Muthuvel Divya, Mohakud Sudipta, Deep Nerbadyswari, Muduly Dillip, Kumar Pankaj, Mishra Pritinanda, Naik Suprava
Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND.
Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND.
Cureus. 2024 Sep 18;16(9):e69634. doi: 10.7759/cureus.69634. eCollection 2024 Sep.
Aim To evaluate the role of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted imaging (DWI) in characterizing suspicious lesions in dense breasts compared to ultrasonography (USG). Materials and methods Eighty-two consecutive female patients with suspicious lesions in dense breast parenchyma showing the American College of Radiology Breast Imaging Reporting And Data System (ACR BI-RADS) c/d composition on mammography underwent USG, where 63 lesions of 63 patients were suspicious. They underwent multiparametric MRI, followed by histopathological evaluation (HPE) of the lesions. Statistical analysis was done to calculate the sensitivity, specificity, and accuracy of USG and MRI in lesion characterization and the combined accuracy of DCE-MRI with DWI. The receiver operating characteristic (ROC) curve analysis provided the cut-off for the apparent diffusion coefficient (ADC) value. Results The sensitivity, specificity, and accuracy of USG were 91.7%, 63%, and 79.4%, respectively. Kinetic curve analysis on DCE-MRI showed a type I curve only in benign lesions. Malignant lesions predominantly showed a type III curve. The sensitivity, specificity, and accuracy of DCE-MRI were 95.8%, 78.5%, and 85.7%, respectively. The optimum cut-off ADC value was 1.05x10-3 mm/s with sensitivity, specificity, and accuracy of 83.3 % each. The specificity and accuracy of combined DCE-MRI with DWI were 94.4% and 88.1%, respectively. Conclusion Advanced MRI, including a combination of DCE-MRI kinetics and DWI, would be more effective and accurate for lesion characterization in dense breasts and act as a superior problem-solving tool compared to USG in differentiating carcinoma from benign lesions.
目的 评估动态对比增强磁共振成像（DCE-MRI）和扩散加权成像（DWI）相较于超声检查（USG）在致密型乳腺可疑病变特征性诊断中的作用。材料与方法 82例连续女性患者，其致密乳腺实质内有可疑病变，乳腺钼靶检查显示美国放射学会乳腺影像报告和数据系统（ACR BI-RADS）c/d级构成，均接受了USG检查，其中63例患者的63个病变可疑。这些患者接受了多参数MRI检查，随后对病变进行组织病理学评估（HPE）。进行统计分析以计算USG和MRI在病变特征性诊断中的敏感性、特异性和准确性，以及DCE-MRI与DWI联合诊断的准确性。通过受试者操作特征（ROC）曲线分析确定表观扩散系数（ADC）值的临界值。结果 USG的敏感性、特异性和准确性分别为91.7%、63%和79.4%。DCE-MRI的动力学曲线分析显示，仅良性病变表现为I型曲线。恶性病变主要表现为III型曲线。DCE-MRI的敏感性、特异性和准确性分别为95.8%、78.5%和85.7%。最佳临界ADC值为1.05×10⁻³ mm²/s，其敏感性、特异性和准确性均为83.3%。DCE-MRI与DWI联合诊断的特异性和准确性分别为94.4%和88.1%。结论 包括DCE-MRI动力学和DWI联合应用的先进MRI技术，在致密型乳腺病变特征性诊断中更有效、准确，与USG相比，在鉴别癌与良性病变方面是一种更优的问题解决工具。
