降低乳腺影像报告和数据系统（BI-RADS）4类乳腺病变的活检率：简化的高级扩散加权成像（DWI）方案的潜力

Reduction of biopsy rate in BI-RADS4 breast lesions: potential of an abbreviated advanced DWI protocol.

作者信息

Goto Mariko, Le Bihan Denis, Sakai Koji, Yamada Kei

机构信息

Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan.

Neurospin, CEA-Saclay, Paris-Saclay University, Gif-sur-Yvette, France.

出版信息

Eur Radiol. 2025 Apr 24. doi: 10.1007/s00330-025-11604-2.

DOI:10.1007/s00330-025-11604-2

PMID:40272489

Abstract

OBJECTIVES

This study compared the diagnostic performance of diffusion biomarkers estimated from an abbreviated diffusion-weighted imaging (DWI) protocol and assessed their potential to reduce unnecessary biopsies of benign BI-RADS 4 lesions identified on dynamic contrast-enhanced (DCE) MRI.

METHODS

A retrospective study was conducted from 2019 to 2023. All patients underwent abbreviated DWI at 3 T with four b-values (0 s/mm, 200 s/mm, 800 s/mm, and 1500 s/mm). Regions of interest were manually placed on DWI, and biomarkers, including the apparent diffusion coefficient (ADC), perfusion fraction intravoxel incoherent motion, non-Gaussian diffusion (ADC and kurtosis [K]), signature index (S-index), and shifted ADC (sADC), were estimated. Diagnostic performance and the potential to reduce unnecessary biopsies were evaluated for each parameter.

RESULTS

In total, 168 female patients (mean age ± standard deviation, 56.2 ± 13.5 years) with 178 BI-RADS 4 lesions on DCE MRI were analyzed. The median ADC, sADC, and ADC were significantly lower in malignant lesions, while S-index and K were significantly higher (all p ≤ 0.001). The diagnostic performance to reclassify lesions as benign or malignant was identical for ADC (area under the curve = 0.67), sADC (0.69), S-index (0.69), ADC (0.68), and K (0.66). Applying an ad-hoc threshold cutoff, all parameters reduced unnecessary biopsies (around 16%), while K resulted in a slightly higher reduction rate than ADC (20.5% vs 15.9%, p = 0.317) without reducing sensitivity.

CONCLUSION

Diffusion MRI biomarkers obtained using an abbreviated DWI protocol reduced unnecessary biopsies in BI-RADS 4 lesions, with K performing slightly better than ADC.

KEY POINTS

Question MRI BI-RADS category 4 includes a substantial number of benign lesions, and reducing unnecessary biopsies remains a critical clinical concern. Findings The parameters from abbreviated DWI show lesion differentiation comparable to ADC and have greater potential to reduce unnecessary biopsies. Clinical relevance This study underscores the potential of imaging biomarkers from abbreviated DWI for assessing breast MRI BI-RADS 4 lesions. These biomarkers may be comparable or superior to standard ADC in reducing unnecessary biopsies and could aid in improving patient management decisions.

摘要

目的

本研究比较了从简化扩散加权成像（DWI）方案估算的扩散生物标志物的诊断性能，并评估了它们减少动态对比增强（DCE）MRI上发现的良性BI-RADS 4类病变不必要活检的潜力。

方法

进行了一项2019年至2023年的回顾性研究。所有患者均在3T下接受简化DWI检查，采用四个b值（0 s/mm、200 s/mm、800 s/mm和1500 s/mm）。在DWI上手动放置感兴趣区域，并估算包括表观扩散系数（ADC）、体素内不相干运动灌注分数、非高斯扩散（ADC和峰度[K]）、特征指数（S指数）和偏移ADC（sADC）在内的生物标志物。对每个参数的诊断性能和减少不必要活检的潜力进行了评估。

结果

总共分析了168例女性患者（平均年龄±标准差，56.2±13.5岁），她们在DCE MRI上有178个BI-RADS 4类病变。恶性病变的ADC、sADC和ADC中位数显著更低，而S指数和K显著更高（所有p≤0.001）。将病变重新分类为良性或恶性的诊断性能，ADC（曲线下面积=0.67）、sADC（0.69）、S指数（0.69）、ADC（0.68）和K（0.66）相同。应用临时阈值截断，所有参数都减少了不必要的活检（约16%），而K导致的减少率略高于ADC（20.5%对15.9%，p=0.317），且不降低敏感性。

结论

使用简化DWI方案获得的扩散MRI生物标志物减少了BI-RADS 4类病变的不必要活检，K的表现略优于ADC。

关键点

问题MRI的BI-RADS 4类包括大量良性病变，减少不必要的活检仍然是一个关键的临床问题。发现简化DWI的参数显示出与ADC相当的病变区分能力，并且有更大的潜力减少不必要的活检。临床意义本研究强调了简化DWI的成像生物标志物在评估乳腺MRI的BI-RADS 4类病变方面的潜力。这些生物标志物在减少不必要活检方面可能与标准ADC相当或更优，并有助于改善患者管理决策。