title: Readout-segmented echo-planar imaging improves the diagnostic performance of diffusion-weighted MR breast examinations at 3.0 T.
abstract: OBJECTIVE
  To qualitatively and quantitatively compare the diagnostic value of diffusion-weighted (DW) magnetic resonance (MR) imaging based on standard single-shot echo-planar imaging and readout-segmented echo-planar imaging in patients with breast cancer at 3.0 T.
  
  
  METHODS
  Institutional review board approval and written informed consent were obtained. Forty-seven patients with 49 histopathologically verified lesions were included in this study. In all patients, DW imaging, with single-shot echo-planar imaging and readout-segmented echo-planar imaging with comparable imaging parameters, was performed with a 3.0-T MR imager. Two independent readers visually assessed image quality and lesion conspicuity, and image properties (ie, signal-to-noise ratio, contrast, geometric distortions) were quantified. Regions of interest were drawn in all lesions (28 malignant, 21 benign) and in the normal breast parenchyma to investigate differences in apparent diffusion coefficient (ADC). Diagnostic accuracy was calculated on the basis of an ADC threshold of 1.25 × 10(-3) mm(2)/sec.
  
  
  RESULTS
  Each reader found a higher diagnostic accuracy for readout-segmented (96%) than for single-shot (90%) echo-planar imaging. The area under the curve for readout-segmented echo-planar imaging (0.981) was significantly larger than for single-shot echo-planar imaging (0.867) (P = .026). There was no significant difference in the ADC obtained by using either DW imaging method. Lesion conspicuity and image quality of readout-segmented echo-planar imaging were rated superior to those of single-shot echo-planar imaging (P < .001). Readout-segmented echo-planar imaging reduced geometric distortions by a factor of three.
  
  
  CONCLUSIONS
  DW imaging based on readout-segmented echo-planar imaging provided significantly higher image quality and lesion conspicuity than single-shot echo-planar imaging by reducing geometric distortions, image blurring, and artifact level with a clinical high-field-strength MR imager. Thereby, readout-segmented echo-planar imaging reached a higher diagnostic accuracy for the differentiation of benign and malignant breast lesions.
authors.affiliation: Department of Radiology, MR Center of Excellence, Department of Radiology, Division of Molecular and Gender Imaging, and Department of Radiology, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Bogner
authors.forename: Katja
authors.initials: K
authors.lastname: Pinker-Domenig
authors.forename: Hubert
authors.initials: H
authors.lastname: Bickel
authors.forename: Marek
authors.initials: M
authors.lastname: Chmelik
authors.forename: Michael
authors.initials: M
authors.lastname: Weber
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Helbich
authors.forename: Siegfried
authors.initials: S
authors.lastname: Trattnig
authors.forename: Stephan
authors.initials: S
authors.lastname: Gruber
mesh_terms: D000704:Analysis of Variance; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D018567:Breast Neoplasms, Male / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D017352:Echo-Planar Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D019047:Phantoms, Imaging; D012372:ROC Curve; D012680:Sensitivity and Specificity; D059629:Signal-To-Noise Ratio
chemical_list: D003287:Contrast Media