Differentiation Of Breast Lesions Research Articles

Ultrasound elastography improves differentiation between benign and malignant breast lumps using B-mode ultrasound and color Doppler

ObjectivesTo evaluate diagnostic yield of mammography, B-mode ultrasound (US), ultrasound elastography (UE) and color Doppler used alone or in combination for differentiating breast lesions. Patients and methodsSixty women presented by breast lump underwent mammographic examination, B-mode US, color Doppler assessment and UE. The result of histopathological examination of excisional biopsy was used as gold standard for comparison of results. ResultsMammography defined 36 patients had dense glandular breast and 24 patients had fatty parenchyma. Eleven patients had dense glandular parenchyma and 7 of those had fatty parenchyma had malignant lesions. Mean resistive index for malignant lesions was significantly higher than benign lesions. The mean strain ratio was significantly higher for malignant. Combined use of US and UE provided better diagnostic yield than US and Doppler, while combined use of US, UE and Doppler improved the diagnostic yield with high sensitivity and specificity and NPV of 95%. ROC curve analysis assured the high diagnostic yield of combination of US, UE and Doppler. ConclusionCombined use of B-mode US, UE and color Doppler achieved NPV of 95% thus allowed sparing of unnecessary invasive diagnostic procedures. UE as a sole diagnostic test has high sensitivity and specificity. Mammography could be used as screening test for its high sensitivity.

Unenhanced breast MRI (STIR, T2-weighted TSE, DWIBS): An accurate and alternative strategy for detecting and differentiating breast lesions

PurposeTo assess the role of STIR, T2-weighted TSE and DWIBS sequences for detecting and characterizing breast lesions and to compare unenhanced (UE)-MRI results with contrast-enhanced (CE)-MRI and histological findings, having the latter as the reference standard. Materials and MethodsTwo hundred eighty consecutive patients (age range, 27–73 years; mean age±standard deviation (SD), 48.8±9.8years) underwent MR examination with a diagnostic protocol including STIR, T2-weighted TSE, THRIVE and DWIBS sequences. Two radiologists blinded to both dynamic sequences and histological findings evaluated in consensus STIR, T2-weighted TSE and DWIBS sequences and after two weeks CE-MRI images searching for breast lesions. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy for UE-MRI and CE-MRI were calculated. UE-MRI results were also compared with CE- MRI. ResultsUE-MRI sequences obtained sensitivity, specificity, diagnostic accuracy, PPV and NPV values of 94%, 79%, 86%, 79% and 94%, respectively. CE-MRI sequences obtained sensitivity, specificity, diagnostic accuracy, PPV and NPV values of 98%, 83%, 90%, 84% and 98%, respectively. No statistically significant difference between UE-MRI and CE-MRI was found. ConclusionBreast UE-MRI could represent an accurate diagnostic tool and a valid alternative to CE-MRI for evaluating breast lesions. STIR and DWIBS sequences allow to detect breast lesions while T2-weighted TSE sequences and ADC values could be useful for lesion characterization.

Differentiation of Breast Lesions by Use of HyperSPACE: Hyper-Spectral Analysis for Characterization in Echography

Early diagnosis represents the cornerstone in breast cancer control. Ultrasound is still a valid tool because of its low invasiveness, reduced costs and reduced risk of harm, but better exploitation of its potential is necessary to extract information on tissue features. The proposed method, HyperSPACE (hyper-spectral analysis for characterization in echography), which processes the ultrasonic radiofrequency signal in an N-dimension spectral hyperspace to define several characteristic parameters of the tissue under investigation, was used with the aim of differentiating two types of breast lesion: infiltrating ductal carcinoma and fibroadenoma. The analyzed data set consisted of 2000 radiofrequency frames related to 200 sections of pathologic breast nodules: 104 infiltrating ductal carcinomas and 96 fibroadenomas. The algorithm was trained on single radiofrequency frames related to 50 sections (26 carcinomas, 24 fibroadenomas) to recognize the two pathologies considered, and all the radiofrequency frames related to the other 150 sections were classified, yielding a sensitivity of 92.2%, specificity of 93%, positive predictive value of 93.2% and negative predictive value of 91%. The results were compared with those of RULES (radiofrequency ultrasonic local estimators), a processing method set developed by our group and used by other researchers in clinical and laboratory environments.

