title: Combined contrast-enhanced magnetic resonance and diffusion-weighted imaging reading adapted to the "Breast Imaging Reporting and Data System" for multiparametric 3-T imaging of breast lesions.
abstract: OBJECTIVE
  To develop and assess a combined reading for contrast-enhanced magnetic resonance (CE-MRI) and diffusion weighted imaging (DWI) adapted to the BI-RADS for multiparametric MRI of the breast at 3 T.
  
  
  METHODS
  A total of 247 patients with histopathologically verified breast lesions were included in this IRB-approved prospective study. All patients underwent CE-MR and DWI at 3 T. MRIs were classified according to BI-RADS and assessed for apparent diffusion coefficient (ADC) values. A reading method that adapted ADC thresholds to the assigned BI-RADS classification was developed. Sensitivity, specificity, diagnostic accuracy and the area under the curve were calculated. BI-RADS-adapted reading was compared with previously published reading methods in the same population. Inter- and intra-reader variability was assessed.
  
  
  RESULTS
  Sensitivity of BI-RADS-adapted reading was not different from the high sensitivity of CE-MRI (P = 0.4). BI-RADS-adapted reading maximised specificity (89.4 %), which was significantly higher compared with CE-MRI (P < 0.001). Previous reading methods did not perform as well as the BI-RADS method except for a logistic regression model. BI-RADS-adapted reading was more sensitive in non-mass-like enhancements (NMLE) and was more robust to inter- and intra-reader variability.
  
  
  CONCLUSIONS
  Multiparametric 3-T MRI of the breast using a BI-RADS-adapted reading is fast, simple to use and significantly improves the diagnostic accuracy of breast MRI. KEYPOINTS : • Multiparametric breast 3-T MRI with BI-RADS-adapted reading improves diagnostic accuracy. • BI-RADS-adapted reading of CE-MRI and DWI is based on established reporting guidelines. • BI-RADS-adapted reading is fast and easy to use in routine clinical practice. • BI-RADS-adapted reading is robust to intra- and inter-reader variability.
authors.affiliation: Department of Radiology, Molecular and Gender Imaging, Medical University Vienna, Vienna, Austria.
authors.forename: K
authors.initials: K
authors.lastname: Pinker
authors.forename: H
authors.initials: H
authors.lastname: Bickel
authors.forename: T H
authors.initials: TH
authors.lastname: Helbich
authors.forename: S
authors.initials: S
authors.lastname: Gruber
authors.forename: P
authors.initials: P
authors.lastname: Dubsky
authors.forename: U
authors.initials: U
authors.lastname: Pluschnig
authors.forename: M
authors.initials: M
authors.lastname: Rudas
authors.forename: Z
authors.initials: Z
authors.lastname: Bago-Horvath
authors.forename: M
authors.initials: M
authors.lastname: Weber
authors.forename: S
authors.initials: S
authors.lastname: Trattnig
authors.forename: W
authors.initials: W
authors.lastname: Bogner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001940:Breast / Q000473:pathology; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology; D003287:Contrast Media / Q000494:pharmacology*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D015588:Observer Variation; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013997:Time Factors; D055815:Young Adult
chemical_list: D003287:Contrast Media