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Breast-lesion assessment using amide proton transfer-weighted imaging and dynamic contrast-enhanced MR imaging

Lulu Zhuang
Lulu Zhuang
, 
Chun Lian
Chun Lian
, 
Zehao Wang
Zehao Wang
, 
Ximin Zhang
Ximin Zhang
, 
Zhigang Wu
Zhigang Wu
 et 
Rong Huang
Rong Huang
   | 30 nov. 2023
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Article Category: Research Article
Publié en ligne: 30 nov. 2023
Pages: 446 - 454
Reçu: 23 mai 2023
Accepté: 01 sept. 2023
DOI: https://doi.org/10.2478/raon-2023-0051
Mots clés
© 2023 Lulu Zhuang et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

FIGURE 1.

Flowchart of patient selection.
Flowchart of patient selection.

FIGURE 2.

Magnetic resonance imaging (MRI) from a 42-year-old woman with invasive breast carcinoma. (A) DWI = diffusion-weighted imaging (B) apparent diffusion coefficient (ADC) (C) dynamic contrast-enhanced (DCE) (D) The amide proton transfer-weighted imaging (APTWI) pseudo-color image was merged with the DCE images and the APT value was 3.9%. (E) The type of time-intensity curves (TIC) was plateau.
Magnetic resonance imaging (MRI) from a 42-year-old woman with invasive breast carcinoma. (A) DWI = diffusion-weighted imaging (B) apparent diffusion coefficient (ADC) (C) dynamic contrast-enhanced (DCE) (D) The amide proton transfer-weighted imaging (APTWI) pseudo-color image was merged with the DCE images and the APT value was 3.9%. (E) The type of time-intensity curves (TIC) was plateau.

FIGURE 3.

Magnetic resonance imaging (MRI) from a 26-year-old woman with intraductal papilloma. (A) Diffusion-weighted imaging (DWI); (B) apparent diffusion coefficient (ADC); (C) dynamic contrast-enhanced (DCE); (D) the amide proton transfer-weighted imaging (APTWI) pseudo-color image was merged with the DCE images and the APT value was 1.6%; (E) the type of time-intensity curves (TIC) was persistent.
Magnetic resonance imaging (MRI) from a 26-year-old woman with intraductal papilloma. (A) Diffusion-weighted imaging (DWI); (B) apparent diffusion coefficient (ADC); (C) dynamic contrast-enhanced (DCE); (D) the amide proton transfer-weighted imaging (APTWI) pseudo-color image was merged with the DCE images and the APT value was 1.6%; (E) the type of time-intensity curves (TIC) was persistent.

FIGURE 4.

The graph displays ROC curves to evaluate the usefulness of various parameters for differentiating between malignant and benign lesions.
The graph displays ROC curves to evaluate the usefulness of various parameters for differentiating between malignant and benign lesions.

Summary of patient characteristics

Benign lesions (n = 14) Malignant lesions (n = 28)
Age (years) 35 ± 14 (13–68) 49 ± 12 (30–77)
Largest diameter (cm) 2.19 ± 2.40 3.31 ± 1.25
Histology Fibroadenoma (n = 7) Invasive breast carcinoma (n = 24)
Juvenile fibroadenoma (n = 1) Ductal carcinoma in situ (n = 4)
Adenosis (n = 2)
Fibroadenoma + adenosis (n = 2)
Intraductal papilloma (n = 1)
Benign phyllodes tumor (n = 1)

Clinical and pathological data of breast cancer

Variable Malignant breast tumors (n = 28)
Tumor diameter
  < 2 cm 3 (10.71)
  ≥ 2 cm 25 (89.29)
Metastatic status of axillary lymph node 15 (53.57)
Calcification 16 (57.14)
Grade of IBC (N, %)
  Grade I 1 (4.17)
  Grade II 12 (50)
  Grade III 11 (45.83)
Receptor status (N, %)
  ER+ 20 (71.43)
  PR+ 20 (71.43)
  HER-2+ 9 (32.14)
  Ki67+ 25 (89.29)

ROC analysis of the performance in separating breast cancer from benign lesions using various criteria and techniques alone or in combination

Multi parameters Cutoff Sensitivity Specificity AUC 95%CI
Parameters
  APT value > 2.35 85.71% 92.86% 0.915 0.786–0.978
  TIC > 1 82.14% 78.57% 0.815 0.665–0.918
  ADC value ≤ 1.26 89.29% 92.86% 0.878 0.739–0.958
Methods
  ADC+APTWI / 85.71% 96.43% 0.921 0.795–0.982
  ADC+DCE / 71.43% 89.29% 0.916 0.788–0.979
  DCE+APTWI / 78.57% 92.86% 0.936 0.816–0.988

Imaging protocol parameters

APTw DWI DCE
TR [ms] 5500 6356 4
TE [ms] 9 84 2
Field of views [mm2] 120 × 120 340 × 309 260 × 340
Voxel size 1.9 × 2.0 × 7 2.7 × 2.3 × 4 0.9 × 0.9 × 3.5
Flip angle 90 90 11
Matrix (mm2) 64 × 60 128 × 133 280× 368
Reconstructed voxel size 0.94 × 0.94 × 7 0.97 × 0.97 × 4 0.61 × 0.61 × 3.5
b-value [s/mm2] NA 0,50,800 NA
Bandwidth [pixel/Hz] 406.9 23.1 783.2
Scan duration 5 min 03 s 2 min 14 s 7 min 44 s

Comparison of different parameters between benign lesions and malignant lesions

Measurement index Benign lesions (n = 14) Malignant lesions (n = 28) P
APT value 2.01 ± 0.51 3.18 ± 1.07 < 0.001
Type of TIC < 0.001
  I 11(78.6%) 5(17.9%)
  II 3(21.4%) 20(71.4%)
  III 0 3(10.7%)
ADC value 1.64 ± 0.41 1.13 ± 0.36 < 0.001
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