Breast DWI Research Articles

Exploring the feasibility of FOCUS DWI with deep learning reconstruction for breast cancer diagnosis: A comparative study with conventional DWI.

This study compared field-of-view (FOV) optimized and constrained undistorted single-shot diffusion-weighted imaging (FOCUS DWI) with deep-learning-based reconstruction (DLR) to conventional DWI for breast imaging. This study prospectively enrolled 49 female patients suspected of breast cancer from July to December 2023. The patients underwent conventional and FOCUS breast DWI and data were reconstructed with and without DLR. Two radiologists independently evaluated three images per patient using a 5-point Likert scale. Objective evaluations, including signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and apparent diffusion coefficient (ADC), were conducted using manual region of interest-based analysis. The subjective and objective evaluations were compared using the Friedman test. The scores for the overall image quality, anatomical details, lesion conspicuity, artifacts, and distortion in FOCUS-DLR DWI were higher than in conventional DWI (all P < 0.001). The SNR of FOCUS-DLR DWI was higher than that of conventional and FOCUS DWI (both P < 0.001), while FOCUS and conventional DWI were similar (P = 0.096). Conventional, FOCUS, and FOCUS-DLR DWI had similar CNR and ADC values. Our findings indicate that images produced by FOCUS-DLR DWI were superior to conventional DWI, supporting the applicability of this technique in clinical practice. DLR provides a new approach to optimize breast DWI.

Vendor-Specific Correction Software for Apparent Diffusion Coefficient Bias Due to Gradient Nonlinearity in Breast Diffusion-Weighted Imaging Using Ice-Water Phantom.

This study aimed to evaluate a vendor-specific correction software for apparent diffusion coefficient (ADC) bias due to gradient nonlinearity in breast diffusion-weighted magnetic resonance imaging using an ice-water phantom. The phantom consists of 5 plastic tubes with a length of 100 mm and a diameter of 15 mm, filled with distilled water and immersed in an ice-water bath. Diffusion-weighted images were acquired by echo-planar imaging sequence on a 3.0-T scanner. ADC maps with and without correction were calculated using 4 b -values (0, 100, 600, and 800 s/mm 2 ). The mean ADCs were measured using a rectangular profile with 5 × 40 pixels in the anterior-posterior (AP) and a square region of interest with 5 × 5 pixels in the right-left (RL) and superior-inferior (SI) directions on the ADC map. ADC was compared with and without correction using a paired t test. Additionally, ADC of the ice-water phantom was measured at the magnet isocenter. ADC increased in the AP and RL directions and decreased in the SI direction with increasing distance from the isocenter before correction. After the correction, ADC at the off-center positions in the AP, RL, and SI directions was reduced to within 5% of the expected value. There were significant differences in the ADC at the off-center positions without and with correction ( P < 0.001); however, ADC at the magnet isocenter did not vary after correction (1.08 ± 0.02 × 10 -3 mm 2 /s). The vendor-specific software corrected the ADC bias due to gradient nonlinearity at the off-center positions in the AP, RL, and SI directions. Therefore, the software will contribute to the accurate ADC assessment in breast DWI.

Fat-signal suppression in breast diffusion-weighted imaging: the Good, the Bad, and the Ugly.

Fat-signal suppression is essential for breast diffusion magnetic resonance imaging (or diffusion-weighted MRI, DWI) as the very low diffusion coefficient of fat tends to decrease absolute diffusion coefficient (ADC) values. Among several methods, the STIR (short-tau inversion recovery) method is a popular approach, but signal suppression/attenuation is not specific to fat contrary to other methods such as SPAIR (spectral adiabatic (or attenuated) inversion recovery). This article focuses on those two techniques to illustrate the importance of appropriate fat suppression in breast DWI, briefly presenting the pros and cons of both approaches. We show here through simulation and data acquired in a dedicated breast DWI phantom made of vials with water and various concentrations of polyvinylpyrrolidone (PVP) how ADC values obtained with STIR DWI may be biased toward tissue componentswith the longest T1 values: ADC values obtained with STIR fat suppression may be over/underestimated depending on the T1 and ADC profile within tissues. This bias is also illustrated in twoclinical examples. Fat-specific methods should be preferred over STIR for fat-signal suppression in breast DWI, such as SPAIR which also provides a higher sensitivity than STIR for lesion detection. One should remain aware, however, that efficient fat-signal suppression with SPAIR requires good B0 shimming to avoid ADC underestimation from residual fat contamination. The spectral adiabatic (or attenuated) inversion recovery (SPAIR) method should be preferred over short-tau inversion recovery (STIR) for fat suppression in breast DWI. Fat-signal suppression is essential for breast DWI; the SPAIR method is recommended. Short-tau inversion recovery (STIR)is not specific to fat; as a result, SNR is decreased and ADC values may be over- or underestimated. The STIR fat-suppression method must not be used after the injection of gadolinium-based contrast agents.