Elastography for breast cancer diagnosis: a useful tool for small and BI-RADS 4 lesions.

The present study aimed at evaluating and comparing the diagnostic performance of B-mode ultrasound (US), elastography score (ES), and strain ratio (SR) for the differentiation of breast lesions. This retrospective study enrolled 431 lesions from 417 in-hospital patients. All patients were examined with both conventional ultrasound and elastography. Two experienced radiologists reviewed ultrasound and elasticity images. The histopathologic result obtained from ultrasound-guided core biopsy or operation excisions were used as the reference standard. Pathologic examination revealed 276 malignant lesions (64%) and 155 benign lesions (36%). A cut-off point of 4.15 (area under the curve, 0.891) allowed significant differentiation of malignant and benign lesions. ROC (receiver-operating characteristic) curves showed a higher value for combination of B-mode ultrasound and elastography for the diagnosis of breast lesions. Conventional ultrasound combined elastography showed high sensitivity, specificity, and accuracy for group II lesions (10mm<lesion diameter ≤20mm). Elastography combined with conventional ultrasound show high specificity and accuracy for differentiation of benign and malignant breast lesions. Elastography is particularly important for the diagnosis of BI-RADS 4 and small breast lesions.

Role of diffusion weighted images combined with breast MRI in improving the detection and differentiation of breast lesions

PurposeTo assess the impact of diffusion-weighted images as a complementary tool to conventional breast MRI in the evaluation of various breast lesions. Materials and methodsFrom November 2013 to June 2014 thirty patients referred from breast clinic by breast symptoms and abnormal sono-mammography lesions have been included in this study. All patients underwent breast DCE-MRI combined with DWI and the results were compared with the histopathological examination which was used as the standard diagnostic method. ResultsThe study included thirty patients complaining of breast lesions, 35 lesions were detected, according to the histopathological analysis, there were 20 malignant lesions (57.14%) and 15 benign lesions (42.86%). DCE-MRI had a sensitivity of 80%, a specificity of 73.33%, PPV of 80%, NPV of 73.3% and accuracy of 77.14%. The malignant lesions showed a mean ADC value of 1.03±0.35. Alternatively, the benign lesions showed a mean ADC value of 1.38±0.26. Among the 20 malignant lesions, 17 lesions showed an ADC value ⩽1.20mm2/s and 3 lesions showed an ADC value >1.20mm2/s. While among the 15 benign lesions, 14 lesions showed ADC value >1.20mm2/s and 1 lesion showed an ADC value ⩽1.20. The ROC curve showed that the best ADC cut-off value to differentiate between benign and malignant lesions was 1.2mm2/s (P<0.001) with sensitivity, specificity, PPV, NPV and accuracy of 85%, 93.33%, 94.4%, 82.4% and 90.3% respectively. ConclusionDWI had a higher sensitivity and specificity than DCE-MRI with ADC cut off value 1.20. This value was a sensitive and specific parameter in differentiating benign and malignant breast lesions.

