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Combined reading of Contrast Enhanced and Diffusion Weighted Magnetic Resonance Imaging by using a simple sum score

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Abstract

Objective

To improve specificity of breast MRI by integrating Apparent Diffusion Coefficient (ADC) values with contrast enhanced MRI (CE-MRI) using a simple sum score.

Methods

Retrospective analysis of a consecutive series of patients referred to breast MRI at 1.5 T for further workup of breast lesions. Reading results of CE-MRI were dichotomized into score 1 (suspicious) or 0 (benign). Lesion’s ADC-values (in *10-3 mm2/s) were assigned two different scores: ADC2: likely malignant (score +1, ADC ≤ 1), indeterminate (score 0, ADC >1- ≤ 1.4) and likely benign (score -1, ADC > 1.4) and ADC1: indeterminate (score 0, ADC ≤ 1.4) and likely benign (score -1, ADC > 1.4). Final added CE-MRI and ADC scores >0 were considered suspicious. Reference standard was histology and imaging follow-up of >24 months. Diagnostic parameters were compared using McNemar tests.

Results

A total of 150 lesions (73 malignant) were investigated. Reading of CE-MRI showed a sensitivity of 100 % (73/73) and a specificity of 81.8 % (63/77). Additional integration of ADC scores increased specificity (ADC2/ADC1, P = 0.008/0.001) without causing false negative results.

Conclusion

Using a simple sum score, ADC-values can be integrated with CE-MRI of the breast, improving specificity. The best approach is using one threshold to exclude cancer.

Key Points

ADC is used to assign levels of suspicion to breast lesions.

ADC values >1.4 *10 -3mm 2 /s are likely benign and effectively rule out malignancy.

ADC values below ≤1*10 -3mm 2 /s) are likely malignant but may be false positive.

CE-MRI (+1: suspicious, 0: benign) and ADC (0: indeterminate, -1: benign) scores are added.

Sum scores >0 should be biopsied.

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Acknowledgments

The authors are grateful for the very constructive peer-review process that significantly improved this manuscript. The scientific guarantor of this publication is Pascal A. T. Baltzer. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that no funding was received for this work. One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, cross sectional study, performed at one institution.

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Correspondence to Pascal A. Baltzer.

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Baltzer, A., Dietzel, M., Kaiser, C.G. et al. Combined reading of Contrast Enhanced and Diffusion Weighted Magnetic Resonance Imaging by using a simple sum score. Eur Radiol 26, 884–891 (2016). https://doi.org/10.1007/s00330-015-3886-x

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  • DOI: https://doi.org/10.1007/s00330-015-3886-x

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