Dong Deshuo, Chen Anliang, Ning Ning, Gao Xue, Zhang Lina, Liu Ailian, Yang Jie, Xie Lizhi, Guan Haonan
Department of Radiology, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Dalian, Liaoning 116011, PR China.
Department of Radiology, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Dalian, Liaoning 116011, PR China; Dalian Medical Imaging artificial intelligence engineering technology research center, 222 Zhongshan Road, Dalian, Liaoning 116011, PR China.
Magn Reson Imaging. 2025 Nov;123:110501. doi: 10.1016/j.mri.2025.110501. Epub 2025 Aug 15.
To evaluate the diagnostic value of intravoxel incoherent motion (IVIM) combined with dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in patients with architectural distortion (AD) changes on mammography.
Data were collected from patients who underwent breast MRI after being diagnosed with AD changes on mammography between April 2019 and February 2022. After applying the inclusion and exclusion criteria, a total of 80 patients were ultimately included in this study. Two independent radiologists recorded DCE-MRI lesion characteristics and IVIM parameters. The final outcomes were determined using pathology results from biopsy or surgical excision or at least two years of clinical and radiological follow-up.
In 33 (41.25 %) patients, no lesions were detected on MRI. Among the remaining 47 (58.75 %) patients, 17 (36.17 %) had benign lesions, while 30 (63.83 %) had malignant lesions. Among the 80 patients included in the study, the sensitivity, specificity, negative predictive value, and positive predictive value of MRI to distinguish benign and malignant AD changes were 100 %, 92 %, 100 %, and 88.2 %, respectively, and the overall accuracy was estimated to be 95 %. Regarding DCE-MRI characteristics of patients with positive MRI findings, lesion diameter, shape and margin of mass enhancement, distribution of non-mass enhancement, internal enhancement and time signal intensity curve (TIC) exhibited significant differences between benign and malignant AD (P < 0.05). Among these, internal enhancement and TIC were identified as independent risk predictors, with a combined area under curve (AUC) of 0.969. In terms of IVIM parameters, ADC, D, D*, and f values demonstrated significant differences between benign and malignant AD (all P < 0.05), with AUC values of 0.908, 0.831, 0.680, and 0.761, respectively. ADC and D* were identified as independent risk predictors, with a combined AUC of 0.925. Combined DCE-MRI and IVIM provided the highest AUC, reaching 0.984.
IVIM combined with DCE-MRI is a reliable predictive tool for the classification of AD changes with high diagnostic efficacy. Also, a negative breast MRI in patients with AD changes can be used to exclude malignancy.
评估体素内不相干运动（IVIM）联合动态对比增强磁共振成像（DCE-MRI）对乳腺钼靶显示结构扭曲（AD）改变患者的诊断价值。
收集2019年4月至2022年2月间乳腺钼靶诊断为AD改变后接受乳腺MRI检查的患者数据。应用纳入和排除标准后，本研究最终纳入80例患者。两名独立放射科医生记录DCE-MRI病变特征和IVIM参数。最终结果根据活检或手术切除的病理结果或至少两年的临床及影像学随访确定。
33例（41.25%）患者MRI未检测到病变。其余47例（58.75%）患者中，17例（36.17%）为良性病变，30例（63.83%）为恶性病变。在纳入研究的80例患者中，MRI区分良性和恶性AD改变的敏感性、特异性、阴性预测值和阳性预测值分别为100%、92%、100%和88.2%，总体准确率估计为95%。对于MRI结果阳性患者的DCE-MRI特征，病变直径、肿块强化的形状和边缘、非肿块强化的分布、内部强化和时间信号强度曲线（TIC）在良性和恶性AD之间存在显著差异（P<0.05）。其中，内部强化和TIC被确定为独立风险预测因子，曲线下面积（AUC）合并值为0.969。就IVIM参数而言，ADC、D、D和f值在良性和恶性AD之间存在显著差异（均P<0.05），AUC值分别为0.908、0.831、0.680和0.761。ADC和D被确定为独立风险预测因子，合并AUC为0.925。DCE-MRI和IVIM联合应用时AUC最高，达到0.984。
IVIM联合DCE-MRI是一种可靠的预测工具，对AD改变进行分类具有较高的诊断效能。此外，AD改变患者乳腺MRI结果为阴性可用于排除恶性肿瘤。