Role of Dynamic Contrast Enhanced MRI in Characterization of Breast Lesions

Purpose: To assess the role of Dynamic contrast enhanced magnetic resonance imaging in characterization of breast lesions and to differentiate benign from malignant lesions on the basis of their morphology and enhancement kinetics. Material and Methods: Sixty patients referred to the department of Radiodiagnosis for breast MRI over a period of twenty months were included. Dynamic contrast enhanced (DCE) Magnetic Resonance Imaging (MRI) was performed to differentiate breast lesions on the basis of morphology and enhancement kinetics. The lesions were classified accordingly into type I (progressive enhancement) Type II (plateau) and Type III (washout) kinetics. Morphology and curves of benign and malignant lesions were compared. Result: fifty one benign lesions were detected in 32 patients and 29 malignant lesions were seen in 22 patients, whereas six patients showed normal MRI. It was found that benign lesion were round or oval in shape with well circumscribed margin and showed homogenous contrast enhancement whereas malignant lesions were irregular with spiculated margin and showed heterogenous contrast enhancement. The distribution curve types of benign lesion were Type I (81.25%-26cases), Type II (18.25%-6cases). For malignant lesions Type I (4.54%-1case), Type II (22.72%-5cases) and Type III (72.72%-16cases). Conclusion: The shape of the time- signal intensity curve were an important criteria in differentiating benign from malignant lesions in dynamic breast MR imaging. A type III time curve is a strong indicator of malignancy and is independent of other criteria. DOI: http://dx.doi.org/10.3126/njr.v4i1.11366 Nepalese Journal of Radiology, Vol.4(1) 2014: 23-33

Diagnostic performances of shear-wave elastography for identification of malignant breast lesions: a meta-analysis.

To examine the performance of shear-wave elastography (SWE) for the differentiation of benign and malignant breast lesions using a meta-analysis. PubMed, Embase and the Cochrane library were searched for studies published up to January 2014. The references of retrieved relevant articles were reviewed to identify potential publications. Random-effect meta-analysis was conducted to assess the overall sensitivity and specificity of SWE in the differentiation of breast lesions. A total of 11 articles, including 2424 patients, were included in the present meta-analysis. The summarized sensitivity and specificity of the shear wave elastography performance based on maximum elasticity were 0.93 (95% CI 0.91-0.95) and 0.81 (95% CI 0.78-0.83), respectively. For the mean elasticity, the summarized sensitivity and specificity were 0.94 (95% CI 0.92-0.96) and 0.71 (95% CI 0.69-0.74), respectively. The summarized sensitivity and specificity were 0.77 (95% CI 0.70-0.83) and 0.88 (95% CI 0.84-0.91) for the SD of elasticity. SWE has a high sensitivity and specificity in the differentiation of benign and malignant breast lesions. More large and prospective studies are warranted to further examine the performance of SWE.

Diagnostic assessment by dynamic contrast-enhanced and diffusion-weighted magnetic resonance in differentiation of breast lesions under different imaging protocols.

BackgroundThe apparent diffusion coefficient (ADC) is a highly diagnostic factor in discriminating malignant and benign breast masses in diffusion-weighted magnetic resonance imaging (DW-MRI). The combination of ADC and other pictorial characteristics has improved lesion type identification accuracy. The objective of this study was to reassess the findings on an independent patient group by changing the magnetic field from 1.5-Tesla to 3.0-Tesla.MethodsThis retrospective study consisted of a training group of 234 female patients, including 85 benign and 149 malignant lesions, imaged using 1.5-Tesla MRI, and a test group of 95 female patients, including 19 benign and 85 malignant lesions, imaged using 3.0-Tesla MRI. The lesion of interest was segmented from the raw image and four sets of measurements describing the morphology, kinetics, DW-MRI, and texture of the pictorial properties of each lesion were obtained. Each lesion was characterized by 28 features in total. Three classical machine-learning algorithms were used to build prediction models on the training group, which evaluated the prognostic performance of the multi-sided features in three scenarios. To reduce information redundancy, five highly diagnostic factors were selected to obtain a compact yet informative characterization of the lesion status.ResultsThree classification models were built on the training of 1.5-Tesla patients and were tested on the independent 3.0-Tesla test group. The following results were found. i) Characterization of breast masses in a multi-sided way dramatically increased prediction performance. The usage of all features gave a higher performance in both sensitivity and specificity than any individual feature groups or their combinations. ii) ADC was a highly effective factor in improving the sensitivity in discriminating malignant from benign masses. iii) Five features, namely ADC, Sum Average, Entropy, Elongation, and Sum Variance, were selected to achieve the highest performance in diagnosis of the 3.0-Tesla patient group.ConclusionsThe combination of ADC and other multi-sided characteristics can increase the capability of discriminating malignant and benign breast lesions, even under different imaging protocols. The selected compact feature subsets achieved a high diagnostic performance and thus are promising in clinical applications for discriminating lesion type and for personalized treatment planning.

