Utility of Multiparametric MRI of the Breast with Combined High b-value DWI and Dynamic Contrast MRI to Differentiate Benign and Malignant Lesions: A Cross-sectional Study
Published: January 1, 2024 | DOI: https://doi.org/10.7860/JCDR/2024/68452.18927
Pratiksha Yadav, Yashraj Patil, Saumya Harit
1. Professor, Department of Radiology and Imaging, Head; Interventional Radiology, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India.
2. Associate Professor, Department of Radiology and Imaging, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India.
3. Research Assistant, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India.
Correspondence
Dr. Pratiksha Yadav,
Professor, Department of Radiology and Imaging, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune-411018, Maharashtra, India.
E-mail: yadavpratiksha@hotmail.com
Introduction: Breast cancer is one of the most frequent malignancies in women worldwide, and it is the leading cause of cancer mortality. Early detection is key to a better prognosis. In India, many patients are diagnosed in later stages due to the absence of screening programs and less awareness in certain regions of the country. MRI is a highly sensitive investigation that can detect small and sometimes hidden or occult lesions not visible on mammography. The diffusion-weighted sequence has the potential to be used in conjunction with mammography, thereby improving diagnostic accuracy.
Aim: To evaluate the utility of multiparametric MRI (mpMRI) of the breast, combining high b-value Diffusion-Weighted Imaging (DWI) and Dynamic Contrast-Enhanced Magnetic Resonance Imaging (DCE-MRI), in differentiation benign and malignant lesions.
Materials and Methods: This cross-sectional study was conducted at a Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, India from Jan 2017 - Dec 2020. A total of 254 women with 272 breast lesions were included. All cases underwent mpMRI on a Tesla scanner, which included T2-weighted imaging, dynamic post-contrast study, and DWI with a b-value of 1500 sec/mm2. Sensitivity, specificity, diagnostic accuracy, and area under the curve were calculated using the results of different parameters. Comparative Receiver Operating Characteristic (ROC) curves were plotted for DCE-MRI, DWI, and mpMRI. Histopathologic diagnosis was considered the standard of reference.
Results: The mean age was 43.73±13.56 years, with an age range of 18-82 years. Both benign and malignant breast lesions were most common in the 40-49 years age group, accounting for a total of 80 (31.4%) lesions. Out of the 272 lesions, 141 (52.03%) were malignant and 131 (47.97%) were benign. DCE-MRI showed 97.87% sensitivity, 80.15% specificity, and 89.33% diagnostic accuracy. Diffusion-weighted MRI showed 97.16% sensitivity, 87.02% specificity, and 92.27% diagnostic accuracy. The ROC analysis for Apparent Diffusion Coefficient (ADC) values of the 272 lesions revealed an area under the curve of 0.985 (p<0.001) and a sensitivity of 92.91%, with an ADC cut-off of 0.987×10-3 mm2/sec. The multiparametric study demonstrated 98.58% sensitivity, 93.13% specificity, and 95.95% diagnostic accuracy. The area under the curve was 0.959 for mpMRI, 0.921 for DWI, and 0.890 for DCE-MRI.
Conclusion: mpMRI with DCE-MRI and DWI using a high b-value of 1500 sec/mm2 can be utilised to improve diagnostic accuracy.
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