STUDI LITERATUR PERANAN SEKUEN DWI-STIR DAN DWI-SPAIR PADA PENCITRAAN MRI BREAST DENGAN KASUS LESI PAYUDARA

ABSTRACT&#x0D; &#x0D; Background: Breast cancer is the most common case in Indonesia. One of the modalities for detecting breast cancer is MRI. The DWI sequence is one of the sequences used in MRI Breast. In breast DWI, the use of effective fat suppression techniques is essential. Several studies have stated that the most common fat suppression techniques used in breast MRI are STIR and SPAIR, because they are considered capable of optimally displaying lesion images. Signal intensity and image quality depend on fat suppression technique, the choice of method used for breast DWI should be considered, because it can affect lesion identification and ROI for calculating ADC used to differentiate benign and malignant lesions.&#x0D; Methods: This study is a literature review study with descriptive qualitative research type. Collect and analyze library sources from several published data. After being reduced based on the topic, 6 main relevant articles were found to be used as a basis to review, describing and discussing the results according to the topic and then criticizing according to the author's view and determining conclusions.&#x0D; Results: The results of this study showed that DWI-STIR and DWI-SPAIR on MRI Breast imaging have use in suppressing fat and can show the difference between benign and malignant lesions of the breast. With the difference in DWI-SPAIR, the results of SNR and CNR are higher, and DWI-STIR, the results are more homogeneous.&#x0D; Conclusion: DWI-STIR and DWI-SPAIR can suppress fat and differentiate lesions well. DWI-SPAIR is better for lesion visibility on high-tesla MRI, and DWI-STIR is better for low-tesla MRI.&#x0D;

A survey by the European Society of Breast Imaging on the implementation of breast diffusion-weighted imaging in clinical practice.

ObjectivesTo perform a survey among all European Society of Breast Imaging (EUSOBI) radiologist members to gather representative data regarding the clinical use of breast DWI.MethodsAn online questionnaire was developed by two board-certified radiologists, reviewed by the EUSOBI board and committees, and finally distributed among EUSOBI active and associated (not based in Europe) radiologist members. The questionnaire included 20 questions pertaining to technical preferences (acquisition time, magnet strength, breast coils, number of b values), clinical indications, imaging evaluation, and reporting. Data were analyzed using descriptive statistics, the Chi-square test of independence, and Fisher’s exact test.ResultsOf 1411 EUSOBI radiologist members, 275/1411 (19.5%) responded. Most (222/275, 81%) reported using DWI as part of their routine protocol. Common indications for DWI include lesion characterization (using an ADC threshold of 1.2–1.3 × 10−3 mm2/s) and prediction of response to chemotherapy. Members most commonly acquire two separate b values (114/217, 53%), with b value = 800 s/mm2 being the preferred value for appraisal among those acquiring more than two b values (71/171, 42%). Most did not use synthetic b values (169/217, 78%). While most mention hindered diffusion in the MRI report (161/213, 76%), only 142/217 (57%) report ADC values.ConclusionThe utilization of DWI in clinical practice among EUSOBI radiologists who responded to the survey is generally in line with international recommendations, with the main application being the differentiation of benign and malignant enhancing lesions, treatment response assessment, and prediction of response to chemotherapy. Report integration of qualitative and quantitative DWI data is not uniform.Key Points • Clinical performance of breast DWI is in good agreement with the current recommendations of the EUSOBI International Breast DWI working group. • Breast DWI applications in clinical practice include the differentiation of benign and malignant enhancing, treatment response assessment, and prediction of response to chemotherapy. • Report integration of DWI results is not uniform. Supplementary InformationThe online version contains supplementary material available at 10.1007/s00330-022-08833-0.

