Abstract
ObjectivesTo demonstrate the value of diffusion-weighted imaging (DWI) in the characterisation of mastitis lesions.MethodsSixty-one non-puerperal patients with pathologically confirmed single benign mastitis lesions underwent preoperative examinations with conventional MRI and axial DWI. Patients were categorised into three groups: (1) periductal mastitis (PDM), (2) granulomatous lobular mastitis (GLM), and (3) infectious abscess (IAB). Apparent diffusion coefficient (ADC) values of each lesion were recorded. A one-way ANOVA with logistic analysis was performed to compare ADC values and other parameters. Discriminative abilities of DWI modalities were compared using the area under the receiver operating characteristic curve (AUC). P < 0.05 was considered statistically significant.ResultsADC values differed significantly among the three groups (P = 0.003) as well as between PDM and IAB and between PDM and GLM. The distribution of non-mass enhancement on dynamic contrast-enhanced (DCE) MRI differed significantly among the three groups (P = 0.03) but not between any two groups specifically. There were no differences in lesion location, patient age, T2WI or DWI signal intensity, enhancement type, non-mass internal enhancement, or mass enhancement characteristics among the three groups.ConclusionsADC values and the distribution of non-mass enhancement are valuable in classifying mastitis subtypes.Key points• Mastitis subtypes exhibit different characteristics on DWI and DCE MRI.• ADC values are helpful in isolating PDM from other mastitis lesions.• Distribution of non-mass enhancement also has value in comparing mastitis subtypes.
Highlights
Mastitis is primarily defined as infectious or non-infectious inflammation of breast tissue [1]
Apparent diffusion coefficient (ADC) values and the distribution of non-mass enhancement are valuable in classifying mastitis subtypes
61 female patients with unilateral mastitis were enrolled in this study, assessed using dynamic contrast-enhanced (DCE) and diffusion-weighted imaging (DWI) magnetic resonance imaging (MRI) scans, and categorised into three sub-groups based on the type of mastitis lesion (17 periductal mastitis (PDM): mean age = 44.47 ± 14.68; 32 granulomatous lobular mastitis (GLM): mean age = 41.34 ± 12.71; 12 infectious abscess (IAB): mean age = 41.33 ± 18.79)
Summary
Mastitis is primarily defined as infectious (usually bacterial) or non-infectious inflammation of breast tissue [1]. Eur Radiol (2018) 28:992–999 puerperal mastitis describes inflammatory lesions of the breast that occur unrelated to pregnancy and breastfeeding [2]. Non-puerperal mastitis accounts for approximately 4-5% of benign breast lesions, but its incidence is increasing, especially in developing countries [3]. Nonpuerperal mastitis represents approximately 2-5% of all breast lesions in China, as compared to 0.3-1.9% of all breast lesions globally [3, 4]. The most common pathological characteristics of PDM, GLM, and IAB are as follows: PDM: greyish discharge exuding from dilated lactiferous ducts, resulting in plasma cell-induced inflammation; GLM: chronic, non-caseating granulomatous lobulitis; and IAB: accumulation of pus in a localised region of the breast [5]
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