义。

结果

方案优化：4 shot 显著提高了清晰度和失真度；RT 显著提高了清晰度、伪影、感知 SNR 和整体图像质量。shot 之间、FB 与 RT 之间或两侧之间的 FGT ADC 无显著差异（P=0.812、P=0.591、P=0.574）。仰卧位与俯卧位：仰卧位图像的清晰度、伪影和整体图像质量评分显著更高。FGT ADC 在仰卧位时更高；病变 ADC 高度相关（ρ=0.92）。