European Radiology: How valuable is breast MR diffusion-weighted imaging?

Dynamic enhanced magnetic resonance imaging (DCE-MRI) is the most sensitive imaging modality for detecting breast cancer, with reported sensitivity of 81% to 100%.

However, MRI-induced positive biopsy predictive values range from 20% to 40%, with a high
false-positive rate.
In this context, diffusion-weighted imaging (DWI) has become a key imaging technique that complements DCE-MRI, improving the display of lesion features and reducing unnecessary biopsies
.

The International Breast DWI Working Group of the European Society of Breast Radiology (EUSOBI) is composed of several breast MRI specialists, MRI physicists and representatives of large supplier companies, whose expertise in breast MRI and DWI has been multifaceted Confirmed
.
The working group considers DWI to be an important component of
multiparametric breast MRI protocols.
The task of the working group is not only to encourage the use of DWI in multiparametric breast MRI protocols, but also to find consensus on the best methods for DWI image processing/analysis, visualization, and interpretation, and to improve the application of breast DWI sequences by working side-by-side with system suppliers.


Recently, a study published in the journal European Radiology by the EUSOBI International Working Group on Breast DWI provides basic requirements for b-value, fat saturation, spatial resolution and other sequence parameters for the routine clinical application of breast DWI, so that DWI can be further widely implemented and applied in clinical practice
.

An online questionnaire was developed by two certified radiologists and reviewed by the EUSOBI Board of Directors and Committees and finally distributed
among EUSOBI active and relevant radiologist members.
The questionnaire included 20 questions on technical preferences (acquisition time, magnetic strength, number of breast coils, number of B values), clinical indications, imaging evaluation and reporting
.
Data was analyzed using descriptive statistics, stand-alone Chi-square tests, and Fisher's exact tests
.

Of the 1411 EUSOBI radiologist members, 275/1411 (19.
5%) responded
.
The majority (222/275, 81%) reported DWI as part of
their regular programme.
Common indications for DWI include lesion characteristics (using an ADC threshold of 1.
2-1.
3 × 10-3 mm2/s) and prediction
of response to chemotherapy.
Members most often obtain two separate B values (114/217, 53%), and among members who obtain more than two B values, B value = 800 s/mm2 is the preferred value for evaluation (71/171, 42%)
.
Most people did not use synthetic B values (169/217, 78%)
.
While most people reported limited diffusion (161/213, 76%) in MRI reports, only 142/217 (57%) reported ADC values
.

Table Relationship between respondents' clinical work using both 1.
5T and 3T scanners or only 3T scanners and their willingness to join the scanner working group

In summary, the data presented in this study can better understand the role and value of DWI in breast clinical MRI, and provide a reference for its standardization and implementation
.

Original source:

Roberto Lo Gullo,Varadan Sevilimedu,Pascal Baltzer,et al.
A survey by the European Society of Breast Imaging on the implementation of breast diffusion-weighted imaging in clinical practice.
DOI:10.
1007/s00330-022-08833-0