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• Clinical Article •
Differential diagnostic value of IVIM combining with dynamic enhanced MRI in non-mass enhancement adenosis and breast cancer
WU Qi  WANG Zhuo  NING Ning  LIANG Hongbing  ZHANG Lina  GAO Xue  SONG Qingwei 

Cite this article as: WU Q, WANG Z, NING N, et al. Differential diagnostic value of IVIM combining with dynamic enhanced MRI in non-mass enhancement adenosis and breast cancer[J]. Chin J Magn Reson Imaging, 2023, 14(2): 37-43, 49. DOI:10.12015/issn.1674-8034.2023.02.007.


[Abstract] Objective To investigate the differential diagnostic value of IVIM in non-mass enhancement (NME) adenosis and breast cancer.Materials and Methods Retrospective analysis of 106 cases with NME manifestation on dynamic contrast-enhanced (DCE) MRI were performed between January 2020 and March 2022. The cases were divided into two groups according to pathological results: adenosis (n=55) and breast cancer (n=51), the intravoxel incoherent motion (IVIM) quantitative parameters [standard apparent diffusion coefficient (SADC), slow ADC (D), fast ADC (D*) and perfusion fraction (f)] were measured, and the lesion location and DCE characteristics [fibroglandular tissue (FGT), background parenchymal enhancement (BPE), distribution characteristics, internal enhancement characteristics, and time-signal intensity curve (TIC) type] were compared and analyzed, univariate analysis was used to analyze the normality of the two groups of data separately, the independent sample t-test was selected for the normal distribution data, and the nonparametric rank sum test was selected for the non-normal distribution, the statistical differences between the two groups were compared and the diagnostic efficacy was evaluated, the best parameters were screened out by multivariate logistic regression analysis for joint diagnosis, and the threshold, sensitivity and specificity were obtained by the receiver operating characteristic (ROC) curve analysis.Results Breast cancer had f was lower than adenosis [(0.52±0.14) vs. (0.58±0.11), P=0.028; threshold was 0.73], and D* was significantly higher than adenosis [(7.85±7.60)×10-3 mm2/s vs. (3.67±1.61)×10-3 mm2/s, P＜0.001; threshold was 4.10×10-3 mm2/s], with an area under the curve (AUC) for disease diagnosis of 0.608 and 0.730, respectively. Within breast cancer lesions were heterogeneous (54.9%), TIC (70.6%), adenosis (65.5%), and TIC type I (72.7%), both AUC for disease diagnosis were 0.709 and 0.810, respectively. D* and TIC types were independent risk factors for NME breast cancer (P=0.003 and 0.006, respectively), the AUC of both for disease diagnosis was 0.730 and 0.810, respectively, and the combination was significantly better (AUC=0.860, sensitivity was 72.5%, specificity was 85.5%). Further comparing pure adenosis (n=39) with sclerosing adenosis (n=16), the SADC, D, and f values were higher than those of sclerosing adenosis (P=0.076, 0.176, 0.181, respectively), D* value lower than adenosis (P=0.331); the internal enhancement characteristics of pure adenosis were dominated by homogeneous enhancement and heterogeneous enhancement (43.6% and 51.3%, respectively), while sclerosing adenosis cases were all heterogeneous enhancement, accounting for 100.0%, the difference was statistically significant (P=0.001), diagnostic performance with an AUC of 0.692, sensitivity was 100.0%.Conclusions Combining IVIM with DCE helps to improve the differential efficacy of MRI for the diagnosis of adenosis and breast cancer with NME manifestation. The TIC type and D* values are independent risk factors for predicting breast cancer with NME manifestation, and the internal enhancement features contribute to the ability of differentiation between the pure adenosis and sclerosing adenosis.
[Keywords] breast cancer；adenosis；non-mass enhancement；intravoxel incoherent motion；dynamic contrast-enhanced；magnetic resonance imaging

WU Qi1   WANG Zhuo1   NING Ning1   LIANG Hongbing1   ZHANG Lina1*   GAO Xue2   SONG Qingwei1  

1 Department of Radiology, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China

2 Department of Pathology, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China

*Correspondence to: Zhang LN, E-mail: zln201045@163.com

Conflicts of interest   None.

Received  2022-11-03
Accepted  2023-02-13
DOI: 10.12015/issn.1674-8034.2023.02.007
Cite this article as: WU Q, WANG Z, NING N, et al. Differential diagnostic value of IVIM combining with dynamic enhanced MRI in non-mass enhancement adenosis and breast cancer[J]. Chin J Magn Reson Imaging, 2023, 14(2): 37-43, 49. DOI:10.12015/issn.1674-8034.2023.02.007.

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