Diagnosis Of Breast Cancer Using 3.0t Dynamic Contrast Enhancement Fischer Score Combined With Diffusion Weighted Imaging

Objective:Although magnetic resonance imaging(MRI) has a high sensitivity in the detection of tumors, there is still much dispute about its role in breast cancer detection. This study explored the diagnostic value of breast cancer by combining the Fischer score of dynamic contrast enhancement(DCE)and diffusion weighted imaging(DWI)at 3.0 T MRI. Materials and methods:MRI data of 66 female patients with breast lesions histopathologically verified by operation or puncture was analyzed retrospectively. Preoperative MRI was performed in all patients(age range is from 18 to 80 years, median age is 45 years), including conventional scanning, DCE-MR and DWI at 3.0-T MRI. With pathological diagnosis as the gold standard, the lesions were divided into benign lesion group(group A) and malignant lesion group(group B). And of them, 22 patients’ contralateral normal mammary gland were selected as normal control group(group C)(age range is form 29 to 70 years, as well as, median age is 45 years).DCE and DWI post-processing and data measurement were performed by using FUNCTOOL software post-processing workstation. Morphological features, enhancement way and the signal enhancement rate(SER), as well as the time-signal intensity curve(TIC) type of lesions were recorded, with a variety of ADC values of lesions measured, including average ADC values(ADCavg), minimum ADC values(ADCmin) and maximum ADC values(ADCmax).Fischer score between benign and malignant lesions were compared by using c2 test. A variety of ADC values among normal glandular tissue, benign and malignant lesions by one-way analysis of variance(one-way ANOVA), with the characteristic curve(ROC) of subjects to determine the diagnostic performance in each parameters. Results:(1)Enhance morphology and way: Both benign and malignant lesions showed mass type and non-mass-like enhancement, Benign mass lesions main features were homogeneous enhancement, centrifugal enhancement and non-enhancement or weak enhancement of internal septation(13/25), with malignant mass lesions being inhomogeneous enhancement, early rim ring-like enhancement and centripetal enhancement(36/50). Non-mass-like enhancement showed presenting ductal, segmental and clustered distribution.(2)TIC type and SER: TIC of breast benign tumor often shows wash-in type(type Ⅰ)(17/25), but that of malignant tumor more shows plateau type(type Ⅱ)(5/50) and wash-out type(type Ⅲ)(44/50). Initial peak SER of benign tumor was significantly lower than that of malignant tumor(p<0.05). Its sensitivity, specificity and accuracy were respectively 80%、88% and 84.6%,with cutoff value 102%.(3)Fischer score: Fischer score of benign tumor was significantly lower than that of malignant tumor(p<0.001), With cutoff value 3 point, its sensitivity, specificity and accuracy were respectively 100%, 76% and 92%.(4)DWI and ADC value: ADCavg, ADCmin and ADCmax among normal glandular tissue, benign lesions and malignant lesions had significantly differences(p<0.001), with each parameter decreasing orderly. ADCd had no significant difference between benign and malignant tumors(p=0.791), and ADCd of benign or malignant tumor were significantly lower than that of normal glandular tissue(p<0.001). ADCavg performed best in diagnosis of breast cancer. With cutoff value 1.15×10-3mm2/s, its sensitivity, specificity and accuracy were respectively 85%、98% and 91.8%。(5)DCE and DWI joint model: The ADCavg in combination with Fischer score performed best in diagnosis of breast cancer.(AUC=0.975). Conclusion:Benign and malignant breast tumors dynamic enhancement has some certain characteristics in morphology and enhancing way. Fischer score helps improve breast MRI diagnostic value. Average ADC values performer best to differentiate breast tumor, which combined with Fischer score can further improve the MRI diagnostic performance.