title: MRI in the differential diagnosis of primary architectural distortion detected by mammography.
abstract: OBJECTIVE
  We aimed to evaluate the diagnostic accuracy of a combination of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and apparent diffusion coefficient (ADC) values in lesions that manifest with architectural distortion (AD) on mammography.
  
  
  METHODS
  All full-field digital mammography (FFDM) images obtained between August 2010 and January 2013 were reviewed retrospectively, and 57 lesions showing AD were included in the study. Two independent radiologists reviewed all mammograms and MRI data and recorded lesion characteristics according to the BI-RADS lexicon. The gold standard was histopathologic results from biopsies or surgical excisions and results of the two-year follow-up. Receiver operating characteristic curve analysis was carried out to define the most effective threshold ADC value to differentiate malignant from benign breast lesions. We investigated the sensitivity and specificity of FFDM, DCE-MRI, FFDM+DCE-MRI, and DCE-MRI+ADC.
  
  
  RESULTS
  Of the 57 lesions analyzed, 28 were malignant and 29 were benign. The most effective threshold for the normalized ADC (nADC) was 0.61 with 93.1% sensitivity and 75.0% specificity. The sensitivity and specificity of DCE-MRI combined with nADC was 92.9% and 79.3%, respectively. DCE-MRI combined with nADC showed the highest specificity and equal sensitivity compared with other modalities, independent of the presentation of calcification.
  
  
  CONCLUSIONS
  DCE-MRI combined with nADC values was more reliable than mammography in differentiating the nature of disease manifesting as primary AD on mammography.
authors.affiliation: Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China. ryzhai219@hotmail.com.
authors.forename: Lifang
authors.initials: L
authors.lastname: Si
authors.forename: Renyou
authors.initials: R
authors.lastname: Zhai
authors.forename: Xiaojuan
authors.initials: X
authors.lastname: Liu
authors.forename: Kaiyan
authors.initials: K
authors.lastname: Yang
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.forename: Tao
authors.initials: T
authors.lastname: Jiang
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D003287:Contrast Media / Q000008:administration & dosage; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D015588:Observer Variation; D055815:Young Adult
chemical_list: D003287:Contrast Media