title: Effect of b value and pre-admission of contrast on diagnostic accuracy of 1.5-T breast DWI: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To evaluate the effect of the choice of b values and prior use of contrast medium on apparent diffusion coefficients (ADCs) of breast lesions derived from diffusion-weighted imaging (DWI), and on the discrimination between benign and malignant lesions.
  
  
  METHODS
  A literature search of relevant DWI studies was performed. The accuracy of DWI to characterize lesions by using b value ≤600 s/mm(2) and b value >600 s/mm(2) was presented as pooled sensitivity and specificity, and the ADC was calculated for both groups. Lesions were pooled as pre- or post-contrast DWI.
  
  
  RESULTS
  Of 198 articles, 26 met the inclusion criteria. Median ADCs were significantly higher (13.2-35.1 %, p < 0.001) for the group of b values ≤600 s/mm(2) compared to >600 s/mm(2). The sensitivity in both groups was similar (91 % and 89 %, p = 0.495) as well as the specificity (75 % and 84 %, p = 0.237). Contrast medium had no significant effects on the ADCs (p ≥ 0.08). The differentiation between benign and malignant lesions was optimal (58.4 %) for the combination of b = 0 and 1,000 s/mm(2).
  
  
  CONCLUSIONS
  The wide variety of b value combinations applied in different studies significantly affects the ADC of breast lesions and confounds quantitative DWI. If only a couple of b values are used, those of b = 0 and 1,000 s/mm(2) are recommended for the best improvement of differentiating between benign and malignant lesions.
  
  
  CONCLUSIONS
  • The choice of b values significantly affects the ADC of breast lesions. • Sensitivity and specificity are not affected by the choice of b values. • b values 0 and 1,000 s/mm (2) are recommended for optimal differentiation between benign and malignant lesions. • Contrast medium prior to DWI does not significantly affect the ADC.
authors.affiliation: University Medical Center Groningen, Center for Medical Imaging - North East Netherlands, University of Groningen, Groningen, The Netherlands, m.d.dorrius@umcg.nl.
authors.forename: Monique D
authors.initials: MD
authors.lastname: Dorrius
authors.forename: Hildebrand
authors.initials: H
authors.lastname: Dijkstra
authors.forename: Matthijs
authors.initials: M
authors.lastname: Oudkerk
authors.forename: Paul E
authors.initials: PE
authors.lastname: Sijens
mesh_terms: D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000175:diagnosis*; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement; D010343:Patient Admission; D011237:Predictive Value of Tests; D015203:Reproducibility of Results
chemical_list: D003287:Contrast Media
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