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Is there a systematic bias of apparent diffusion coefficient (ADC) measurements of the breast if measured on different workstations? An inter- and intra-reader agreement study

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Abstract

Objectives

To evaluate the influence of post-processing systems, intra- and inter-reader agreement on the variability of apparent diffusion coefficient (ADC) measurements in breast lesions.

Methods

Forty-one patients with 41 biopsy-proven breast lesions gave their informed consent and were included in this prospective IRB-approved study. Magnetic resonance imaging (MRI) examinations were performed at 1.5 T using an EPI-DWI sequence, with b-values of 0 and 1000 s/mm2. Two radiologists (R1, R2) reviewed the images in separate sessions and measured the ADC for lesion, using MRI-workstation (S-WS), PACS-workstation (P-WS) and a commercial DICOM viewer (O-SW). Agreement was evaluated using the intraclass correlation coefficient (ICC), Bland–Altman plots and coefficient of variation (CV).

Results

Thirty-one malignant, two high-risk and eight benign mass-like lesions were analysed. Intra-reader agreement was almost perfect (ICC-R1 = 0.974; ICC-R2 = 0.990) while inter-reader agreement was substantial (ICC from 0.615 to 0.682). Bland–Altman plots revealed a significant bias in ADC values measured between O-SW and S-WS (P = 0.025), no further systematic differences were identified. CV varied from 6.8 % to 7.9 %.

Conclusion

Post-processing systems may have a significant, although minor, impact on ADC measurements in breast lesions. While intra-reader agreement is high, the main source of ADC variability seems to be caused by inter-reader variation.

Key points

• ADC provides quantitative information on breast lesions independent from the system used.

• ADC measurement using different workstations and software systems is generally reliable.

• Systematic, but minor, differences may occur between different post-processing systems.

• Inter-reader agreement of ADC measurements exceeded intra-reader agreement.

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Acknowledgments

The scientific guarantor of this publication is Chiara Zuiani. 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 this work has not received any funding. One of the authors has significant statistical expertise. Institutional review board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, cross-sectional, performed at one institution.

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Authors and Affiliations

  1. Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna/General Hospital Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria

    Paola Clauser & Pascal A. T. Baltzer

  2. Institute of Diagnostic Radiology, Department of Medical and Biological Sciences, University of Udine, Udine, Italy

    Paola Clauser, Magda Marcon, Chiara Zuiani & Massimo Bazzocchi

  3. Department of Radiology, University Hospital Zurich, Zurich, Switzerland

    Magda Marcon

  4. SOC Fisica Sanitaria, Azienda Ospedaliero-Universitaria, S.Maria della Misericordia, Udine, Italy

    Marta Maieron

Authors
  1. Paola Clauser
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  2. Magda Marcon
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  3. Marta Maieron
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  4. Chiara Zuiani
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  5. Massimo Bazzocchi
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  6. Pascal A. T. Baltzer
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Corresponding author

Correspondence to Pascal A. T. Baltzer.

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Clauser, P., Marcon, M., Maieron, M. et al. Is there a systematic bias of apparent diffusion coefficient (ADC) measurements of the breast if measured on different workstations? An inter- and intra-reader agreement study. Eur Radiol 26, 2291–2296 (2016). https://doi.org/10.1007/s00330-015-4051-2

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  • DOI: https://doi.org/10.1007/s00330-015-4051-2

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