title: Unenhanced breast MRI (STIR, T2-weighted TSE, DWIBS): An accurate and alternative strategy for detecting and differentiating breast lesions.
abstract: OBJECTIVE
  To assess the role of STIR, T2-weighted TSE and DWIBS sequences for detecting and characterizing breast lesions and to compare unenhanced (UE)-MRI results with contrast-enhanced (CE)-MRI and histological findings, having the latter as the reference standard.
  
  
  METHODS
  Two hundred eighty consecutive patients (age range, 27-73 years; mean age±standard deviation (SD), 48.8±9.8years) underwent MR examination with a diagnostic protocol including STIR, T2-weighted TSE, THRIVE and DWIBS sequences. Two radiologists blinded to both dynamic sequences and histological findings evaluated in consensus STIR, T2-weighted TSE and DWIBS sequences and after two weeks CE-MRI images searching for breast lesions. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy for UE-MRI and CE-MRI were calculated. UE-MRI results were also compared with CE- MRI.
  
  
  RESULTS
  UE-MRI sequences obtained sensitivity, specificity, diagnostic accuracy, PPV and NPV values of 94%, 79%, 86%, 79% and 94%, respectively. CE-MRI sequences obtained sensitivity, specificity, diagnostic accuracy, PPV and NPV values of 98%, 83%, 90%, 84% and 98%, respectively. No statistically significant difference between UE-MRI and CE-MRI was found.
  
  
  CONCLUSIONS
  Breast UE-MRI could represent an accurate diagnostic tool and a valid alternative to CE-MRI for evaluating breast lesions. STIR and DWIBS sequences allow to detect breast lesions while T2-weighted TSE sequences and ADC values could be useful for lesion characterization.
authors.affiliation: DIM - Interdisciplinary Department of Medicine - Section of Diagnostic Imaging - Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124 Bari, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Telegrafo
authors.affiliation: DIM - Interdisciplinary Department of Medicine - Section of Diagnostic Imaging - Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124 Bari, Italy.
authors.forename: Leonarda
authors.initials: L
authors.lastname: Rella
authors.affiliation: DIM - Interdisciplinary Department of Medicine - Section of Diagnostic Imaging - Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124 Bari, Italy.
authors.forename: Amato Antonio
authors.initials: AA
authors.lastname: Stabile Ianora
authors.affiliation: DIM - Interdisciplinary Department of Medicine - Section of Diagnostic Imaging - Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124 Bari, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Angelelli
authors.affiliation: DIM - Interdisciplinary Department of Medicine - Section of Diagnostic Imaging - Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124 Bari, Italy. Electronic address: marco.moschetta@gmail.com.
authors.forename: Marco
authors.initials: M
authors.lastname: Moschetta
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D001943:Breast Neoplasms / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008875:Middle Aged; D010363:Pattern Recognition, Automated / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: Breast; DWIBS; MRI; STIR; T2 TSE; Unenhanced imaging