Breast Lesions: Evaluation with Shear Wave Elastography, with Special Emphasis on the “Stiff Rim” Sign

To analyze the diagnostic performance of shear wave elastography (SWE) in differentiating between benign and malignant breast lesions, with special emphasis on the value of the "stiff rim" sign, as compared with conventional ultrasonography (US). For this ethics committee-approved retrospective study, all patients provided verbal informed consent for the analysis of their imaging data. A total of 193 consecutive women (age range, 18-82 years; mean age, 46 years) with 193 breast lesions (56 malignant, 137 benign) were included. The stiff rim sign, a qualitative SWE feature, was evaluated at the display setting of less than 180 kPa and at 180 kPa. The quantitative SWE features were assessed. Sensitivity, specificity, the area under the receiver operating characteristic curve (Az), and positive and negative likelihood ratios were calculated for conventional US features, for SWE features, and for combined conventional US and SWE features. Among all qualitative and quantitative SWE features, the stiff rim sign at the display setting (<180 kPa) showed the highest Az (0.918; 95% confidence interval [CI]: 0.870, 0.953), which was comparable to that for conventional US (0.891; 95% CI: 0.838, 0.931) (P = .40). The combination of the stiff rim sign at less than 180 kPa and conventional US features, with a positive likelihood ratio of 12.23 (95% CI: 11.5, 13.0) and a negative likelihood ratio of 0.02 (95% CI: 0.003, 0.1), yielded the highest Az (0.982; 95% CI: 0.951, 0.995)-higher than those for conventional US only and for any single SWE feature alone (P < .001 for all)-and yielded higher sensitivity (98.2% [55 of 56]; 95% CI: 90.4%, 100.0%) and similar specificity (92.0% [126 of 137]; 95% CI: 86.1%, 95.9%) compared with conventional US (P < .001 and P = .58, respectively). With use of this combination, the rate of recommendation of benign lesions for interventional procedures would decrease from 56.9% (78 of 137) (on the basis of conventional US features) to 15.3% (21 of 137), and 100.0% (56 of 56) (95% CI: 93.6%, 100.0%) malignant lesions would be correctly selected for biopsy. Adding SWE features, especially the stiff rim sign at the display setting (<180 kPa), to conventional US has the potential to improve the differentiation of breast lesions.

Incremental value of real-time ultrasound elastography in differentiating breast masses

Aim of the workTo evaluate the value of real-time ultrasound elastography (RTE) in differentiating benign from malignant breast masses. Materials and methodsThis study included, whether palpable or non-palpable, 145 sonographically proven breast masses in 121 patients, imaged by conventional B-mode US, color-flow Doppler US and RTE with histopathological analysis considered as the golden standard reference. ResultsLesions were differentiated into benign and malignant by conventional B-mode US (79; 45.5% and 66; 54.5%, respectively), RTE (80; 55.2% and 65; 44.8% respectively), and histopathology (82; 56.6% and 63; 43.4%, respectively). The mean difference in the mass size was significant between B-mode US and RTE in malignant masses (P=0.002), while not significant among benign masses (P=0.153). The B-mode US depicted sensitivity of 92.06%, specificity of 90.24%, PPV of 87.88%, NPV of 93.67% and accuracy of 91.03%, while the RTE showed sensitivity of 98.41%, specificity of 96.34%, PPV of 95.38%, NPV of 98.75% and accuracy of 97.24%. ConclusionCombined use of RTE can complement conventional B-mode US with improving its diagnostic performance in differentiating breast lesions with subsequent reduction in the rate of unnecessary biopsies in benign lesions.

