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Diffusion-weighted imaging (DWI) in MR mammography (MRM): clinical comparison of echo planar imaging (EPI) and
P A T Baltzer1, D M Renz, K-H Herrmann
1Institute of Diagnostic and Interventional Radiology, Friedrich-Schiller-University Jena, Erlanger Allee 101, 07740, Jena, Germany. pascal.baltzer@med.uni-jena.de
Abstract:
Diffusion-weighted imaging (DWI) techniques have shown potential to differentiate between benign and malignant neoplasms. However, the diagnostic significance of using DWI under routine conditions remains unclear. This study investigated the use of echo planar imaging (EPI) and half-Fourier acquired single-shot turbo spin echo (HASTE)-DWI with respect to the three parameters: lesion visibility, apparent diffusion coefficient (ADC) measurements, and size estimation. Following MRM (1.5 T), EPI- and HASTE-DWI were applied in 65 patients. Lesion visibility on DWI was compared with lesion visibility on subtracted contrast-enhanced T1w images (CE-T1w). Statistical tests were applied to diameter, visibility, and ADC value measurements. Seventy-four lesions were identified. ADC value measurements did not differ significantly between the two DWI sequences. The sensitivity and specificity of routine diagnostics (97.4% and 85.7%) were superior to EPI-DWI (87.2% and 82.9%) and HASTE-DWI (76.9% and 88.6%). Selecting only nonmass lesions, DWI did not prove to be of diagnostic value. Lesion demarcation by DWI was significantly lower compared with that by CE-T1w, with EPI-DWI showing the better performance (p < 0.001). No significant differences were found for size measurements between CE-T1w and DWI. Although clearly inferior compared with CE-T1w imaging, both DWI techniques are applicable for lesion assessment and size measurements.
Insights
Diffusion-weighted imaging (DWI) shows potential for lesion assessment, but routine diagnostics offer superior sensitivity and specificity. Both echo planar imaging (EPI) and HASTE-DWI are applicable for size measurements, though lesion demarcation is less effective than contrast-enhanced T1w imaging.
Area of Science:
- Radiology and Medical Imaging
- Oncology
- Biomedical Engineering
Background:
- Diffusion-weighted imaging (DWI) is a promising technique for distinguishing benign from malignant neoplasms.
- The diagnostic utility of DWI under routine clinical conditions requires further clarification.
- Key parameters for DWI assessment include lesion visibility, apparent diffusion coefficient (ADC) measurements, and size estimation.
Purpose of the Study:
- To investigate the diagnostic performance of echo planar imaging (EPI)-DWI and half-Fourier acquired single-shot turbo spin echo (HASTE)-DWI.
- To compare lesion visibility, ADC measurements, and size estimation between EPI-DWI and HASTE-DWI.
- To evaluate the effectiveness of DWI compared to contrast-enhanced T1w (CE-T1w) imaging for lesion characterization.
Main Methods:
- Sixty-five patients with 74 lesions underwent MRM (1.5 T) with both EPI-DWI and HASTE-DWI sequences.
- Lesion visibility on DWI was compared with CE-T1w images.
- Statistical analyses were performed on diameter, visibility, and ADC value measurements.
Main Results:
- ADC measurements did not significantly differ between EPI-DWI and HASTE-DWI.
- Routine diagnostics demonstrated higher sensitivity (97.4%) and specificity (85.7%) compared to EPI-DWI (87.2%, 82.9%) and HASTE-DWI (76.9%, 88.6%).
- Lesion demarcation was significantly better with CE-T1w imaging than with DWI, although EPI-DWI performed better than HASTE-DWI (p < 0.001). Size measurements showed no significant differences between CE-T1w and DWI.
Conclusions:
- While routine diagnostics outperform DWI techniques in sensitivity and specificity, both EPI-DWI and HASTE-DWI are applicable for lesion assessment and size measurements.
- DWI was found to be of limited diagnostic value for nonmass lesions.
- CE-T1w imaging remains superior for lesion demarcation, but DWI techniques offer valuable complementary information.
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