title: Bilateral diffusion-weighted MR imaging of breast tumors with submillimeter resolution using readout-segmented echo-planar imaging at 7 T.
abstract: OBJECTIVE
  To evaluate the image quality, robustness, and diagnostic performance of submillimeter in-plane resolution diffusion-weighted ( DW diffusion-weighted ) magnetic resonance (MR) imaging at 7 T in the assessment of breast tumors.
  
  
  METHODS
  Institutional review board approval and written informed consent of five volunteers and 33 patients with 33 breast lesions (31 with histopathologic confirmation, two with confirmation at follow-up) were obtained. Image quality optimization and comparisons of readout-segmented echo-planar imaging ( rs-EPI readout-segmented echo-planar imaging ) and single-shot echo-planar imaging ( ss-EPI single-shot echo-planar imaging ) with or without parallel imaging were performed in volunteers. In all patients, bilateral DW diffusion-weighted imaging was performed in 3 minutes 35 seconds by using combined rs-EPI readout-segmented echo-planar imaging and parallel imaging with 0.9 × 0.9 mm in-plane resolution with a 7-T whole-body MR imager. Image quality, lesion conspicuity, and image properties (ie, signal-to-noise ratio, contrast-to-noise ratio) were assessed. Regions of interest were drawn in the largest lesion in each patient (23 malignant lesions, 10 benign lesions) by two independent readers. Apparent diffusion coefficient ( ADC apparent diffusion coefficient ) values were used to differentiate between benign and malignant breast tumors.
  
  
  RESULTS
  DW diffusion-weighted imaging with combined parallel imaging and rs-EPI readout-segmented echo-planar imaging reduced artifacts (ie, blurring and geometric distortions) by a calculated factor of seven when compared with DW diffusion-weighted imaging with ss-EPI single-shot echo-planar imaging , and it improved image quality from a score of 1 of 10 to a score of 8 of 10. The rs-EPI readout-segmented echo-planar imaging sequence with a b value of 0 sec/mm(2) yielded high-spatial-resolution T2-weighted MR images. An ADC apparent diffusion coefficient threshold of 1.275 × 10(-3) mm(2)/sec enabled differentiation between benign and malignant breast lesions, with sensitivity and specificity of 96% and 100%, respectively, for both independent readers.
  
  
  CONCLUSIONS
  At 7 T, one DW diffusion-weighted imaging examination of less than 4 minutes yielded high-quality ADC apparent diffusion coefficient maps and high-spatial-resolution T2-weighted MR images that were used to assess tumor and breast morphology. ADC apparent diffusion coefficient quantification alone enabled excellent differentiation of benign and malignant breast lesions.
authors.affiliation: From the MRCE, Department of Biomedical Imaging and Image-guided Therapy (W.B., O.Z., L.M., S.T., S.G.), Division of Molecular and Gender Imaging, Department of Radiology (K.P., P.B., T.H.H.), Department of Pathology, Comprehensive Cancer Center (Z.B.), and Department of Surgery (P.D.), Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria; and Siemens, Healthcare Sector, Erlangen, Germany (D.P.).
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Bogner
authors.forename: Katja
authors.initials: K
authors.lastname: Pinker
authors.forename: Olgica
authors.initials: O
authors.lastname: Zaric
authors.forename: Pascal
authors.initials: P
authors.lastname: Baltzer
authors.forename: Lenka
authors.initials: L
authors.lastname: Minarikova
authors.forename: David
authors.initials: D
authors.lastname: Porter
authors.forename: Zsuzsanna
authors.initials: Z
authors.lastname: Bago-Horvath
authors.forename: Peter
authors.initials: P
authors.lastname: Dubsky
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: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D017352:Echo-Planar Imaging; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008327:Mammography; D008408:Mastectomy; D015412:Mastectomy, Segmental; D008875:Middle Aged; D011446:Prospective Studies; D059629:Signal-To-Noise Ratio; D016217:Ultrasonography, Mammary
chemical_list: D003287:Contrast Media