The contribution of diffusion tensor imaging and magnetic resonance spectroscopy for the differentiation of breast lesions at 3T

Conventional breast magnetic resonance imaging (MRI), including dynamic contrast-enhanced MR mammography (DCE-MRM), may lead to ambiguous diagnosis and unnecessary biopsies. To investigate the contribution of proton MR spectroscopy (1H-MRS) combined with diffusion tensor imaging (DTI) metrics in the discrimination between benign and malignant breast lesions. Fifty-one women with known breast abnormalities from conventional imaging were examined on a 3T MR scanner. DTI was performed during breast MRI, and fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were measured in the breast lesions and the contralateral normal breast. FA and ADC were compared between malignant lesions, benign lesions, and normal tissue. 1H-MRS was performed after gadolinium administration and choline peak was qualitatively evaluated. In our study 1H-MRS showed a sensitivity of 93.5%, specificity 80%, and accuracy 88.2%. FA was significantly higher in breast carcinomas compared to benign lesions. However, no significant difference was observed in ADC between benign and malignant lesions. The combination of Cho presence and FA achieved higher levels of accuracy and specificity in discriminating malignant from benign lesions over Cho presence or FA alone. In conclusion, applying DTI and 1H-MRS together, adds incremental diagnostic value in the characterization of breast lesions and may sufficiently improve the low specificity of conventional breast MRI.

Role of ultrasound elastography in the differentiation of breast lesions

Background: Breast biopsy remains the gold standard for diagnosis of breast lesions; however, most of the breast specimens reveal benign results. Therefore, in order to avoid unnecessary breast biopsies, noninvasive diagnostic tools have been developed. Ultrasound elastography (USE) is a noninvasive technique which helps in reducing the frequency of breast biopsies. Aims: The aim of the study was to study the role of ultrasound elastography in differentiation of breast lesions which will ultimately help in better patient diagnosis. Materials and Methods: In this study, 54 patients with 66 breast lesions were first assessed with sonography and then with USE after obtaining informed patient consent. The examination was carried out in Department of Onco Imaging, Delhi State Cancer Institute, Delhi, India. from July 2011 to February 2012. Statistical Analysis: Statistical analysis was performed using SPSS software (version 20.0). Results and Conclusion: The lesions were classified on elastography using scoring system described by Itoh et al., 2006 with elasticity score of 1,2,3 as benign and score of 4 and 5 as malignant. The sensitivity of USE was found to be 88.57% with specificity of 90.32% and positive predictive value of 91.18%. Thus, we conclude that in the present scenario, USE can be used in early diagnosis and differentiation of breast masses into benign and malagnant and henceforth, can be influential in reducing the number of breast biopsies.

The contribution of diffusion tensor imaging and magnetic resonance spectroscopy for the differentiation of breast lesions at 3T

BackgroundConventional breast magnetic resonance imaging (MRI), including dynamic contrast-enhanced MR mammography (DCE-MRM), may lead to ambiguous diagnosis and unnecessary biopsies.PurposeTo inve...

Diagnostic value of elastography using acoustic radiation force impulse imaging and strain ratio for breast tumors.

