title: A Simplified Approach to Measure the Effect of the Microvasculature in Diffusion-weighted MR Imaging Applied to Breast Tumors: Preliminary Results.
abstract: Purpose To evaluate the relative change of the apparent diffusion coefficient (ADC) at low- and medium-b-value regimens as a surrogate marker of microcirculation, to study its correlation with dynamic contrast agent-enhanced (DCE) magnetic resonance (MR) imaging-derived parameters, and to assess its potential for differentiation between malignant and benign breast tumors. Materials and Methods Ethics approval and informed consent were obtained. From May 2013 to June 2015, 61 patients diagnosed with either malignant or benign breast tumors were prospectively recruited. All patients were scanned with a 3-T MR imager, including diffusion-weighted imaging (DWI) and DCE MR imaging. Parametric analysis of DWI and DCE MR imaging was performed, including a proposed marker, relative enhanced diffusivity (RED). Spearman correlation was calculated between DCE MR imaging and DWI parameters, and the potential of the different DWI-derived parameters for differentiation between malignant and benign breast tumors was analyzed by dividing the sample into equally sized training and test sets. Optimal cut-off values were determined with receiver operating characteristic curve analysis in the training set, which were then used to evaluate the independent test set. Results RED had a Spearman rank correlation of 0.61 with the initial area under the curve calculated from DCE MR imaging. Furthermore, RED differentiated cancers from benign tumors with an overall accuracy of 90% (27 of 30) on the test set with 88.2% (15 of 17) sensitivity and 92.3% (12 of 13) specificity. Conclusion This study presents promising results introducing a simplified approach to assess results from a DWI protocol sensitive to the intravoxel incoherent motion effect by using only three b values. This approach could potentially aid in the differentiation, characterization, and monitoring of breast pathologies.©RSNA, 2016 Online supplemental material is available for this article.
authors.affiliation: From the Departments of Circulation and Medical Imaging (J.R.T., T.E.S., T.F.B.), Physics (P.E.G), and Cancer Research and Molecular Medicine (H.E.F.), Faculty of Medicine, Norwegian University of Science and Technology (NTNU), PO Box 8905, 7491 Trondheim, Norway; and Department of Surgery (H.E.F.), and Clinic of Radiology and Nuclear Medicine (J.R.T., P.E.G., A.Ø.), St. Olav's University Hospital, Trondheim, Norway.
authors.forename: Jose R
authors.initials: JR
authors.lastname: Teruel
authors.affiliation: From the Departments of Circulation and Medical Imaging (J.R.T., T.E.S., T.F.B.), Physics (P.E.G), and Cancer Research and Molecular Medicine (H.E.F.), Faculty of Medicine, Norwegian University of Science and Technology (NTNU), PO Box 8905, 7491 Trondheim, Norway; and Department of Surgery (H.E.F.), and Clinic of Radiology and Nuclear Medicine (J.R.T., P.E.G., A.Ø.), St. Olav's University Hospital, Trondheim, Norway.
authors.forename: Pål E
authors.initials: PE
authors.lastname: Goa
authors.affiliation: From the Departments of Circulation and Medical Imaging (J.R.T., T.E.S., T.F.B.), Physics (P.E.G), and Cancer Research and Molecular Medicine (H.E.F.), Faculty of Medicine, Norwegian University of Science and Technology (NTNU), PO Box 8905, 7491 Trondheim, Norway; and Department of Surgery (H.E.F.), and Clinic of Radiology and Nuclear Medicine (J.R.T., P.E.G., A.Ø.), St. Olav's University Hospital, Trondheim, Norway.
authors.forename: Torill E
authors.initials: TE
authors.lastname: Sjøbakk
authors.affiliation: From the Departments of Circulation and Medical Imaging (J.R.T., T.E.S., T.F.B.), Physics (P.E.G), and Cancer Research and Molecular Medicine (H.E.F.), Faculty of Medicine, Norwegian University of Science and Technology (NTNU), PO Box 8905, 7491 Trondheim, Norway; and Department of Surgery (H.E.F.), and Clinic of Radiology and Nuclear Medicine (J.R.T., P.E.G., A.Ø.), St. Olav's University Hospital, Trondheim, Norway.
authors.forename: Agnes
authors.initials: A
authors.lastname: Østlie
authors.affiliation: From the Departments of Circulation and Medical Imaging (J.R.T., T.E.S., T.F.B.), Physics (P.E.G), and Cancer Research and Molecular Medicine (H.E.F.), Faculty of Medicine, Norwegian University of Science and Technology (NTNU), PO Box 8905, 7491 Trondheim, Norway; and Department of Surgery (H.E.F.), and Clinic of Radiology and Nuclear Medicine (J.R.T., P.E.G., A.Ø.), St. Olav's University Hospital, Trondheim, Norway.
authors.forename: Hans E
authors.initials: HE
authors.lastname: Fjøsne
authors.affiliation: From the Departments of Circulation and Medical Imaging (J.R.T., T.E.S., T.F.B.), Physics (P.E.G), and Cancer Research and Molecular Medicine (H.E.F.), Faculty of Medicine, Norwegian University of Science and Technology (NTNU), PO Box 8905, 7491 Trondheim, Norway; and Department of Surgery (H.E.F.), and Clinic of Radiology and Nuclear Medicine (J.R.T., P.E.G., A.Ø.), St. Olav's University Hospital, Trondheim, Norway.
authors.forename: Tone F
authors.initials: TF
authors.lastname: Bathen
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis; D001943:Breast Neoplasms / Q000473:pathology*; D003287:Contrast Media; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008536:Meglumine; D055806:Microvessels / Q000473:pathology*; D008875:Middle Aged; D009942:Organometallic Compounds; D011446:Prospective Studies; D012680:Sensitivity and Specificity
chemical_list: D014408:Biomarkers, Tumor; D003287:Contrast Media; D009942:Organometallic Compounds; D008536:Meglumine; C072417:gadoterate meglumine