title: Independent value of image fusion in unenhanced breast MRI using diffusion-weighted and morphological T2-weighted images for lesion characterization in patients with recently detected BI-RADS 4/5 x-ray mammography findings.
abstract: OBJECTIVE
  The aim of this study was to evaluate the accuracy and applicability of solitarily reading fused image series of T2-weighted and high-b-value diffusion-weighted sequences for lesion characterization as compared to sequential or combined image analysis of these unenhanced sequences and to contrast- enhanced breast MRI.
  
  
  METHODS
  This IRB-approved study included 50 female participants with suspicious breast lesions detected in screening X-ray mammograms, all of which provided written informed consent. Prior to biopsy, all women underwent MRI including diffusion-weighted imaging (DWIBS, b = 1500s/mm2). Images were analyzed as follows: prospective image fusion of DWIBS and T2-weighted images (FU), side-by-side analysis of DWIBS and T2-weighted series (CO), combination of the first two methods (CO+FU), and full contrast-enhanced diagnostic protocol (FDP). Diagnostic indices, confidence, and image quality of the protocols were compared by two blinded readers.
  
  
  RESULTS
  Reading the CO+FU (accuracy 0.92; NPV 96.1 %; PPV 87.6 %) and the CO series (0.90; 96.1 %; 83.7 %) provided a diagnostic performance similar to the FDP (0.95; 96.1 %; 91.3 %; p > 0.05). FU reading alone significantly reduced the diagnostic accuracy (0.82; 93.3 %; 73.4 %; p = 0.023).
  
  
  CONCLUSIONS
  MR evaluation of suspicious BI-RADS 4 and 5 lesions detected on mammography by using a non-contrast-enhanced T2-weighted and DWIBS sequence protocol is most accurate if MR images were read using the CO+FU protocol.
  
  
  CONCLUSIONS
  • Unenhanced breast MRI with additional DWIBS/T2w-image fusion allows reliable lesion characterization. • Abbreviated reading of fused DWIBS/T2w-images alone decreases diagnostic confidence and accuracy. • Reading fused DWIBS/T2w-images as the sole diagnostic method should be avoided.
authors.affiliation: Department of Radiology, German Cancer Research Center (dkfz), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany. s.bickelhaupt@dkfz.de.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Bickelhaupt
authors.affiliation: Department of Radiology, German Cancer Research Center (dkfz), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
authors.forename: Jana
authors.initials: J
authors.lastname: Tesdorff
authors.affiliation: Medical Physics in Radiology, German Cancer Research Center (dkfz), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
authors.forename: Frederik Bernd
authors.initials: FB
authors.lastname: Laun
authors.affiliation: Medical Physics in Radiology, German Cancer Research Center (dkfz), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
authors.forename: Tristan Anselm
authors.initials: TA
authors.lastname: Kuder
authors.affiliation: Radiological Practice at the ATOS Clinic Heidelberg, Bismarckplatz 9-15, 69123, Heidelberg, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Lederer
authors.affiliation: Radiological Practice at the ATOS Clinic Heidelberg, Bismarckplatz 9-15, 69123, Heidelberg, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Teiner
authors.affiliation: Junior Group Medical Image Computing, German Cancer Research Center (dkfz), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Maier-Hein
authors.affiliation: Radiology Center Mannheim (RZM), Rosengartenplatz 7, 61818, Mannheim, Germany.
authors.forename: Heidi
authors.initials: H
authors.lastname: Daniel
authors.affiliation: Department of Clinical and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
authors.forename: Anne
authors.initials: A
authors.lastname: Stieber
authors.affiliation: Department of Radiology, German Cancer Research Center (dkfz), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Delorme
authors.affiliation: Department of Radiology, German Cancer Research Center (dkfz), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
authors.forename: Heinz-Peter
authors.initials: HP
authors.lastname: Schlemmer
mesh_terms: D000368:Aged; D001940:Breast / Q000473:pathology; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media
keywords: Breast; Diffusion-weighted imaging (DWI); Image fusion; MRI; Screening