Abstract
BackgroundDynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) has always been a problem solver in troublesome breast lesions. Despite its many advantages, the encountered low specificity results in unnecessary biopsies. Diffusion-weighted MRI (DW-MRI) is a well-established technique that helps in characterizing breast lesions according to their water diffusivity. So this work aimed to assess the diagnostic performance of DW-MRI in troublesome breast lesions and see if it can replace DCE-MRI study.ResultsIn our prospective study, we included 86 patients with mammography and/or ultrasound-detected 90 probably benign or probably malignant (BIRADS 3 or 4) breast lesions. Among the studied cases, 49/90 lesions were benign, and 41/90 were malignant. Combined analysis of morphological and kinetic findings in DCE-MRI had achieved the highest sensitivity of 95.1%. DW-MRI alone was less sensitive (73.2%) yet more specific (83.7%) than DCE-MRI (77.6%). Diagnostic accuracy of DCE-MRI was higher (85.6%) as compared to DW-MRI which was (78.9%).ConclusionDCE-MRI is the cornerstone in the workup of troublesome breast lesions. DW-MRI should not be used as supplementary tool unless contrast administration is contraindicated. Combining both DCE-MRI and DW-MRI is the ultimate technique for better lesion evaluation.
Highlights
Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) has always been a problem solver in troublesome breast lesions
Despite its many advantages including high image quality and high sensitivity which surpasses that of mammography and ultrasound [5], it has been shown that a major disadvantage of MRI is its low specificity [6]
Kinetic curves were done by placing a region of interest (ROI) at the area of maximum enhancement to measure the amount of contrast uptake, and dynamic curve patterns were prepared
Summary
Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) has always been a problem solver in troublesome breast lesions. This work aimed to assess the diagnostic performance of DWMRI in troublesome breast lesions and see if it can replace DCE-MRI study. Non-invasive functional magnetic resonance imaging (MRI) is used to obtain information about the microstructure as well as the biologic environment of a tumor. Dynamic contrastenhanced MRI (DCE-MRI) is a dynamic investigation that allows tracking of enhancement in different types of tissues where malignant cells will usually show rapid uptake and washout while normal glandular tissue will demonstrate slow progressive kinetics [4]. Despite its many advantages including high image quality and high sensitivity which surpasses that of mammography and ultrasound [5], it has been shown that a major disadvantage of MRI is its low specificity [6]
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