Li Xue, Wang Hong, Gao Jiayin, Jiang Lei, Chen Min
Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.
Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
Quant Imaging Med Surg. 2023 Oct 1;13(10):7092-7104. doi: 10.21037/qims-23-331. Epub 2023 Sep 12.
Suspicious breast lesions [Breast Imaging Reporting and Data System (BI-RADS) category 4 or 5] detected only by magnetic resonance imaging (MRI) and invisible on other initial imaging modalities (MRI-only lesions) are usually small and poorly characterized in previous literature, thus making diagnosis and management difficult. This study aimed to investigate the clinical significance of quantitative apparent diffusion coefficient (ADC) metrics derived from conventional diffusion-weighted imaging (DWI) on evaluating MRI-only lesions.
A total of 90 suspicious MRI-only lesions were evaluated, including 51 malignant and 39 benign lesions. Morphological and kinetic characteristics of all lesions (termed BI-RADS parameters) were described according to the BI-RADS lexicon on dynamic contrast-enhanced (DCE) imaging. Minimum, maximum, and mean ADC values (ADC, ADC, ADC) were obtained by measuring the ADC map of DWI. ADC was then obtained by the following formula: ADC = (ADC - ADC)/ADC. Diagnostic performance of these parameters was assessed and compared using the receiver operating characteristic (ROC) curve.
Of the 90 MRI-only lesions, there were 45 masses and 45 non-mass lesions. Among BI-RADS parameters, only two different kinetic patterns were significantly different between benign and malignant groups (P=0.005 and P<0.001, respectively). The area under the ROC curve (AUC) of combined significant ADC parameters (ADC, ADC, and ADC, all P≤0.001) was significantly higher than that of the two different kinetic patterns (P=0.006 for both). For MRI-only masses, only ADC and ADC, among all BI-RADS and ADC parameters, had diagnostic value (combined AUC =0.833). For non-mass lesions, size, distribution, ADC, and ADC were significantly different between benign and malignant groups (P=0.004, P<0.001, P=0.001, and P<0.001, respectively). In addition, ADC had the highest diagnostic performance among all ADC parameters, regardless of mass or non-mass (AUC =0.825 and 0.812, respectively). ADC showed no significant differences, no matter in mass or non-mass groups (P=0.62 and 0.43, respectively).
In differentiating MRI-only suspicious lesions, quantitative ADC metrics generally performed better than BI-RADS parameters, and ADC is still the best ADC parameter to distinguish MRI-only lesions.
仅通过磁共振成像（MRI）检测到且在其他初始成像方式下不可见的可疑乳腺病变[乳腺影像报告和数据系统（BI-RADS）4类或5类]（仅MRI病变）在以往文献中通常较小且特征不明显，因此诊断和管理较为困难。本研究旨在探讨从常规扩散加权成像（DWI）得出的定量表观扩散系数（ADC）指标在评估仅MRI病变中的临床意义。
共评估了90个仅MRI的可疑病变，其中包括51个恶性病变和39个良性病变。根据动态对比增强（DCE）成像的BI-RADS词典描述了所有病变的形态和动力学特征（称为BI-RADS参数）。通过测量DWI的ADC图获得最小、最大和平均ADC值（ADCmin、ADCmax和ADCmean）。然后通过以下公式获得ADC差值：ADC差值 =（ADCmax - ADCmin）/ADCmean。使用受试者工作特征（ROC）曲线评估和比较这些参数的诊断性能。
在90个仅MRI病变中，有45个肿块和45个非肿块病变。在BI-RADS参数中，良性和恶性组之间只有两种不同的动力学模式存在显著差异（分别为P = 0.005和P < 0.001）。联合显著ADC参数（ADCmin、ADCmax和ADC差值，均P≤0.001）的ROC曲线下面积（AUC）显著高于两种不同的动力学模式（两者均为P = 0.006）。对于仅MRI的肿块，在所有BI-RADS和ADC参数中，只有ADCmin和ADC差值具有诊断价值（联合AUC = 0.833）。对于非肿块病变，良性和恶性组之间的大小、分布、ADCmin和ADC差值存在显著差异（分别为P = 0.004、P < 0.001、P = 0.001和P < 0.001）。此外，无论肿块或非肿块，ADC差值在所有ADC参数中诊断性能最高（AUC分别为0.825和0.812）。ADCmean在肿块或非肿块组中均无显著差异（分别为P = 0.62和0.43）。
在鉴别仅MRI的可疑病变时，定量ADC指标通常比BI-RADS参数表现更好，且ADC差值仍是区分仅MRI病变的最佳ADC参数。
