Abstract
BackgroundDynamic contrast-enhanced (DCE) MRI sequences plays a vital role in diagnosing breast masses with high sensitivity and specificity as compared to other diagnostic modalities. The addition of diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) values significantly improves diagnostic accuracy. This study aimed to study the breast masses on DCE-MRI, restricted diffusion on DWI, ADC values, and choline peak on spectroscopy in breast cancer diagnosis.Material and methodsThis study was a prospective observational study which involved subjects with breast lumps. Baseline data was collected from the patients along with pertinent clinical history and relevant laboratory investigations. MR mammography (MRM) was performed on a 1.5 Tesla MR Scanner (MAGNETOM® Avanto, Siemens AG, Munich Germany) using a dedicated double breast coil.ResultsForty-one subjects were included with a total of 54 breast masses in them. The mean age of the study population was 47.1±14.7 years. From the MRI final diagnosis, the majority (53.70%) were diagnosed as malignant lesions and 46.30% as benign. Out of 20 lesions diagnosed as benign on histopathology, only five percent had ADC value <1.3 ×10−3mm2/s, and the majority (95%) had ADC value >1.3 ×10−3mm2/s. All 20 lesions were circumscribed, ovoid, or round in shape showing no restricted diffusion on DWI, with corresponding ADC value of >1.3×10−3mm2/s, homogeneous post-contrast enhancement, or with dark internal septations, type I kinetic enhancement curve, and they showed no choline peak on spectroscopy. Out of 34 malignant lesions diagnosed on histopathology, the majority (85.29%) displayed restricted diffusion on DWI and had an ADC value of <1.3×10−3mm2/s, most of them had spiculated margins, type II/ III kinetic curve with choline peak on spectroscopy.ConclusionMultiparametric MR mammography, which included DCE-MRM, DWI, ADC values, and spectroscopy, correlated well with the histopathological diagnosis of benign and malignant breast masses.
Highlights
Breast cancer is the most frequent cancer diagnosed in women and is the leading cause of death among females [1]
Out of 34 malignant lesions diagnosed on histopathology, the majority (85.29%) displayed restricted diffusion on diffusion-weighted imaging (DWI) and had an apparent diffusion coefficient (ADC) value of
We analyzed the role of the discrete BI-RADS descriptors for Dynamic contrast-enhanced (DCE)-MRI and restricted diffusion on DWI and its ADC values; and correlated these findings with the histopathology of the lesions
Summary
Breast cancer is the most frequent cancer diagnosed in women and is the leading cause of death among females [1]. This study aimed to study the breast masses on DCE-MRI, restricted diffusion on DWI, ADC values, and choline peak on spectroscopy in breast cancer diagnosis. DWI sequences at 50, 400, and 800 s/mm 2 b values were taken, followed by their corresponding ADC sequence Both the sequences, i.e., DWI at 800 s/mm b value and ADC sequence, were compared to assess the presence or absence of restricted diffusion within the breast mass. In the case of malignant lesions, multiple oval-shaped regions of interest each measuring ~25 mm, were drawn over the areas of restricted diffusion. In the case of benign breast masses, multiple ROIs each measuring ~25 mm, are drawn throughout the lesions as the lesions show no restricted diffusion. Proton MR spectroscopy is derived over the lesion, and the presence or absence of the choline peak was assessed and tabulated
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