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Incidentally detected enhancing lesions found in breast MRI: analysis of apparent diffusion coefficient and T2 signal intensity significantly improves specificity

  • Breast
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Abstract

Objectives

To evaluate the value of adding T2- and diffusion-weighted imaging (DWI) to the BI-RADS® classification in MRI-detected lesions.

Methods

This retrospective study included 112 consecutive patients who underwent 3.0T structural breast MRI with T2- and DWI on the basis of EUSOMA recommendations. Morphological and kinetic features, T2 signal intensity (T2 SI) and apparent diffusion coefficient (ADC) findings were assessed.

Results

Thirty-three (29.5 %) patients (mean age 57.0 ± 12.7 years) had 36 primarily MRI-detected incidental lesions of which 16 (44.4 %) proved to be malignant. No single morphological or kinetic feature was associated with malignancy. Both low T2 SI (P = 0.009) and low ADC values (≤0.87 × 10−3 mm2s−1, P < 0.001) yielded high specificity (80.0 %/80.0 %). The BI-RADS classification supplemented with information from DWI and T2-WI improved the diagnostic performance of the BI-RADS classification as sensitivity remained 100 % and specificity improved from 30 % to 65.0 %. The numbers of false positive lesions declined from 39 % (N = 14) to 19 % (N = 7).

Conclusion

MRI-detected incidental lesions may be challenging to characterize as they have few specific malignancy indicating features. The specificity of MRI can be improved by incorporating T2 SI and ADC values into the BI-RADS assessment.

Key Points

• MRI-detected incidental lesions have few specific malignancy indicating features.

• ≥ 1 suspicious morphologic or kinetic feature may warrant biopsy.

• T2 signal intensity and DWI assessment are feasible in primarily MRI-detected lesions.

• T2 SI and DWI assessment improve the BI-RADS specificity in MRI-detected lesions.

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Acknowledgments

The scientific guarantor of this publication is Prof. Ritva Vanninen. 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. Otso Arponen received an EVO grant from Kuopio University Hospital (https://www.psshp.fi/) and a grant from the Cancer Society of Finland (http://www.cancer.fi/en/). The funders had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript. Tuomas Selander (Kuopio University Hospital) kindly provided statistical advice for this manuscript. Institutional review board approval was obtained. Written informed consent was waived by the chair of the hospital district for this study because of the clinical imaging protocols and retrospective nature of the analyses. Some study subjects or cohorts have been previously reported in the following paper: Arponen O, Sudah M, Masarwah A, Taina M, Rautiainen S, Könönen M, Sironen R, Kosma VM, Sutela A, Hakumäki J, Vanninen R. Diffusion-Weighted Imaging in 3.0 Tesla Breast MRI: Diagnostic Performance and Tumor Characterization Using Small Subregions vs. Whole Tumor Regions of Interest. Plos One. DOI: 10.1371/journal.pone.0138702. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.

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Authors and Affiliations

  1. Kuopio University Hospital, Diagnostic Imaging Centre, Department of Clinical Radiology, Kuopio University Hospital, PO Box 1777, Puijonlaaksontie 2, 70210, Kuopio, Finland

    Otso Arponen, Amro Masarwah, Anna Sutela, Mikko Taina, Mervi Könönen, Juhana Hakumäki, Ritva Vanninen & Mazen Sudah

  2. University of Eastern Finland, Institute of Clinical Medicine, School of Medicine, Department of Clinical Radiology, Kuopio University Hospital, PO Box 1777, Puijonlaaksontie 2, 70210, Kuopio, Finland

    Otso Arponen, Amro Masarwah, Mikko Taina & Ritva Vanninen

  3. Kuopio University Hospital, Department of Pathology, Kuopio University Hospital, PO Box 1777, Puijonlaaksontie 2, 70210, Kuopio, Finland

    Reijo Sironen

  4. University of Eastern Finland, Institute of Clinical Medicine, School of Medicine, Clinical Pathology and Forensic Medicine, Kuopio University Hospital, PO Box 1777, Puijonlaaksontie 2, 70210, Kuopio, Finland

    Reijo Sironen

  5. University of Eastern Finland, Cancer Center of Eastern Finland, Yliopistonranta 1, 70210, Kuopio, Finland

    Reijo Sironen & Ritva Vanninen

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  1. Otso Arponen
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Correspondence to Otso Arponen.

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Arponen, O., Masarwah, A., Sutela, A. et al. Incidentally detected enhancing lesions found in breast MRI: analysis of apparent diffusion coefficient and T2 signal intensity significantly improves specificity. Eur Radiol 26, 4361–4370 (2016). https://doi.org/10.1007/s00330-016-4326-2

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  • DOI: https://doi.org/10.1007/s00330-016-4326-2

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