PurposeThe aim of this study was to determine whether the combination of B-mode ultrasonography (BUS), acoustic radiation force impulse (ARFI) elastography, and strain ratio (SR) provides better diagnostic performance of breast lesion differentiation than BUS alone.MethodsARFI elastography and SR evaluations were performed on patients with 157 breast lesions diagnosed by BUS from June to September 2013. BUS images were classified according to the Breast Imaging-Reporting and Data System. ARFI elastography was performed using Virtual Touch™ tissue imaging (VTI) and Virtual Touch™ tissue quantification (VTQ). In VTI mode, we evaluated the color-mapped patterns of the breast lesion and surrounding tissue. The lesions were classified into five categories by elasticity score. In VTQ mode, each lesion was assessed using shear wave velocity (SWV) measurements. SR was calculated from the lesion and comparable lateral fatty tissue. We compared the diagnostic performance of BUS alone and the combination of BUS, ARFI elastography, and SR evaluations.ResultsAmong the 157 lesions, 40 were malignant and 117 were benign. The mean elasticity score (3.7±1.0 vs. 1.6±0.8, p<0.01), SWV (4.23±1.09 m/sec vs. 2.22±0.88 m/sec, p<0.01), and SR (5.69±1.63 vs. 2.69±1.40, p<0.01) were significantly higher for malignant lesions than benign lesions. The results for BUS combined with ARFI elastography and SR values were 97.5% sensitivity, 92.3% specificity, 93.6% accuracy, a 79.6% positive predictive value (PPV), and a 99.1% negative predictive value. The combination of the 3 radiologic examinations yielded superior specificity, accuracy, and PPV compared to BUS alone (p<0.01 for each).ConclusionARFI elastography and SR evaluations showed significantly different mean values for benign and malignant lesions. Moreover, these two modalities complemented BUS and improved the diagnostic performance of breast lesion detection. Therefore, ARFI elastography and SR evaluations can be used as complementary modalities to make more accurate breast lesion diagnoses.

Diagnostic Efficacy of Contrast‐Enhanced Sonography by Combined Qualitative and Quantitative Analysis in Breast Lesions

The purpose of this study was to evaluate the diagnostic efficacy of contrast-enhanced sonography for differentiation of breast lesions by combined qualitative and quantitative analyses in comparison to magnetic resonance imaging (MRI). Fifty-six patients with American College of Radiology Breast Imaging Reporting and Data System category 3 to 5 breast lesions on conventional sonography were evaluated by contrast-enhanced sonography and MRI. A comparative analysis of diagnostic results between contrast-enhanced sonography and MRI was conducted in light of the pathologic findings. Pathologic analysis showed 26 benign and 30 malignant lesions. The predominant enhancement patterns of the benign lesions on contrast-enhanced sonography were homogeneous, centrifugal, and isoenhancement or hypoenhancement, whereas the patterns of the malignant lesions were mainly heterogeneous, centripetal, and hyperenhancement. The detection rates for perfusion defects and peripheral radial vessels in the malignant group were much higher than those in the benign group (P < .05). As to quantitative analysis, statistically significant differences were found in peak and time-to-peak values between the groups (P < .05). With pathologic findings as the reference standard, the sensitivity, specificity, and accuracy of contrast-enhanced sonography and MRI were 90.0%, 92.3%, 91.1% and 96.7%, 88.5%, and 92.9%, respectively. The two methods had a concordant rate of 87.5% (49 of 56), and the concordance test gave a value of κ = 0.75, indicating that there was high concordance in breast lesion assessment between the two diagnostic modalities. Contrast-enhanced sonography provided typical enhancement patterns and valuable quantitative parameters, which showed good agreement with MRI in diagnostic efficacy and may potentially improve characterization of breast lesions.

Abstract P4-03-06: Non-invasive classification of microcalcifications by the use of X-ray phase contrast mammography as a novel tool in breast diagnostics

