Abstract
To retrospectively evaluated the influence of administration of the gadolinium based intravenous contrast agent (G-CA) on apparent diffusion coefficient (ADC) values in ADC maps generated using multiple b value combinations. A total of 106 women underwent bilateral 3.0 T breast MRI. As an internal validation, diffusion-weighted imaging (b values of 0, 200, 400, 600, 800 s/mm2) was performed before and after the G-CA (gadoterate meglumine (0.2 ml/kg, 3 ml/s)). Whole lesion and fibroglandular tissue (FGT) covering region-of-interests (ROIs) were drawn on the b = 800 s/mm2 images; ROIs were then propagated to multiple retrospectively generated ADC maps. Twenty-seven patients (mean age 55.8 ± 10.8 years) with 32 mass-like enhancing breast lesions including 25 (78.1 %) histopathologically malignant lesions were enrolled. Lesion ADC values were statistically significantly higher in pre-G-CA than post-G-CA ADC maps (ADC0,200,400,600,800: 1.05 ± 0.35 × 10−3 mm2/s vs. 1.02 ± 0.36 × 10−3 mm2/s (P < 0.05); ADC0,200,400: 1.25 ± 0.42 × 10−3 mm2/s vs. 1.20 ± 0.35 × 10−3 mm2/s (P < 0.05)). ADC values between pre- and post-contrast maps were not statistically different when the maps were generated using other b value combinations. Contrast agent administration did not affect the FGT ADC values. G-CA statistically significantly reduced the ADC values of breast lesions on ADC maps generated using the clinically widely utilized b values.
Highlights
Breast MRI has emerged as the most sensitive imaging technique in the detection and evaluation of breast lesions; it has proved to be an important adjunct to mammography in the preoperative local staging of breast cancer and has been suggested to benefit women in average to high breast cancer risk populations as a screening method
Yuen et al speculated that the change in apparent diffusion coefficient (ADC) values with regard to gadolinium based intravenous contrast agent (G-CA) could be caused by a microperfusion effect[17], while other investigators have proposed that contrast medium eliminates pseudo-diffusion contributions[17,20] or causes local magnetic field susceptibilities[21,22,23]
The mean ADC values of the lesions varied according to the b value combination (Fig. 2)
Summary
Breast MRI has emerged as the most sensitive imaging technique in the detection and evaluation of breast lesions; it has proved to be an important adjunct to mammography in the preoperative local staging of breast cancer and has been suggested to benefit women in average to high breast cancer risk populations as a screening method. Despite promising results in clinical practice[3], the overlap of ADC values between malignant and benign lesions in different reports but even within the same study, has hindered the establishment of universal ADC thresholds and optimal imaging protocol[15]. Gadolinium based intravenous contrast agents (G-CA) are routinely used when performing breast MRI, their effects on ADC values of breast lesions remain uncertain and the published results are inconsistent[16,17,18,19]. Decreases in breast lesion ADC values due to gadolinium based intravenous contrast agent (G-CA) have been reported to be as substantial as −11 % to −23 % when using 1.5 T scanners[17,18]. We aimed to compare the ADC values obtained from breast lesions and fibroglandular tissue (FGT) before and after dynamic contrast enhanced (DCE) MRI using ADC maps generated using numerous combinations from two to five clinically relevant b values
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