Microstructural breast tissue characterization: A head-to-head comparison of Diffusion Weighted Imaging and Acoustic Radiation Force Impulse elastography with clinical implications

Panagiotis Kapetas; Paola Clauser; Ruxandra-Iulia Milos; Sara Vigano; Maria Bernathova; Thomas H Helbich; Pascal A T Baltzer

doi:10.1016/j.ejrad.2021.109926

Microstructural breast tissue characterization: A head-to-head comparison of Diffusion Weighted Imaging and Acoustic Radiation Force Impulse elastography with clinical implications

Eur J Radiol. 2021 Oct:143:109926. doi: 10.1016/j.ejrad.2021.109926. Epub 2021 Aug 19.

Authors

Panagiotis Kapetas¹, Paola Clauser², Ruxandra-Iulia Milos³, Sara Vigano⁴, Maria Bernathova⁵, Thomas H Helbich⁶, Pascal A T Baltzer⁷

Affiliations

¹ Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Waehringer Guertel 18-20, 1090 Vienna, Austria. Electronic address: panagiotis.kapetas@meduniwien.ac.at.
² Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Waehringer Guertel 18-20, 1090 Vienna, Austria. Electronic address: paola.clauser@meduniwien.ac.at.
³ Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Waehringer Guertel 18-20, 1090 Vienna, Austria. Electronic address: ruxandra-iulia.milos@meduniwien.ac.at.
⁴ Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via della Commenda 10, 20122 Milan, Italy.
⁵ Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Waehringer Guertel 18-20, 1090 Vienna, Austria. Electronic address: maria.bernathova@meduniwien.ac.at.
⁶ Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Waehringer Guertel 18-20, 1090 Vienna, Austria. Electronic address: thomas.helbich@meduniwien.ac.at.
⁷ Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Waehringer Guertel 18-20, 1090 Vienna, Austria. Electronic address: pascal.baltzer@meduniwien.ac.at.

PMID: 34438330
DOI: 10.1016/j.ejrad.2021.109926

Abstract

Purpose: Head-to-head comparison of Diffusion Weighted Imaging (DWI) and Acoustic Radiation Force Impulse (ARFI) elastography regarding the characterization of breast lesions in an assessment setting.

Method: Patients undergoing an ultrasound examination including ARFI and an MRI protocol including DWI for the characterization of a BI-RADS 3-5 breast lesion between 06/2013 and 10/2016 were eligible for inclusion in this retrospective, IRB-approved study. 60 patients (30-84 years, median 50) with a median lesion size of 16 mm (range 5-55 mm) were included. The maximum shear wave velocity (SWV_max) and mean apparent diffusion coefficient (ADC_mean) for each lesion were retrospectively evaluated by a radiologist experienced in the technique. Histology was the reference standard. Diagnostic performances of ARFI and DWI were assessed using ROC curve analysis. Spearman's rank correlation coefficient and multivariate logistic regression were used to investigate the independence of both tests regarding their diagnostic information to distinguish benign from malignant lesions.

Results: Corresponding areas under the ROC curve for differentiation of benign (n = 16) and malignant (n = 49) lesions were 0.822 (ARFI) and 0.871 (DWI, p-value = 0.48). SWVmax and ADCmean values showed a significant negative correlation (ρ = -0.501, p-value < 0.001). In multivariate analysis, combination of ARFI and DWI did not improve the results of each single modality, thus no significant independent diagnostic information was present.

Conclusion: Significant correlation between quantitative findings of ARFI and DWI in breast lesions exists. Thus, ARFI provides similar diagnostic information as a DWI-including protocol of an additional "problem-solving" MRI for the characterization of a sonographically evident breast lesion, improving the immediate patient management in the assessment setting.

Keywords: Acoustic Radiation Force Impulse elastography; Breast; Diffusion Weighted Imaging; MRI; Ultrasound.

MeSH terms

Acoustics
Breast / diagnostic imaging
Breast Neoplasms* / diagnostic imaging
Elasticity Imaging Techniques*
Female
Humans
ROC Curve
Retrospective Studies
Sensitivity and Specificity
Ultrasonography