Diagnostic performance of quantitative diffusion tensor imaging for the differentiation of breast lesions at 3 T MRI

Ioannis Tsougos; Michael Bakosis; Dimitra Tsivaka; Evangelos Athanassiou; Ioannis Fezoulidis; Dimitrios Arvanitis; Katerina Vassiou

doi:10.1016/j.clinimag.2018.10.002

Diagnostic performance of quantitative diffusion tensor imaging for the differentiation of breast lesions at 3 T MRI

Clin Imaging. 2019 Jan-Feb:53:25-31. doi: 10.1016/j.clinimag.2018.10.002. Epub 2018 Oct 3.

Authors

Ioannis Tsougos¹, Michael Bakosis², Dimitra Tsivaka², Evangelos Athanassiou³, Ioannis Fezoulidis⁴, Dimitrios Arvanitis⁵, Katerina Vassiou⁶

Affiliations

¹ Department of Medical Physics, Medical School, University of Thessaly, Biopolis, Larissa, Greece. Electronic address: tsougos@med.uth.gr.
² Department of Medical Physics, Medical School, University of Thessaly, Biopolis, Larissa, Greece.
³ Department of Surgery, Medical School, University of Thessaly, Biopolis, Larissa, Greece.
⁴ Department of Diagnostic Radiology, Medical School, University of Thessaly, Biopolis, Larissa, Greece.
⁵ Department of Anatomy-Histology-Embryology, University of Thessaly Medical School, Larissa, Greece.
⁶ Department of Diagnostic Radiology, Medical School, University of Thessaly, Biopolis, Larissa, Greece; Department of Anatomy-Histology-Embryology, University of Thessaly Medical School, Larissa, Greece.

PMID: 30308430
DOI: 10.1016/j.clinimag.2018.10.002

Abstract

Background: Conventional breast magnetic resonance imaging (MRI), including dynamic contrast-enhanced MR mammography, may lead to ambiguous diagnosis and unnecessary biopsies.

Purpose: To investigate the contribution of quantitative diffusion tensor imaging (DTI) in the discrimination between benign and malignant breast lesions at 3 T MRI.

Material and methods: The study included a total of 86 lesions (44 benign and 42 malignant) in 58 women (34 with malignant lesions, 23 with benign lesions and 1 with both types of lesions). All patients were examined on a 3 T MRI scanner. Fractional Anisotropy (FA), Mean Diffusivity (MD), Apparent Diffusion Coefficient (ADC), as well as eigenvalues (λ₁, λ₂, λ₃) were calculated and compared between benign and malignant lesions using two different software packages (GE Functool and ExploreDTI).

Results: Malignant lesions exhibited significantly lower ADC values compared to benign ones (ADC_mal = 1.06 × 10^-3 mm²/s, ADC_ben = 1.54 × 10^-3 mm²/s, p-value < 0.0001). FA measurements in carcinomas indicated slightly higher values than those in benign lesions (FA_mal = 0.20 ± 0.07, FA_ben = 0.15 ± 0.05, p-value = 0.0003). Eigenvalues λ₁, λ₂, λ₃, showed significantly lower values in malignant tumors compared to benign lesions and normal breast tissue. ROC curve analysis of ADC and DTI metrics demonstrated that ADC provides high diagnostic performance (AUC = 0.944) while, MD and λ₁ showed best discriminative results (AUC = 0.906) for the differentiation of malignant and benign lesions in contrast to other DTI parameters.

Conclusion: The addition of eigenvalue analysis improves DTI's ability to differentiate between benign and malignant breast lesions.

Keywords: 3 T; Apparent Diffusion Coefficient; Breast MRI; Diffusion tensor imaging; Quantitative MRI.

Publication types

Evaluation Study

MeSH terms

Adult
Aged
Anisotropy
Biopsy
Breast / pathology*
Breast Diseases / diagnosis
Breast Neoplasms / diagnosis*
Breast Neoplasms / pathology
Carcinoma / diagnosis*
Carcinoma / pathology
Cell Differentiation
Diffusion Magnetic Resonance Imaging / methods
Diffusion Tensor Imaging / methods*
Female
Humans
Magnetic Resonance Imaging
Mammography
Middle Aged
ROC Curve
Reproducibility of Results
Sensitivity and Specificity