Retrospective Correction of ADC for Gradient Nonlinearity Errors in Multicenter Breast DWI Trials: ACRIN6698 Multiplatform Feasibility Study.

The presented analysis of multisite, multiplatform clinical oncology trial data sought to enhance quantitative utility of the apparent diffusion coefficient (ADC) metric, derived from diffusion-weighted magnetic resonance imaging, by reducing technical interplatform variability owing to systematic gradient nonlinearity (GNL). This study tested the feasibility and effectiveness of a retrospective GNL correction (GNC) implementation for quantitative quality control phantom data, as well as in a representative subset of 60 subjects from the ACRIN 6698 breast cancer therapy response trial who were scanned on 6 different gradient systems. The GNL ADC correction based on a previously developed formalism was applied to trace-DWI using system-specific gradient-channel fields derived from vendor-provided spherical harmonic tables. For quantitative DWI phantom images acquired in typical breast imaging positions, the GNC improved interplatform accuracy from a median of 6% down to 0.5% and reproducibility of 11% down to 2.5%. Across studied trial subjects, GNC increased low ADC (<1 µm2/ms) tumor volume by 16% and histogram percentiles by 5%–8%, uniformly shifting percentile-dependent ADC thresholds by ∼0.06 µm2/ms. This feasibility study lays the grounds for retrospective GNC implementation in multiplatform clinical imaging trials to improve accuracy and reproducibility of ADC metrics used for breast cancer treatment response prediction.

Six DWI questions you always wanted to know but were afraid to ask: clinical relevance for breast diffusion MRI.

Diffusion MRI (often called diffusion-weighted imaging or DWI) has enjoyed a tremendous growth since its introduction in the mid-1980s, especially to investigate neurological disorders and in oncology. At a time when standardization and quality control appear as critical as ever to support widespread utilization, our aim was to address common fundamental questions that arise regarding results obtained with DWI. We focus on six questions taking breast DWI as an example, as breast DWI is increasingly used in clinical practice, but most of our conclusions would apply to DWI in general. We show especially that noise can act in a pernicious way specific to DWI. Ignoring such noise effects could lead to incorrect data interpretations or conclusions, of which authors and readers may be genuinely unaware. While addressing these six questions, we give practical examples of how noise effects can be understood, corrected when possible, or taken to our advantage. Key Points • Ignoring noise effects in DWI could lead to incorrect data interpretations or conclusions, of which authors and readers may be genuinely unaware. • In vivo apparent diffusion coefficient (ADC) decreases with b value, which must therefore be reported along with ADC. • Synthesized DWI boosts contrast at the expense of accurate diffusion/microstructure characterization.

Diffusion kurtosis imaging does not improve differentiation performance of breast lesions in a short clinical protocol

BackgroundDiffusion weighted magnetic resonance imaging (DWI) is known to differentiate between malignant and benign lesions via the apparent diffusion coefficient (ADC). Here, the value of diffusion kurtosis imaging (DKI) for differentiation and further characterization of benign and malignant breast lesions and their subtypes in a clinically feasible protocol is investigated. Material and methodsThis study included 85 patients (with 68 malignant and 73 benign lesions) who underwent 3 T breast DWI using three b values (50, 750, 1500 s/mm2), with a total measurement time < 5 min. ADC maps were calculated from b values 50, 750 s/mm2. The diffusion kurtosis model was fitted to the diffusion weighted images, yielding in each lesion the average kurtosis-corrected diffusion coefficient DK and mean kurtosis K. Histopathology was obtained of radiologically suspicious lesions; follow-up scans were used as a standard of reference for benign appearing lesions. Receiver operating characteristic curves were used to evaluate the parameters' diagnostic performance for differentiation of lesion types and grades. The difference in diffusion parameters between subgroups was analysed statistically using the Wilcoxon rank sum test and Kruskal-Wallis test, applying a Bonferroni correction for multiple testing where necessary. ResultsADC, DK and K showed significant differences between malignant and benign lesions (p < 10−5). All parameters had similar areas under the curve (AUC) (ADC: 0.92, DK: 0.91, K: 0.89) for differentiation of malignant and benign lesions. Sensitivity was highest for ADC (ADC: 0.96, DK: 0.94, K: 0.93), as well as specificity (ADC: 0.85, DK: 0.82, K: 0.82). ADC and DK showed significant differences between tumor histologic grades (p = 6.8⋅10−4, p = 6.6 · 10−5, respectively), whereas K did not (p = 0.99). All three parameters differed significantly between subtypes of benign lesions (ADC: p < 10−5, DK: p< 10−5, K: p = 4.1·10−4), but not between subtypes of malignant lesions (ADC: p = 0.21, DK: p = 0.25, K: p = 0.08). ConclusionDKI parameters and conventional ADC can differentiate between malignant and benign lesions. Differentiation performance was best for ADC. Different tumor grades were significantly different in ADC and DK, which may have an impact on therapy planning and monitoring. In our study, K did not add value to the diagnostic performance of DWI in a clinical setting.

