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18.05.2016 | Breast

Independent value of image fusion in unenhanced breast MRI using diffusion-weighted and morphological T2-weighted images for lesion characterization in patients with recently detected BI-RADS 4/5 x-ray mammography findings

verfasst von: Sebastian Bickelhaupt, Jana Tesdorff, Frederik Bernd Laun, Tristan Anselm Kuder, Wolfgang Lederer, Susanne Teiner, Klaus Maier-Hein, Heidi Daniel, Anne Stieber, Stefan Delorme, Heinz-Peter Schlemmer

Erschienen in: European Radiology | Ausgabe 2/2017

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Abstract

Objectives

The aim of this study was to evaluate the accuracy and applicability of solitarily reading fused image series of T2-weighted and high-b-value diffusion-weighted sequences for lesion characterization as compared to sequential or combined image analysis of these unenhanced sequences and to contrast- enhanced breast MRI.

Methods

This IRB-approved study included 50 female participants with suspicious breast lesions detected in screening X-ray mammograms, all of which provided written informed consent. Prior to biopsy, all women underwent MRI including diffusion-weighted imaging (DWIBS, b = 1500s/mm²). Images were analyzed as follows: prospective image fusion of DWIBS and T2-weighted images (FU), side-by-side analysis of DWIBS and T2-weighted series (CO), combination of the first two methods (CO+FU), and full contrast-enhanced diagnostic protocol (FDP). Diagnostic indices, confidence, and image quality of the protocols were compared by two blinded readers.

Results

Reading the CO+FU (accuracy 0.92; NPV 96.1 %; PPV 87.6 %) and the CO series (0.90; 96.1 %; 83.7 %) provided a diagnostic performance similar to the FDP (0.95; 96.1 %; 91.3 %; p > 0.05). FU reading alone significantly reduced the diagnostic accuracy (0.82; 93.3 %; 73.4 %; p = 0.023).

Conclusions

MR evaluation of suspicious BI-RADS 4 and 5 lesions detected on mammography by using a non-contrast-enhanced T2-weighted and DWIBS sequence protocol is most accurate if MR images were read using the CO+FU protocol.

Key Points

• Unenhanced breast MRI with additional DWIBS/T2w-image fusion allows reliable lesion characterization.

• Abbreviated reading of fused DWIBS/T2w-images alone decreases diagnostic confidence and accuracy.

• Reading fused DWIBS/T2w-images as the sole diagnostic method should be avoided.

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Titel: Independent value of image fusion in unenhanced breast MRI using diffusion-weighted and morphological T2-weighted images for lesion characterization in patients with recently detected BI-RADS 4/5 x-ray mammography findings
verfasst von: Sebastian Bickelhaupt
Jana Tesdorff
Frederik Bernd Laun
Tristan Anselm Kuder
Wolfgang Lederer
Susanne Teiner
Klaus Maier-Hein
Heidi Daniel
Anne Stieber
Stefan Delorme
Heinz-Peter Schlemmer
Publikationsdatum: 18.05.2016
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 2/2017
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-016-4400-9

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Independent value of image fusion in unenhanced breast MRI using diffusion-weighted and morphological T2-weighted images for lesion characterization in patients with recently detected BI-RADS 4/5 x-ray mammography findings