Original contributionIntravoxel incoherent motion diffusion-weighted imaging as an adjunct to dynamic contrast-enhanced MRI to improve accuracy of the differential diagnosis of benign and malignant breast lesions
Introduction
Breast cancer is one of the most common causes of cancer death worldwide for females, with the highest morbidity among all cancers in women. Early detection, specific diagnosis and early treatment are crucial for the prognosis of cancer patients. Given its high sensitivity, no ionizing radiation damage, high soft tissue resolution and multi-dimensional imaging, dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is recognized as clinical primary method of examination for the detection of breast tumors, staging of breast cancer and treatment evaluation [1], [2], [3], [4]. However, its' low specificity for cancer diagnosis is a significant limitation that may lead to unnecessary biopsy [1], [3], [5], [6].
Recent work has shown the use of diffusion weighted imaging (DWI) for quantitative characterization of in vivo movement of water at the molecular level that reflects the tissue physiology or pathological status, and which may help improve the specificity of DCE-MRI for diagnosis of benign and malignant lesions [7], [8], [9], [10], [11], [12], [13], [14]. However, previous studies have employed a monoexponential model, and the calculated apparent diffusion coefficient (ADC) values reflect both the molecular diffusion of water molecules and microperfusion related to microcirculation [15], [16]. This may lower the diagnostic accuracy of ADC value, especially in richly perfused cancerous tissue.
Intravoxel incoherent motion (IVIM) biexponential model proposed by Le Bihan et al. [15] differentiates between microperfusion caused by microvascular blood flow from the molecular diffusion of water molecules. Quantitative parameters including perfusion fraction (f), molecular diffusion coefficient (D), and microperfusion coefficient (D*) were used in IVIM to evaluate the molecular diffusion of water molecules in the tissues and microvascular perfusion. Diffusion-weighted imaging based on the IVIM biexponential model more accurately reflects the physiological and pathological state of the tissues. IVIM has been applied in various cancers, including breast [17], [18], [19], [20] and finally studies looking at IVIM and DCE-MRI have found that some parameters are not correlated [18], [19], but there has not been a detailed examination of whether IVIM improves sensitivity and specificity when combined with DCE and that's where this work comes in.
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Patients
This prospective study was approved by the Ethics Committee at the Binzhou Medical University Hospital; written informed consent was obtained from all patients prior to their enrolment in the study. From August 5, 2013 to November 29, 2015, patients who met the following inclusion criteria were included in the study. 1) Patients with suspicious breast lesions were detected in our hospital on physical examination, mammography or ultrasonography. 2) Patients did not undergo biopsy, chemotherapy
Pathological findings
Postoperative pathological examination confirmed a total of 128 lesions (47 benign and 81 malignant). The histological classification was summarized in Table 1.
DCE-MRI and IVIM-DWI parameters for benign and malignant lesions
The morphology, MSI, and TIC types in DCE-MRI examination were significantly different between the benign and malignant groups (P < 0.05). There was no significant difference in enhancement pattern (P > 0.05) (Table 2). On IVIM-DWI, the f value (8.53 ± 2.14) and D* values (7.64 ± 2.07) in the malignant group were higher than those of the benign
Discussion
DCE-MRI is among the most important and most proven methods for imaging of breast lesions. It not only provides a wealth of morphological information but also reflects the hemodynamic characteristics of lesions. This technology has been widely used in clinical practice for differentiating benign from malignant lesions [23]. Among the DCE-MRI parameters tested, morphology of the lesion, MSI and TIC type were found to be significantly different between benign and malignant groups. On logistic
Acknowledgments
The authors are grateful for the technical guidance by Qinglei Shi, the engineer at the China Healthcare Sector MR Business Group of Siemens Ltd.
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