Diffusion-Weighted MRI-Based Virtual Elastography and Shear-Wave Elastography for the Assessment of Breast Lesions.

TL;DR: Both SWE and DWI-vMRE with the use of sADC could be used for the differentiation of benign versus malignant breast lesions and DWI-vMRE with the use of sADC show relatively higher AUC values than SWE.

Abstract: BACKGROUND Diffusion-weighted imaging (DWI)-based virtual MR elastography (DWI-vMRE) in the assessment of breast lesions is still in the research stage. PURPOSE To investigate the usefulness of elasticity values on DWI-vMRE in the evaluation of breast lesions, and the correlation with the values calculated from shear-wave elastography (SWE). STUDY TYPE Prospective. POPULATION/SUBJECTS 153 patients (mean age ± standard deviation: 55 ± 12 years) with 153 pathological confirmed breast lesions (24 benign and 129 malignant lesions). FIELD STRENGTH/SEQUENCE 1.5-T MRI, multi-b readout segmented echo planar imaging (b-values of 0, 200, 800, and 1000 sec/mm2 ). ASSESSMENT For DWI-vMRE assessment, lesions were manually segmented using apparent diffusion coefficient (ADC0-1000 ) map, then the region of interests were copied to the map of shifted-ADC (sADC200-800 , sADC 200-1500 ). For SWE assessment, the shear modulus of the lesions was measured by US elastic modulus (μUSE ). Intraclass/interclass kappa coefficients were calculated to measure the consistency. STATISTICAL TESTS Pearson's correlation was used to assess the relationship between sADC and μUSE . A receiver operating characteristic analysis with the area under the curve (AUC) was performed to compare the diagnostic accuracy between benign and malignant breast lesions of sADC and μUSE . A P value <0.05 was considered statistically significant. RESULTS There were significant differences between benign and malignant breast lesions of μUSE (24.17 ± 10.64 vs. 37.20 ± 12.61), sADC200-800 (1.38 ± 0.31 vs. 0.97 ± 0.18 × 10-3  mm2 /sec), and sADC200-1500 (1.14 ± 0.30 vs. 0.78 ± 0.13 × 10-3  mm2 /sec). In all breast lesions, a moderate but significant correlation was observed between μUSE and sADC200-800 /sADC200-1500 (r = -0.49/-0.44). AUC values to differentiate benign from malignant lesions were as follows: μUSE , 0.78; sADC200-800 , 0.89; sADC200-1500 , 0.89. DATA CONCLUSIONS Both SWE and DWI-vMRE could be used for the differentiation of benign versus malignant breast lesions. Furthermore, DWI-vMRE with the use of sADC show relatively higher AUC values than SWE. LEVEL OF EVIDENCE 4 TECHNICAL EFFICACY: Stage 2.