Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria Della Misericordia, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy.
Institute of Radiology, University Hospital S. Maria Della Misericordia, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy.
Eur Radiol. 2024 May;34(5):3352-3363. doi: 10.1007/s00330-023-10418-4. Epub 2023 Nov 7.
To investigate whether using the diffusion levels (DLs) proposed by the European Society of Breast Imaging (EUSOBI) improves the diagnostic accuracy of breast MRI.
This retrospective study included 145 women who, between September 2019 and June 2020, underwent breast 1.5-T MRI with DWI. Reader 1 and reader 2 (R1-R2) independently assessed breast lesions using the BI-RADS on dynamic contrast-enhanced imaging and T2-weighted imaging. DWI was subsequently disclosed, allowing readers able to measure lesions ADC and subjectively express the overall risk of malignancy on a 1-5 Likert scale. ADCs were interpreted as a range of values corresponding to the EUSOBI DLs. The analysis evaluated the inter-reader agreement in measuring ADC and DLs, the per-DL malignancy rate, and accuracy for malignancy using ROC analysis against histological examination or a 3-year follow-up.
Lesions were malignant and showed non-mass enhancement in 67.7% and 76.1% of cases, respectively. ADC was measurable in 63.2%/66.7% of lesions (R1/R2), with a minimal discrepancy on Bland-Altman analysis and 0.948 (95%CI 0.925-0.965)/0.989 (95%CI 0.988-0.991) intraclass correlation coefficient in measuring ADC/DLs. The malignancy rate (R1/R2) increased from 0.5/0.5% ("very high" DL) to 96.0/96.8% ("very low" DL), as expected. Likert categorization showed larger areas under the curve than the BI-RADS for both R1 (0.91 versus 0.87; p = 0.0208) and R2 (0.91 versus 0.89; p = 0.1171), with improved specificity (81.5% versus 78.5% for R1 and 84.4% versus 81.2% for R2).
Though ADC was not measurable in about one-third of lesions, DLs were categorized with excellent inter-reader agreement, improving the specificity for malignancy.
DLs proposed by the EUSOBI are a reproducible tool to interpret the ADC of breast lesions and, in turn, to improve the specificity of breast MRI and reduce unnecessary breast biopsies.
• The European Society of Breast Imaging proposed diffusion levels for the interpretation of the apparent diffusion coefficient in diffusion-weighted imaging of the breast. • Adding diffusion levels to the interpretation of magnetic resonance imaging improved the diagnostic accuracy for breast cancer, especially in terms of specificity. • Diffusion levels can favor a more widespread and standardized use of diffusion-weighted imaging of the breast.
研究乳腺磁共振成像（MRI）中使用欧洲乳腺影像学学会（EUSOBI）提出的弥散水平（DLs）是否可以提高诊断准确性。
本回顾性研究纳入了 145 名于 2019 年 9 月至 2020 年 6 月间接受乳腺 1.5-T MRI 检查及弥散加权成像（DWI）的女性患者。阅读者 1 和阅读者 2（R1-R2）分别使用 BI-RADS 对动态对比增强成像和 T2 加权成像进行乳腺病变评估。随后对 DWI 进行了评估，使阅读者能够测量病变的 ADC 值，并通过 1-5 级 Likert 量表主观表达总体恶性风险。ADC 值的解释为与 EUSOBI DLs 对应的一系列值。分析评估了在测量 ADC 和 DLs 方面的读者间一致性、每个 DL 的恶性率，以及使用 ROC 分析与组织学检查或 3 年随访结果对比时对恶性肿瘤的诊断准确性。
病变在 67.7%和 76.1%的病例中表现为恶性和非肿块样强化。63.2%/66.7%（R1/R2）的病变可测量 ADC 值，Bland-Altman 分析差异较小，ADC 值的测量的组内相关系数为 0.948（95%CI 0.925-0.965）/0.989（95%CI 0.988-0.991）。恶性率（R1/R2）从 0.5/0.5%（“极高”DL）增加至 96.0/96.8%（“极低”DL），符合预期。Likert 分类在 R1（0.91 比 0.87；p=0.0208）和 R2（0.91 比 0.89；p=0.1171）中比 BI-RADS 具有更大的曲线下面积，并且特异性得到改善（R1 为 81.5%比 78.5%，R2 为 84.4%比 81.2%）。
尽管约三分之一的病变无法测量 ADC 值，但 DLs 可通过出色的读者间一致性进行分类，从而提高恶性肿瘤的特异性。
EUSOBI 提出的 DLs 是一种可重复性工具，用于解释乳腺病变的 ADC 值，进而提高乳腺 MRI 的特异性，并减少不必要的乳腺活检。
欧洲乳腺影像学学会提出了扩散水平，用于解释乳腺磁共振成像中扩散加权成像的表观扩散系数。
将扩散水平纳入磁共振成像的解释可以提高乳腺癌的诊断准确性，特别是在特异性方面。
扩散水平可以促进更广泛和标准化地使用乳腺扩散加权成像。
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