Diffusion-Weighted MRI of Breast Cancer: Improved Lesion Visibility and Image Quality Using Synthetic b-Values.

BackgroundDiffusion‐weighted imaging (DWI) is an MRI technique with the potential to serve as an unenhanced breast cancer detection tool. Synthetic b‐values produce images with high diffusion weighting to suppress residual background signal, while avoiding additional measurement times and reducing artifacts.PurposeTo compare acquired DWI images (at b = 850 s/mm2) and different synthetic b‐values (at b = 1000–2000 s/mm2) in terms of lesion visibility, image quality, and tumor‐to‐tissue contrast in patients with malignant breast tumors.Study TypeRetrospective.PopulationFifty‐three females with malignant breast lesions.Field Strength/SequenceT2w, DWI EPI with STIR fat‐suppression, and dynamic contrast‐enhanced T1w at 3T.AssessmentFrom acquired images using b‐values of 50 and 850 s/mm2, synthetic images were calculated at b = 1000, 1200, 1400, 1600, 1800, and 2000 s/mm2. Four readers independently rated image quality, lesion visibility, preferred b‐value, as well as the lowest and highest b‐value, over the range of b‐values tested, to provide a diagnostic image.Statistical TestsMedians and mean ranks were calculated and compared using the Friedman test and Wilcoxon signed‐rank test. Reproducibility was analyzed by intraclass correlation (ICC), Fleiss, and Cohen's κ.ResultsRelative signal‐to‐noise and contrast‐to‐noise ratios decreased with increasing b‐values, while the signal‐intensity ratio between tumor and tissue increased significantly (P < 0.001). Intermediate b‐values (1200–1800 s/mm2) were rated best concerning image quality and lesion visibility; the preferred b‐value mostly lay at 1200–1600 s/mm2. Lowest and highest acceptable b‐values were 850 s/mm2 and 2000 s/mm2. Interreader agreement was moderate to high concerning image quality (ICC: 0.50–0.67) and lesion visibility (0.70–0.93), but poor concerning preferred and acceptable b‐values (κ = 0.032–0.446).Data ConclusionSynthetically increased b‐values may be a way to improve tumor‐to‐tissue contrast, lesion visibility, and image quality of breast DWI, while avoiding the disadvantages of performing DWI at very high b‐values. Level of Evidence: 3 Technical Efficacy: Stage 2J. Magn. Reson. Imaging 2019;50:1754–1761.

Nyquist ghost correction of breast diffusion weighted imaging using referenceless methods.

Correction of Nyquist ghosts for single-shot spin-echo EPI using the standard 3-line navigator often fails in breast DWI because of incomplete fat suppression, respiration, and greater B0 inhomogeneity. The purpose of this work is to compare the performance of the 3-line navigator with 4 data-driven methods termed "referenceless methods," including 2 previously proposed in literature, 1 introduced in this work, and finally a combination of all 3, in breast DWI. Breast DWI was acquired for 41 patients with SS SE-EPI. Raw data was corrected offline with the standard 3-line navigator and 4 referenceless methods, which modeled the ghost as a linear phase error and minimized 3 unique cost functions as well as the median solution of all 3. Ghost levels were evaluated based on the signal intensity in the background region, defined by a mask auto-generated from a T1 -weighted anatomical image. Ghost intensity measurements were fit to a linear mixed model including ghost correction method and b-value as covariates. All 4 referenceless methods outperformed the standard 3-line navigator with statistical significance at all 4 b-values tested (b = 0, 100, 600, and 800 s/mm2 ). Referenceless methods provide a robust way to reduce Nyquist ghosts in breast DWI without the need for any additional calibration scan.

