J Korean Med Sci.  2015 Nov;30(11):1689-1697. 10.3346/jkms.2015.30.11.1689.

Reproducibility of Apparent Diffusion Coefficient Measurements in Malignant Breast Masses

• Jang M
• Kim SM
• Yun BL
• Ahn HS
• Kim SY
• Kang E
• Kim SW

• KMID: 2351122
• DOI: http://doi.org/10.3346/jkms.2015.30.11.1689

Abstract

This study aimed to evaluate the reproducibility of apparent diffusion coefficient (ADC) measurements in malignant breast masses, and to determine the influence of mammographic parenchymal density on this reproducibility. Sixty-six patients with magnetic resonance findings of the mass were included. Two breast radiologists measured the ADC of the malignant breast mass and the same area on the contralateral normal breast in each patient twice. The effects of mammographic parenchymal density, histology, and lesion size on reproducibility were also assessed. There was no significant difference in the mean ADC between repeated measurements in malignant breast masses and normal breast tissue. The overall reproducibility of ADC measurements was good in both. The 95% limits of agreement for repeated ADCs were approximately 30.2%-33.4% of the mean. ADC measurements in malignant breast masses were highly reproducible irrespective of mass size, histologic subtype, or coexistence of microcalcifications; however, the measurements tended to be less reproducible in malignant breast masses with extremely dense parenchymal backgrounds. ADC measurements in malignant breast masses are highly reproducible; however, mammographic parenchymal density can potentially influence this reproducibility.

Keyword

Magnetic Resonance; Apparent Diffusion Coefficient; Diffusion Magnetic Resonance Imaging; Reproducibility; Breast; Neoplasms

MeSH Terms

Adult
Aged
Aged, 80 and over
*Algorithms
Breast Neoplasms/*pathology
Diffusion Magnetic Resonance Imaging/*methods
Female
Humans
Image Enhancement/*methods
Image Interpretation, Computer-Assisted/*methods
Middle Aged
Reproducibility of Results
Sensitivity and Specificity

Figure

• 

  Fig. 1 Imaging of a 39-yr-old woman with a 37-mm-sized invasive ductal carcinoma in her left breast. (A) The first axial diffusion-weighted image (b value, 800 sec/mm2), showing a high-signal malignant mass in the left breast. (B) The region of interest (ROI) for the malignant mass was drawn manually (left), and the apparent diffusion coefficient (ADC) was calculated automatically in the ADC map. (C, D) Similarly, the ROI for normal tissue in the contralateral breast was drawn manually (right), and the ADC was calculated automatically. The same methods then were repeated. (E) The high-resolution postcontrast subtraction image was correlated.

• 

  Fig. 2 Imaging of a 44-yr-old woman with a 26-mm-sized invasive ductal carcinoma in her left breast. (A) The first axial diffusion-weighted image (b value, 800 sec/mm2), showing a high-signal malignant mass in the left breast. (B) The region of interest (ROI) for the malignant mass was drawn manually (left), and the apparent diffusion coefficient (ADC) was calculated automatically in the ADC map. (C and D) Similarly, the ROI for normal tissue in the contralateral breast was drawn manually (right), and the ADC was calculated automatically. The same methods then were repeated. (E) The high-resolution postcontrast subtraction image was correlated.

• 

  Fig. 3 Bland-Altman plots, showing the reproducibility of ADC measurements with repeated diffusion-weighted imaging (DWI) of malignant masses and normal breast tissue for reader 1 (A, B) and reader 2 (C, D). The x-axis shows the mean ADC measurements on repeated DWI, and the y-axis shows the difference between the ADC measurements of each set as a percentage of their mean. (blue thick solid line = mean absolute difference; red dashed line = 95% limits of agreement).

• 

  Fig. 4 Graph, showing apparent diffusion coefficient (ADC) measurements based on mammographic density. The x-axis shows the mean ADC measurements on repeated diffusion-weighted imaging, according to the mammographic parenchymal density. The ADC measurements show relative differences in malignant breast masses with extremely dense parenchyma. Adjusted ADC values show consistency irrespective of mammographic density. 1st, first measured ADC; 2nd, second measured ADC; Gr, mammographic density grade.

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