Diffusion-Weighted MR Imaging of Benign and Malignant Breast Lesions Before and After Contrast Enhancement

Abstract

Purpose: Many publications describe the use of diffusion-weighted imaging (DWI) in breast MRI. This article addresses the question of when to apply the DWI sequence in the course of the scan protocol. The effect of T1-shortening contrast media (CM) on the ADC values of breast lesions is investigated.

Materials and Methods: Data were acquired on a 1.5 T scanner. 60 patients with 79 lesions (20 benign, 59 malignant) were included. The DWI sequence (4 mm slice thickness, b-values: 50, 400, 800) was applied before and after CM administration. Before calculating the ADC map, the b50, b400 and b800 series were analyzed concerning lesion displacement. ADC values before and after CM application were compared.

Results: The mean lesion size was 1.5 ± 0.8 cm. On the basis of the b50 and b400 measurements, the mean ADC value of benign lesions was 1.89 ± 0.30 × 10^-3 mm²/s before and 1.85 ± 0.28 ×10^-3 mm²/s after CM administration. The consecutive values for two pure mucinous carcinomas were 1.88 × 10^-3 mm²/s and 1.81 × 10³ mm²/s and for the remaining malignant lesions 1.00 ± 0.18 × 10^-3 mm²/s and 0.88 ± 0.21 × 10^-3 mm². On the basis of the b50, b400 and b800 measurements, the mean ADC value of benign lesions was 1.99 ± 0.37 × 10^-3 mm²/s before and 1.97 ± 0.30 × 10^-3 mm²/s after CM application, whereas the mean ADC value of the malignant lesions was 0.90 ± 0.14 × 10^-3 mm²/s before and 0.80 ± 0.14 × 10^-3 mm²/s after CM application. While there was no significant change for benign lesions, the ADC value decrease in post-contrast malignant lesions was highly significant.

Conclusion: DWI after CM is possible and even leads to slightly better lesion discrimination between benign and malignant. However, further studies need to be performed to verify this.

Citation Format:

• Janka R, Hammon M, Geppert C et al. Diffusion-Weighted MR Imaging of Benign and Malignant Breast Lesions Before and After Contrast Enhancement. Fortschr Röntgenstr 2014; 186: 130 – 135

Zusammenfassung

Ziel: In vielen Publikationen werden diffusionsgewichtete Sequenzen für die MRT der Brust beschrieben. In dieser Arbeit soll die Frage beantwortet werden, wann die diffusionsgewichtete Sequenz im Scanprotokoll gemessen werden soll, wobei ein Effekt von T1-Zeit verkürzendem Kontrastmittel (KM) auf den ADC-Wert von Brustläsionen untersucht wird.

Material und Methoden: Die Untersuchungen wurden an einem 1,5 T-MRT durchgeführt. Eingeschlossen wurden 60 Patientinnen mit 79 Brustläsionen (20 benigne, 59 maligne). Die diffusionsgewichtete Sequenz (4 mm Schichtdicke, b-Werte: 50, 400 und 800) wurde vor und nach KM-Gabe gemessen und die entsprechenden ADC-Werte der Läsionen verglichen. Vor der Berechnung der ADC-Werte wurden die Läsionen bezüglich ihrer konstanten Lokalisation in den diffusionsgewichteten Sequenzen analysiert.

Ergebnisse: Die mittlere Größe der Läsionen war 1,5 ± 0,8 cm. Auf der Basis der b50- und b400- Messung betrug der durchschnittliche ADC-Wert der benignen Läsionen 1,89 ± 0,30 × 10^-3 mm²/s vor und 1,85 ± 0,28 × 10^-3 mm²/s nach KM-Gabe. Die entsprechenden Werte für zwei muzinöse Karzinome betrugen 1,88 × 10^-3 mm²/s und 1,81 × 10³ mm²/s und für die übrigen malignen Läsionen 1,00 ± 0,18 × 10^-3 mm²/s und 0,88 ± 0,21 × 10^-3 mm². Auf der Basis der b50-, b400- und b800-Messung betrug der durchschnittliche ADC-Wert der benignen Läsionen 1,99 ± 0,37 × 10^-3 mm²/s vor und 1,97 ± 0,30 × 10^-3 mm²/s nach KM-Gabe. Der mittlere ADC-Wert der malignen Läsionen betrug 0,90 ± 0,14 × 10^-3 mm²/s vor und 0,80 ± 0,14 × 10^-3 mm²/s nach KM-Gabe. Während der ADC- Wert der gutartigen Läsionen durch das Kontrastmittel nicht signifikant beinflusst wurde, war er bei den malignen Läsionen nach Kontrastmittelgabe signifikant niedriger.

Schlussfolgerung: Die Messung der diffusionsgewichteten Sequenz ist auch nach KM-Gabe möglich und führt zu einer besseren Differenzierbarkeit von malignen zu benignen Läsionen. Um dieses Ergebnis zu verifizieren sind weitere Studien nötig.

Key words

breast - diffusion-weighted MR imaging - contrast media

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