How to optimize breast MRI protocol? The value of combined analysis of ultrafast and diffusion-weighted MRI sequences - 27/05/23
, Vincent Flament a, Yoram Gueniche a, Edith Kermarrec a, Nathalie Chabbert-Buffet b, c, Émile Darai b, c, Cyril Touboul b, c, Leo Razakamanantsoa a, Isabelle Thomassin-Naggara a, b
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Highlights |
• | Ultrafast MRI sequences and diffusion-weighted sequences are useful to improve specificity and improve BI-RADS classification of breast lesions presenting with benign morphology. |
• | Washout criteria issued from the analysis of time intensity curves can be equally replaced by early enhancement analysis (≤ 30 s after injection) on ultrafast MRI sequences. |
• | Apparent diffusion coefficient ≥ 1.5 × 10−3 mm2/s allows excluding malignancy in mass or non-mass breast lesions (excluding focus) rated BI-RADS 3, 4A or 4B. |
• | BI-RADS analysis based on a simple short protocol plus early enhancement on ultrafast sequences and apparent diffusion coefficient value has a greater diagnostic accuracy than a conventional protocol and may avoid unnecessary breast biopsy. |
Abstract |
Purpose |
The purpose of this retrospective study was to demonstrate the validity of early enhancement criteria on ultrafast magnetic resonance imaging (MRI) sequence to predict malignancy in a large population, and the benefit of diffusion-weighted imaging (DWI) to improve the performance of breast MRI.
Material and methods |
Women who underwent breast MRI examination between April 2018 and September 2020 and further breast biopsy were retrospectively included. Two readers quoted the different conventional features and classified the lesion according to the BI-RADS classification based on the conventional protocol. Then, the readers checked for the presence of early enhancement (≤ 30 s) on ultrafast sequence and the presence of an apparent diffusion coefficient (ADC) ≥ 1.5 × 10−3 mm2/s to classify the lesions based on morphology and these two functional criteria only.
Results |
Two hundred fifty-seven women (median age: 51 years; range: 16–92 years) with 436 lesions (157 benign, 11 borderline and 268 malignant) were included. A MRI protocol plus two simple functional features, early enhancement (≤ 30 s) and an ADC value ≥ 1.5 × 10−3 mm2/s, had a greater accuracy than the conventional protocol to distinguish benign from malignant breast lesions with or without ADC value (P = 0.01 and P = 0.001, respectively) on MRI, mainly due to better classification of benign lesions (increased specificity) with increasing diagnostic confidence of 3.7% and 7.8% respectively.
Conclusion |
BI-RADS analysis based on a simple short MRI protocol plus early enhancement on ultrafast sequence and ADC value has a greaterr diagnostic accuracy than a conventional protocol and may avoid unnecessary biopsy.
Le texte complet de cet article est disponible en PDF.Keywords : BI-RADS, Breast cancer, Diffusion magnetic resonance imaging, Magnetic resonance imaging
Plan
Vol 104 - N° 6
P. 284-291 - juin 2023 Retour au numéro
Article précédent
- Multiple parameters from ultrafast dynamic contrast-enhanced magnetic resonance imaging to discriminate between benign and malignant breast lesions: Comparison with apparent diffusion coefficient
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