title: Rim sign in breast lesions on diffusion-weighted magnetic resonance imaging: diagnostic accuracy and clinical usefulness.
abstract: OBJECTIVE
  To investigate the diagnostic accuracy and clinical usefulness of the rim sign in breast lesions observed in diffusion-weighted magnetic resonance imaging (DWI).
  
  
  METHODS
  The magnetic resonance imaging (MRI) findings of 98 pathologically confirmed lesions (62 malignant and 36 benign) in 84 patients were included. Five breast radiologists were asked to independently review the breast MRI results, to grade the degree of high peripheral signal, the "rim sign," in the DWI, and to confirm the mean apparent diffusion coefficient (ADCmean ) values. We analyzed the diagnostic accuracy and compared the consensus (when ≥ 4 of 5 independent reviewers agreed) results of the rim sign with the ADCmean values. Additionally, we evaluated the correlation between the dynamic contrast-enhanced (DCE)-MRI morphologic appearance and DWI rim sign.
  
  
  RESULTS
  According to the consensus results, the rim sign in DWI was observed on 59.7% of malignant lesions and 19.4% of benign lesions. The sensitivity, specificity, and area under the curve (AUC) value for the rim sign in DWI were 59.7%, 80.6%, and 0.701, respectively. The sensitivity, specificity, and AUC value for the ADCmean value (criteria ≤ 1.46 × 10(-3) mm(2) /sec) were 82.3%, 63.9%, and 0.731, respectively. Based on consensus, no correlation was observed between the DCE-MRI and DWI rim signs.
  
  
  CONCLUSIONS
  In DWI, a high-signal rim is a valuable morphological feature for improving specificity in DWI.
authors.affiliation: Radiology Seoul St Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea.
authors.forename: Bong Joo
authors.initials: BJ
authors.lastname: Kang
authors.forename: Jafi Alyssa
authors.initials: JA
authors.lastname: Lipson
authors.forename: Katie RoseMary
authors.initials: KR
authors.lastname: Planey
authors.forename: Sophia
authors.initials: S
authors.lastname: Zackrisson
authors.forename: Debra M
authors.initials: DM
authors.lastname: Ikeda
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kao
authors.forename: Sunita
authors.initials: S
authors.lastname: Pal
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Moran
authors.forename: Bruce Lewis
authors.initials: BL
authors.lastname: Daniel
mesh_terms: D000328:Adult; D000368:Aged; D001940:Breast / Q000473:pathology; D001943:Breast Neoplasms / Q000175:diagnosis*; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D005682:Gadolinium; D006801:Humans; D007089:Image Enhancement; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D003287:Contrast Media; D005682:Gadolinium
keywords: breast cancer; diffusion-weighted image; magnetic resonance imaging