Abstract Purpose: Phase-contrast and scattering-based x-ray imaging are known to provide additional and complementary information to conventional, absorption-based methods. The goal of this study is to evaluate this method to distinguish between benign and malignant microcalcifications with the benefit to increase accuracy of early breast cancer diagnosis. Phase-contrast mammography has been shown to increase image quality of native breast samples when compared to conventional mammography. Two major types of microcalcifications are found within breast tissue. Type I consist of calcium oxalate dehydrate and type II microcalcifications are composed of calcium phosphates. Type I is seen most frequently in benign lesions whereas type II is indicative for proliferative lesions, including carcinomas. Phase contrast mammography is shown here to distinguish between the two types of microcalcifications and therefore indicates a step forward to improve early breast cancer diagnosis. Material and Methods: Freshly dissected breast specimens (n = 50) were imaged using a Talbot-Lau interferometer equipped with a conventional x-ray tube; the interferometer was operated at the fifth Talbot distance, tube voltage of 40 kVp with mean energy of 28 keV, and current of 25 mA. The device simultaneously recorded absorption, differential phase and small-angle scattering signals. These quantities were combined into novel, high-frequency-enhanced radiographic images. Histopathological analysis was performed and regions of interests correlated with the findings of phase contrast mammography. Results: Our novel imaging approach yields complementary and otherwise inaccessible information on electron density distribution and small-angle scattering power of the sample at microscopic scale. Recently we generated the world's first phase contrast mammograms of native, not-fixed human whole breast samples. Our results indicate the superiority of the new technique with respect to image quality and lesion conspicuity. A clinical reader study is currently carried out. Exploiting the multiple, complementary information obtained by grating-based interferometry, we are able to classify microcalcifications by a non-invasive technique within the clinical environment. By considering the small-angle scattering signal as a complement to the absorption signal, our method can analyze the differences in the attenuation coefficient as well as in the crystal structure of the microcalcifications. Further, the scattering signal is used to decouple the thickness parameter. We demonstrate that type I and type II microcalcifications give opposite absorption and scattering signals and in addition the small-angle scattering signal helps to determine the type of microcalcification. Conclusions: The potential clinical significance of phase-contrast enhanced mammography has been evaluated by our team. This technique yields improved diagnostic capabilities when compared with conventional mammography, can provide superior contrast, inaccessible and complementary information, and potentially also reduce dose deposition. The non-invasive classification of microcalcifications is an important step toward early diagnosis and differentiation of breast lesions. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-03-06.

Study of quantitative elastography with supersonic shear imaging in the diagnosis of breast tumours

This study was undertaken to evaluate the value of quantitative elastography in the diagnosis of breast tumours. Conventional ultrasound (US) and quantitative elastography were performed in 108 women with 114 breast lesions by two experienced radiologists, and pathological results were available in all cases. For each lesion, the maximum, mean, and minimum (min) elasticity and elasticity ratio between lesions and surrounding tissue were measured. The Breast Imaging Reporting and Data System (BI-RADS) categories were assessed with conventional US in all lesions. Malignant lesions exhibited significantly higher maximum and mean elasticity (111.57 ± 69.29 kPa and 54.49 ± 33.70 kPa) than did benign lesions (59.00 ± 45.3 kPa and 36.64 ± 26.18 kPa) (p<0.01). For maximum elasticity versus BI-RADS, performance results were sensitivity 60.9 % vs. 78.3%, specificity 85.3% vs. 98.5%, positive predictive value (PPV) 73.7% vs. 97.3 %, negative predictive value (NPV) 76.3% vs. 87.0 % and accuracy 75.4% vs. 90.3%. BI-RADS had significantly better accuracy than maximum elasticity (p<0.01). Maximum and mean elasticity of invasive ductal carcinoma (IDC) were significantly higher than those of fibroadenoma (p<0.01), whereas the difference was not statistically significant with fibroadenosis, papilloma and inflammation (p>0.01). Maximum and mean elasticity and elasticity ratio of BI-RADS 5 were all significantly higher than those of BI-RADS 3 (p<0.01). Reliability for maximum and mean elasticity were almost perfect [intraclass correlation coefficients (ICC)=0.87 and 0.79]. Shear-wave elastography gives quantitative elasticity information that could potentially help in breast-lesion characterisation, although it cannot replace conventional BI-RADS in the differentiation of breast lesions.

