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Combination of an ultrafast TWIST-VIBE Dixon sequence protocol and diffusion-weighted imaging into an accurate easily applicable classification tool for masses in breast MRI

  • Breast
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Abstract

Objectives

This study aimed to develop a tool for the classification of masses in breast MRI, based on ultrafast TWIST-VIBE Dixon (TVD) dynamic sequences combined with DWI. TVD sequences allow to abbreviate breast MRI protocols, but provide kinetic information only on the contrast wash-in, and because of the lack of the wash-out kinetics, their diagnostic value might be hampered. A special focus of this study was thus to maintain high diagnostic accuracy in lesion classification.

Materials and methods

Sixty-one patients who received breast MRI between 02/2014 and 04/2015 were included, with 83 reported lesions (60 malignant). Our institute’s standard breast MRI protocol was complemented by an ultrafast TVD sequence. ADC and peak enhancement of the TVD sequences were integrated into a generalised linear model (GLM) for malignancy prediction. For comparison, a second GLM was calculated using ADC and conventional DCE curve type. The resulting GLMs were evaluated for standard diagnostic parameters. For easy application of the GLMs, nomograms were created.

Results

The GLM based on peak enhancement of the TVD and ADC was as equally accurate as the GLM based on conventional DCE and ADC, with no significant differences (sensitivity, 93.3%/93.3%; specificity, 91.3%/87.0%; PPV, 96.6%/94.9%; NPV, 84.0%/83.3%; all, p ≥ 0.315).

Conclusions

This study presents a method to integrate ultrafast TVD sequences into a breast MRI protocol, allowing a reduction of the examination time while maintaining diagnostic accuracy. A GLM based on the combination of TVD-derived peak enhancement and ADC provides high diagnostic accuracy, and can be easily applied using a nomogram.

Key Points

• Ultrafast TWIST-VIBE Dixon sequence protocols in combination with diffusion-weighted imaging allow to shorten breast MRI examinations, while diagnostic accuracy is maintained.

• Integrating peak enhancement from the TWIST-VIBE Dixon sequence and the apparent diffusion coefficient into a generalised linear model provides a comprehensible image evaluation approach.

• This approach is further facilitated by nomograms.

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Abbreviations

ADC:

Apparent diffusion coefficient

AIC:

Akaike information criteria

AUC:

Area under the curve

DCE:

Dynamic contrast enhancement/enhanced

DWI:

Diffusion-weighted imaging

GLM:

Generalised linear model

LOOCV:

Leave-one-out cross-validation

MRI:

Magnetic resonance imaging

MS:

Maximum slope

NPV:

Negative predictive value

PPV:

Positive predictive value

ROC:

Receiver operating characteristic

ROI:

Region of interest

SPAIR:

Spectral attenuated inversion recovery

STIR:

Short tau inversion recovery

TTE:

Time-to-enhancement

TVD:

TWIST-VIBE Dixon

TWIST:

Time-resolved angiography with stochastic trajectories

VIBE:

Volumetric interpolated breath-hold examination

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, Erlangen University Hospital, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054, Erlangen, Germany

    Sandra C. Peter, Evelyn Wenkel, Matthias Dietzel, Rolf Janka, Michael Uder & Stephan Ellmann

  2. Siemens Healthcare GmbH, Allee am Röthelheimpark 2, 91052, Erlangen, Germany

    Elisabeth Weiland

  3. Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany

    Arndt Hartmann

  4. Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen – EMN, 91054, Erlangen, Germany

    Julius Emons

Authors
  1. Sandra C. Peter
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  4. Matthias Dietzel
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  9. Stephan Ellmann
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Corresponding author

Correspondence to Stephan Ellmann.

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Guarantor

The scientific guarantor of this publication is Dr. Stephan Ellmann.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: Evelyn Wenkel, Rolf Janka, and Michael Uder are members of the Siemens Speakers’ Bureau. Elisabeth Weiland is a Siemens Healthcare GmbH employee. All other authors have no potential conflict of interest to declare.

Statistics and biometry

One of the authors has significant statistical expertise.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained, and the need for informed consent was waived because of the retrospective nature of this study.

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• Retrospective

• Diagnostic or prognostic study

• Performed at one institution

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Peter, S.C., Wenkel, E., Weiland, E. et al. Combination of an ultrafast TWIST-VIBE Dixon sequence protocol and diffusion-weighted imaging into an accurate easily applicable classification tool for masses in breast MRI. Eur Radiol 30, 2761–2772 (2020). https://doi.org/10.1007/s00330-019-06608-8

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