Karam Rasha, Elmokadem Ali H, El-Rakhawy Mohamed Magdy, Soliman Nermin, Elnahas Waleed, Abdel-Khalek Ahmed Mohamed
Department of Radiology, Mansoura University, Elgomhoria St. 35516, Mansoura, Egypt.
Department of Surgical Oncology, Oncology Center, Mansoura University, Mansoura, Egypt.
Radiol Med. 2023 Mar;128(3):289-298. doi: 10.1007/s11547-023-01600-1. Epub 2023 Feb 10.
To evaluate the added value of the diffusion tensor imaging (DTI) parameters to abbreviated breast MRI protocol in differentiating recurrent breast cancer from post-operative changes in cases of breast conservative surgery (BCS).
This prospective study was approved by our institutional review board. Written informed consent was obtained in all patients. 47 female patients (mean age, 49 years; range, 32-66 years) that previously underwent breast conservative surgery with a palpable mass were included in this study (62 breast lesions). Two abbreviated MRI protocols were compared using 1.5 Tesla MRI, AB-MRI 1 (axial T1, T2, pre-contrast T1, 1st post-contrast and subtracted images) and AB-MRI 2 (same sequences plus adding DTI). In both protocols, the wash-in rate was calculated. Histopathology was used as the standard of reference. Appropriate statistical tests were used to assess sensitivity, specificity, and diagnostic accuracy for each protocol.
The mean total acquisition time was of 6 min for AB-MRI 1 and 10 min for AB-MRI 2 protocols while the mean interpretation time was of 57.5 and 75 s, respectively. Among analyzed DTI parameters, MD (mean diffusivity) showed the highest sensitivity (96.43%) and specificity (91.18%) (P value = < 0.001). FA (fractional anisotropy), AD (axial diffusivity) and RD (radial diffusivity) showed sensitivity = (78.57%, 82.14% and 85.71%), specificity = (88.24, 85.29% and 79.41%), respectively, P value (< 0.001).
DTI may be included in abbreviated MRI protocols without a significant increase in acquisition time and with the advantage of increasing specificity and clinical utility in the characterization of post-conservative breast lesions.
评估扩散张量成像（DTI）参数对简化乳腺MRI方案在保乳手术（BCS）病例中鉴别复发性乳腺癌与术后改变的附加价值。
本前瞻性研究经机构审查委员会批准。所有患者均获得书面知情同意。本研究纳入了47例曾接受保乳手术且可触及肿块的女性患者（平均年龄49岁；范围32 - 66岁）（62个乳腺病变）。使用1.5特斯拉MRI比较了两种简化MRI方案，AB - MRI 1（轴位T1、T2、增强前T1、首次增强后及减影图像）和AB - MRI 2（相同序列加DTI）。在两种方案中均计算了强化率。组织病理学用作参考标准。使用适当的统计检验评估每种方案的敏感性、特异性和诊断准确性。
AB - MRI 1方案的平均总采集时间为6分钟，AB - MRI 2方案为10分钟，而平均解读时间分别为57.5秒和75秒。在所分析的DTI参数中，平均扩散率（MD）显示出最高的敏感性（96.43%）和特异性（91.18%）（P值 = < 0.001）。分数各向异性（FA）、轴向扩散率（AD）和径向扩散率（RD）的敏感性分别为（78.57%、82.14%和85.71%），特异性分别为（88.24%、85.29%和79.41%），P值（< 0.001）。
DTI可纳入简化MRI方案中，采集时间无显著增加，且具有提高保乳术后乳腺病变特征性诊断的特异性和临床实用性的优势。