Quantificação por imagem ponderada em difusão (DWI) das lesões tumorais da mama

Introduction – The Magnetic Resonance (MR) diffusion technique measures the movement of water molecules in tissues. Therefore, it provides useful information about tissue architecture, specially regarding tissue cellularity, cell volume and membrane permeability. The quantification of diffusion weighted imaging (DWI) data is done by measuring the so-called. Apparent Diffusion Coefficient (ADC). This parameter provides additional clinical information about breast lesions, and potentially allows for in-vivo histological characterization. Purpose – To characterize and differentiate breast lesions through ADC analysis. Methodology – The study comprised 20 women, with 23 breast lesions: 3 benign lesions - 3 Fibroadenomas (FA); and 20 malignant - 16 Invasive Ductal Carcinomas(CDI), 2 Ductal Carcinomas In Situ (CDIS), 2 Invasive Lobular Carcinoma (CLI). On a 1.5T equipment a diffusion-weighted sequence with 6 b-values (b=0,50,250,500,750,1000 s/mm2) was used to examine the patients. ADC was obtained by fitting an exponential to data of lesion signal intensity vs. b values. A correspondence of ADC values to histological lesion characterization was done and finally, the results were comparison with the literature. Results and Discussion – Malignant lesions showed inferior ADCs significantly (p=0.014) lower ((0.94±0.22)x10-3 mm2/s) than the benign lesions ((1.43±0.25)x10-3 mm2/s). This may be associated to increasead cellularity in malignant lesions, which result in higher tissue restriction to diffusion. CDI showed low ADC values ((0.88±0.17)x10-3 mm2/s), while the CDIS showed higher ADCs ((1.33±0.29)x10-3 mm2/s). These results agree with the fact that CDIS are limited to mammary ducts, maintaining a less altered neighboring tissue structure, which results in a lower restriction to diffusion than observed in CDI. Significant differences between FA and CDI (p=0.010) and between CDI and CDIS (p=0.049) were observed. Conclusion – The ADC parameter is able to differentiate between malignant and benign breast lesions, as well as between some histological types

MR-Spectroscopy at 1.5 tesla and 3 tesla. Useful? A systematic review and meta-analysis

Dynamic contrast enhanced magnetic resonance imaging is the most sensitive method for detection of breast cancer [1,2]. These T1-weighted imaging studies measure the extracellular distribution of paramagnetic contrast agents which are mainly affected by vascular properties of the tissue investigated. Although cancers show a characteristically early and strong enhancement, substantial overlaps of enhancement characteristics between benign and malignant breast lesions have been described. Consequently, for lesion classification in clinical practice, a combination of morphologic criteria and dynamic enhancement pattern analysis is applied [3]. Such an approach is mainly subjective and thus prone to experience related mistakes and interobserver variation. Proton magnetic resonance spectroscopy (H MR spectroscopy, MRS) is a noninvasive examination technique for the assessment of biochemical tissue properties. Presence of a compound resonance around 3.23 ppm is attributed to choline metabolites such as choline, phosphocholine and glycerophosphocholine and simply referred to as total choline (tCho). Increased levels of tCho have been detected in malignant cancers and are ascribed to an increased cellular membrane turnover [4–6]. In vivo qualitative and quantitative tCho measurements have been used as a diagnostic test in the workup of neoplastic breast lesions. The present systematic review and meta-analysis aims to investigate the diagnostic capability of tCho measurements for the differentiation of breast lesions focusing on state of the art field strengths for clinical breast imaging of 1.5 and 3 tesla.

Quantitative diffusion-weighted imaging (DWI) in breast cancer

Introduction - The Magnetic Resonance (MR) diffusion technique measures the movement of water molecules in tissues. Therefore, it provides useful information about tissue architecture, specially regarding tissue cellularity, cell volume and membrane permeability. The quantification of diffusion weighted imaging (DWI) data is done by measuring the so-called. Apparent Diffusion Coefficient (ADC). This parameter provides additional clinical information about breast lesions, and potentially allows for in-vivo histo- logical characterization. Purpose - To characterize and differentiate breast lesions through ADC analysis. Methodology - The study comprised 20 women, with 23 breast lesions: 3 benign lesions - 3 Fibroadenomas (FA); and 20 malignant - 16 Invasive Ductal Carcinomas