The Role of Dynamic Contrast Enhanced and Diffusion Weighted MRI in Characterization of Suspicious Breast Masses

Background: Early detection and diagnosis of breast cancer are mandatory for accurate management. Traditionally, mammography and ultrasound are the basic imaging techniques for the detection and localization of breast masses. The low sensitivity and specificity of these imaging tools resulted in a demand for new imaging modalities. Aim of study: to evaluate the role of either diffusion weighted images-MRI or dynamic contrast enhanced MRI in differentiating malignant from benign breast lesions comparing with histopathology results. Patients and Methods: from November 2016 to July 2017, a total of 20 patients presented with suspicious breast lesions BIRADS (4&5) were included in the study. All participants underwent breast DWI and DCE-MRI. Results were compared with histopathological results as a standard final diagnostic method. Results: the study included 20 female patients with suspicious breast lesions, there was 15 (75%) malignant lesions while benign lesions, while benign lesions were 5 (25%) cases. DCE-MRI was found to have a sensitivity of 86.7% and specificity of 80%. ADC cutoff value was found to have a value of 1.143*10-3, which was the best to differentiate between benign and malignant breast masses. DWI MRI was found to have sensitivity of 93.3% and a specificity of 80%. Conclusion: DW-MRI alone gave the same performance as in combination with DCE-MRI. The comparison of DWI and DCE-MRI provides a dramatic superiority in the sensitivity, specificity and accuracy of breast DWI-MRI over other modality.

Influence of menstrucal cycle and anatomic site on fractional anisotropy of diffusion tensor imaging in normal breast

Objective To investigate the influence of menstrucal cycle and anatomic site on the fractional anisotropy (FA) values of diffusion tensor imaging (DTI) in normal breast. Methods Prospectively enrolled 96 volunteers, who have identified with normal menstrucal phase and without breast diseases were found via the breast examination, ultrasound and MRI scan. The cases were divided into three groups according to menstrucal phase: menstrual period group (menstrual cramps 1 to 6 d), proliferative phase group(menstrual cramps 7 to 14 d) and secretory phase group(menstrual cramps 15 d to the next), and each group consisted of 32 subjects. All subjects were performed bilateral breast cross-sectional T1WI, T2WI, DWI and DTI scaning. On the nipple level figture, the mammary gland was divided into three regions including the anterior, central and posterior parts, and the FA values of the different phases and regions were measured. The Kruskal-Wallis H test was applied to analyse the difference of FA values in different menstrual phase and anatomic site. Results The FA values of the anterior region in menstrual phase, proliferative phase and secretary phase were 0.21±0.07, 0.24±0.09 and 0.17±0.07, and the difference had significant difference(P=0.014).The FA values of the central region were respectively 0.15±0.08, 0.18±0.09 and 0.15±0.07, and without the statistically significant difference(P=0.090). The FA values of the posterior region were 0.21±0.11, 0.24 ± 0.13 and 0.16 ± 0.11, and also showed significant difference (P=0.002). In different regions, the difference of FA values between menstrual phases and proliferative phases were also had statistically significant (P=0.018, 0.045, respectively). In the same region, the FA value was lowest in the secretary phase, and the proliferative phase was slightly higher than menstrual phase. Conclusion The FA values are affected by menstrual cycle and anatomic site. Key words: Mammary glands,human; Magnetic resonance imaging; Menstrual cycle

Comparison and Optimization of 3.0 T Breast Images Quality of Diffusion-Weighted Imaging with Multiple B-Values

