Abstract
Objective The aim was to evaluate the diagnostic value of MRI in lesions with architectural distortion manifested in mammography. Methods A retrospective analysis of MRI was performed in 60 patients with 61 lesions manifested as architectural distortion in full - field digital mammography (FFDM) and subsequently confirmed by pathology or two year's follow-up, 30 were malignant and 31 were benign. All the patients underwent MRI within 2 weeks of mammography. MRI protocol included conventional MR, DWI and dynamic contrast-enhanced MRI. The breast imaging reporting and data system (BI-RADS) was used as the reference standard. BI-RADS categories 1 to 3 were considered as negative for malignancy and BI-RADS categories 4 to 5 were considered as positive for malignancy. ADCs of suspicious lesion of interest and glandular tissue were calculated. nADC was then calculated using the following formula: nADC=ADC (lesion)/ADC (glandular tissue). ADC and nADC were compared by using t test. ROC analysis was carried out to define the most effective threshold ADC and nADC value to differentiate malignant from benign lesion in the breast. Diagnostic performance of the FFDM, DCE - MRI and DCE-MRI combined nADC were calculated. Results ADC value of malignant and benign lesions was (1.35±0.31) ×10-3 mm2/s and (1.07±0.40)×10-3 mm2/s, respectively . nADC values were 0.83±0.17 and 0.59±0.25, respectively (t values were 2.82 and 4.54, P<0.01). Area under the curve of ADC and nADC were 0.829 and 0.753 respectively. When threshold of ADC was set at 1.19×10-3mm2/s, sensitivity and specificity were 71.0% and 86.7%, respectively. For a nADC value threshold of 0.589, sensitivity and specificity were 93.5% and 76.7%, respectively. Sensitivity, specificity and accuracy with FFDM were 80.0%(24/30), 9.7% (3/31) and 44.3%(27/61), Sensitivity, specificity and accuracy with DCE-MRI were 90.0%(27/30), 41.9% (13/31) and 65.6%(40/61), Sensitivity, specificity and accuracy with DCE-MRI combined nADC were 93.3% (28/30), 77.4%(24/31) and 85.2%(52/61), respectively. Conclusion Sensitivity and specificity with DCE-MRI combined nADC is higher, and DCE-MRI combined nADC values is helpful to differentiate malignant from benign lesions with architectural distortion manifested in FFDM. Key words: Breast neoplasms; Mammography; Magnetic resonance imaging
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