Elsevier

Academic Radiology

Volume 14, Issue 9, September 2007, Pages 1077-1083
Academic Radiology

Original investigation
Diffusion Weighted Imaging in Breast MRI: Comparison of Two Different Pulse Sequences

https://doi.org/10.1016/j.acra.2007.06.006Get rights and content

Rationale and Objectives

Comparison of two different diffusion weighted (DW) sequences in breast MRI regarding the differentiation between benign and malignant lesions.

Materials and Methods

Breast MRI including two different DW sequences was performed in 165 consecutive women. Inclusion criteria for DW imaging and ADC evaluation were histologically proven focal mass lesions with a diameter of more than 5 mm in dynamic contrast-enhanced MRI. The DW sequences were pre-contrast echo-planar imaging with spectral fat saturation (EPI fs) and DW EPI with inversion recovery (EPI STIR) (b-values: 50, 400, and 800). Lesions were analyzed regarding visibility in DW sequences and ADC values.

Results

Inclusion criteria were fulfilled in 56 women with 69 lesions. Five lesions could not be evaluated for different reasons. Finally, DW sequences were evaluated in 51 women with 64 focal mass lesions (15 benign, 49 malignant). The visibility of the lesions was significantly better in the EPI fs sequence (P<0.05). The ADC values (10−3 mm2/s) in the EPI fs were 1.76, 2.58, and 1.21 (mean, maximum, minimum, respectively) for benign lesions and 0.90, 1.19, and 0.34 for malignant lesions. Respective values in the EPI STIR sequence were 1.92, 3.20, 1.10, and 0.91, 1.43, 0.35. Only in the EPI fs sequence there was no overlap in ADC values between benign and malignant lesions.

Conclusion

The DW MRI of the breast with EPI fs and EPI STIR sequences has a high potential to differentiate between benign and malignant breast lesions. Due to better lesion visibility and selectivity, the EPI fs sequence should be preferred.

Section snippets

Patients

From March to November 2006, we performed 233 breast MRI examinations. Patients who took part in another study (n = 54) and patients who refused DW sequences (n = 14) were excluded. All other patients (n = 165) gave informed consent to apply the DW sequences additionally to our normal breast MRI protocol. The study was approved by the local ethics committee.

MRI

Imaging was performed on a 1.5-T scanner (Magnetom Avanto, Siemens Medical Solutions, Erlangen, Germany) using a bilateral breast array

Results

A total of 165 MRI exams with DW sequences were performed. Seventy-six patients did not require histological interventions. In 89 patients, histological specimens were obtained either by core or excisional biopsy on the basis of the clinical examination, ultrasound, mammography, and MR findings. Of 89 patients, 33 did not have a biopsied lesion larger than 5 mm in the contrast enhanced MRI. The remaining 56 patients had 69 histologically proven lesions. Of 69 histologically proven lesions, 54

Discussion

Detection of breast lesions has become more sensitive in mammography, ultrasound, and MRI due to technical developments in the past years. Digital mammography seems to be more sensitive for breast lesion detection in dense breasts (17). Higher spatial resolution leads to higher detection rates in ultrasound (18) and MRI.

However, the characterization of the detected lesions can be difficult. Up to now, breast MRI is analyzed according to morphologic criteria, the enhancement kinetics, and the T2

Conclusion

DW MRI of the breast with EPI fs and EPI STIR sequences has a high potential to differentiate between benign and malignant breast lesions. Due to significant better lesion delineation, better selectivity, and shorter acquisition time the DW EPI fs sequence is superior.

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