Breast 3.0 T magnetic resonance diffusion-weighted imaging (MR-DWI) of benign and malignant lesions were obtained to measure and calculate the signal-to-noise ratio (SNR), signal intensity ratio (SIR), and contrast-to-noise ratio (CNR) of lesions at different b-values. The variation patterns of SNR and SIR were analyzed with different b-values and the images of DWI were compared at four different b-values with higher image quality. The effect of SIR on the differential diagnostic efficiency of benign and malignant lesions was compared using receiver operating characteristic curves to provide a reference for selecting the optimal b-value. A total of 96 qualified patients with 112 lesions and 14 patients with their contralateral 14 normal breasts were included in this study. The single-shot echo planar imaging sequence was used to perform the DWI and a total of 13 b-values were used: 0, 50, 100, 200, 400, 600, 800, 1000, 1200, 1500, 1800, 2000, and 2500 s/mm2. On DWI, the suitable regions of interest were selected. The SNRs of normal breasts (SNRnormal), SNRlesions, SIR, and CNR of benign and malignant lesions were measured on DWI with different b-values and calculated. The variation patterns of SNR, SIR, and CNR values on DWI for normal breasts, benign lesions, and malignant lesions with different b-values were analyzed by using Pearson correlation analysis. The SNR and SIR of benign and malignant lesions with the same b-values were compared using t-tests. The diagnostic efficiencies of SIR with different b-values for benign and malignant lesions were evaluated using receiver operating characteristic curves. Breast DWI had higher CNR for b-values ranging from 600 to 1200 s/mm2. It had the best CNR at b = 1000 s/mm2 for the benign lesions and at b = 1200 s/mm2 for the malignant lesions. The signal intensity and SNR values of normal breasts decreased with increasing b-values, with a negative correlation (r = -0.945, P < 0.01). The mean SNR values of benign and malignant lesions were negatively correlated (r = -0.982 and -0.947, respectively, and P < 0.01), gradually decreasing with increasing b-values. The mean SIR value of benign lesions gradually decreased with increasing b-values, a negative correlation (r = -0.991, P < 0.01). The mean SIR values of malignant lesions gradually increased with increasing b-values between 0 and 1200 s/mm2, and gradually decreased with increasing b-values ≥ 1500 s/mm2. For b-values of 600, 800, 1000, and 1200 s/mm2, the sensitivity and specificity of SIR in identifying benign and malignant lesions gradually increased with increasing b-values, peaking at 1200 s/mm2. Breast DWI had higher image quality for b-values ranging from 600 to 1200 s/mm2, and was best for b-values ranging from 1000 to 1200 s/mm2. The SIR had the highest diagnostic efficiency in differentiating benign and malignant lesions for a b-value of 1200 s/mm2.

Impact of fibroglandular tissue and background parenchymal enhancement on diffusion weighted imaging of breast lesions

PurposeTo evaluate the influence of the amount of fibroglandular breast tissue (FGT) and background-parenchymal enhancement (BPE) on lesion detection, quantitative analysis of normal breast tissue and of breast lesions on DWI. Materials and methodsIRB approved this retrospective study on focal findings at contrast-enhanced (CE) breast MR and DWI performed during July–December 2011. Patients with cysts, previous irradiation, silicone implants and current chemotherapy were excluded. DWI with fat suppression was acquired before dynamic acquisition (b factors: 0.1000s/mm2) using 1.5 and 3T scanners. Using correlation with dynamic and T2 images, ROIs were drawn free-hand within the borders of any visible lesion and in contralateral normal breast. Fisher's exact test to evaluate visibility and Wilcoxon-rank-sum test for comparison of ADC values were used. The amount of FGT and BPE was visually assessed by concurrent MRI. Analysis was stratified by menopausal status. Results25/127 (20%) lesions were excluded for technical reasons. 65/102 (64%) lesions were visible on DWI (median diameter: 1.85cm). Mass lesions (M) were more visible (43/60=72%) than non-mass enhancement (NME) (22/42=52%) and malignant lesions were more visible (55/72=76%) than benign (10/30=33%). BPE and FGT did not influence visibility of M (p=0.35 and p=0.57 respectively) as well as of NME (p=0.54 and p=0.10). BPE and FGT did not influence visibility of malignant (p=0.96 and p=1.0) and benign lesions (p=1.0 and p=0.10). Results were confirmed adjusting for menopausal status. The ADC value of normal breast tissue was not influenced by BPE, while it was lower in predominantly fatty breasts compared to dense ones (p=0.002). ConclusionsFGT affects the quantitative evaluation of ADC in normal breast tissue whereas BPE does not. Furthermore, both BPE and FGT do not influence visibility of benign or malignant findings, including both mass lesions and non-mass enhancement, on DWI.