Abbreviated protocol combining quantitative diffusion-weighted imaging: a new strategy increasing diagnostic accuracy for breast magnetic resonance imaging?

Zhenzhen Shao; Peifang Liu; Shuping Zhang; Hong Lu

doi:10.21037/gs-21-463

Abbreviated protocol combining quantitative diffusion-weighted imaging: a new strategy increasing diagnostic accuracy for breast magnetic resonance imaging?

Gland Surg. 2021 Sep;10(9):2705-2714. doi: 10.21037/gs-21-463.

Authors

Zhenzhen Shao¹, Peifang Liu¹, Shuping Zhang¹, Hong Lu¹

Affiliation

¹ Department of Breast Imaging, Tianjin Medical University Cancer Institute, and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.

Abstract

Background: To compare the diagnostic accuracy of an abbreviated protocol (AP) with or without quantitative apparent diffusion coefficient (ADC) values on diffusion-weighted imaging (DWI) and a full diagnostic protocol (FDP) in terms of the Breast Imaging Reporting and Data System (BI-RADS) classification of breast magnetic resonance imaging (MRI).

Methods: Our study sample consisted of 436 patients undergoing breast MRI from January to October 2015 in a clinical setting. The three reviews included a pre-contrast and the first single post-contrast T1-weighted (T1W) sequences (AP1), AP1 combined with quantitative DWI (AP2), and the FDP, the AP1 of which were assessed independently by a junior and senior radiologist. Agreement on the evaluation of the BI-RADS classifications (between the junior and senior radiologists, between AP1 and FDP, and between AP2 and FDP) was assessed using the kappa test statistic. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were compared between AP1 and FDP plus between AP2 and FDP. Diagnostic parameters of these reviews were examined using the McNemar test.

Results: The study included 436 patients, with 251 breast cancers, 99 benign lesions, and 86 patients with benign or no lesions and followed up for at least 24 months. The agreement of the BI-RADS classifications between the junior and senior radiologists was very good (kappa =0.847). The agreement between AP2 and FDP (kappa =0.931) was higher than the agreement between AP1 and FDP (kappa =0.872) on evaluating the BI-RADS benign and malignant classifications. The sensitivity/specificity/PPV/NPV was 95.6%/83.8%/88.9%/93.4% for AP1, 98.0%/83.8%/89.1%/96.9% for AP2, 98.8%/83.8%/89.2%/98.1% for FDP, respectively.

Conclusions: The addition of quantitative DWI to the abbreviated MRI protocol based on the pre-and first post-contrast sequence improved diagnostic performance for characterizing breast lesions. Quantitative DWI may be a useful adjunct to dynamic contrast enhancement (DCE) of breast MRI.

Keywords: Breast cancers; abbreviated protocol (AP); diffusion-weighted images; magnetic resonance imaging (MRI).