Journal Article
. 2016 Sep; 27(5):1883-1892.
doi: 10.1007/s00330-016-4564-3.

Diffusion-weighted imaging of breast lesions: Region-of-interest placement and different ADC parameters influence apparent diffusion coefficient values

Hubert Bickel 1 Katja Pinker 1 Stephan Polanec 1 Heinrich Magometschnigg 1 Georg Wengert 1 Claudio Spick 1 Wolfgang Bogner 2 Zsuzsanna Bago-Horvath 3 Thomas H Helbich 4 Pascal Baltzer 1 
  • PMID: 27578047
  •     41 References
  •     27 citations


Objectives: To investigate the influence of region-of-interest (ROI) placement and different apparent diffusion coefficient (ADC) parameters on ADC values, diagnostic performance, reproducibility and measurement time in breast tumours.

Methods: In this IRB-approved, retrospective study, 149 histopathologically proven breast tumours (109 malignant, 40 benign) in 147 women (mean age 53.2) were investigated. Three radiologists independently measured minimum, mean and maximum ADC, each using three ROI placement approaches:1 - small 2D-ROI, 2 - large 2D-ROI and 3 - 3D-ROI covering the whole lesion. One reader performed all measurements twice. Median ADC values, diagnostic performance, reproducibility, and measurement time were calculated and compared between all combinations of ROI placement approaches and ADC parameters.

Results: Median ADC values differed significantly between the ROI placement approaches (p < .001). Minimum ADC showed the best diagnostic performance (AUC .928-.956), followed by mean ADC obtained from 2D ROIs (.926-.94). Minimum and mean ADC showed high intra- (ICC .85-.94) and inter-reader reproducibility (ICC .74-.94). Median measurement time was significantly shorter for the 2D ROIs (p < .001).

Conclusions: ROI placement significantly influences ADC values measured in breast tumours. Minimum and mean ADC acquired from 2D-ROIs are useful for the differentiation of benign and malignant breast lesions, and are highly reproducible, with rapid measurement.

Key Points: • Region of interest placement significantly influences apparent diffusion coefficient of breast tumours. • Minimum and mean apparent diffusion coefficient perform best and are reproducible. • 2D regions of interest perform best and provide rapid measurement times.

Keywords: Breast cancer; Diffusion magnetic resonance imaging; Magnetic resonance imaging; Molecular imaging; Reproducibility of results and findings.

Is there a systematic bias of apparent diffusion coefficient (ADC) measurements of the breast if measured on different workstations? An inter- and intra-reader agreement study.
Paola Clauser, Magda Marcon, +3 authors, Pascal A T Baltzer.
Eur Radiol, 2015 Oct 08; 26(7). PMID: 26443604
Region of interest demarcation for quantification of the apparent diffusion coefficient in breast lesions and its interobserver variability.
Luísa Nogueira, Sofia Brandão, +4 authors, Isabel Ramos.
Diagn Interv Radiol, 2015 Feb 24; 21(2). PMID: 25698095    Free PMC article.
The role of mean diffusivity (MD) as a predictive index of the response to chemotherapy in locally advanced breast cancer: a preliminary study.
Chiara Iacconi, Marco Giannelli, +6 authors, Davide Caramella.
Eur Radiol, 2009 Sep 18; 20(2). PMID: 19760422
Improved diagnostic accuracy with multiparametric magnetic resonance imaging of the breast using dynamic contrast-enhanced magnetic resonance imaging, diffusion-weighted imaging, and 3-dimensional proton magnetic resonance spectroscopic imaging.
Katja Pinker, Wolfgang Bogner, +9 authors, Thomas H Helbich.
Invest Radiol, 2014 Feb 26; 49(6). PMID: 24566292
Detection of invasive components in cases of breast ductal carcinoma in situ on biopsy by using apparent diffusion coefficient MR parameters.
Naoko Mori, Hideki Ota, +6 authors, Shoki Takahashi.
Eur Radiol, 2013 Jun 05; 23(10). PMID: 23732688
Diffusion-Weighted Imaging-guided MR Spectroscopy in Breast Lesions using Readout-Segmented Echo-Planar Imaging.
Kun Sun, Weimin Chai, +4 authors, Fuhua Yan.
Eur Radiol, 2015 Sep 20; 26(6). PMID: 26385807
Readout-segmented echo-planar imaging improves the diagnostic performance of diffusion-weighted MR breast examinations at 3.0 T.
Wolfgang Bogner, Katja Pinker-Domenig, +5 authors, Stephan Gruber.
Radiology, 2012 Mar 23; 263(1). PMID: 22438442
Informatics in radiology (infoRAD): navigating the fifth dimension: innovative interface for multidimensional multimodality image navigation.
Antoine Rosset, Luca Spadola, Lance Pysher, Osman Ratib.
Radiographics, 2006 Jan 19; 26(1). PMID: 16418259
Diagnostic efficacy of the diffusion weighted imaging in the characterization of different types of breast lesions.
Sibel Kul, Ilker Eyuboglu, Aysegul Cansu, Etem Alhan.
J Magn Reson Imaging, 2014 Jun 14; 40(5). PMID: 24923252
Apparent diffusion coefficient values for discriminating benign and malignant breast MRI lesions: effects of lesion type and size.
Savannah C Partridge, Christiane D Mullins, +4 authors, Constance D Lehman.
AJR Am J Roentgenol, 2010 May 22; 194(6). PMID: 20489111
Diffusion-weighted MR for differentiation of breast lesions at 3.0 T: how does selection of diffusion protocols affect diagnosis?
Wolfgang Bogner, Stephan Gruber, +6 authors, Siegfried Trattnig.
Radiology, 2009 Aug 26; 253(2). PMID: 19703869
Assessment of breast lesions with diffusion-weighted MRI: comparing the use of different b values.
Fernanda Philadelpho Arantes Pereira, Gabriela Martins, +4 authors, Emerson Leandro Gasparetto.
AJR Am J Roentgenol, 2009 Sep 23; 193(4). PMID: 19770326
Quantitative apparent diffusion coefficient as a noninvasive imaging biomarker for the differentiation of invasive breast cancer and ductal carcinoma in situ.
Hubert Bickel, Katja Pinker-Domenig, +5 authors, Pascal Baltzer.
Invest Radiol, 2014 Oct 22; 50(2). PMID: 25333308
Bilateral diffusion-weighted MR imaging of breast tumors with submillimeter resolution using readout-segmented echo-planar imaging at 7 T.
Wolfgang Bogner, Katja Pinker, +8 authors, Stephan Gruber.
Radiology, 2014 Oct 24; 274(1). PMID: 25341078
Diffusion-weighted imaging (DWI) in MR mammography (MRM): clinical comparison of echo planar imaging (EPI) and half-Fourier single-shot turbo spin echo (HASTE) diffusion techniques.
P A T Baltzer, D M Renz, +6 authors, W A Kaiser.
Eur Radiol, 2009 Mar 17; 19(7). PMID: 19288109
Apparent diffusion coefficient as an MR imaging biomarker of low-risk ductal carcinoma in situ: a pilot study.
Mami Iima, Denis Le Bihan, +7 authors, Kaori Togashi.
Radiology, 2011 Jun 03; 260(2). PMID: 21633054
White paper on imaging biomarkers.
European Society of Radiology (ESR).
Insights Imaging, 2010 May 01; 1(2). PMID: 22347903    Free PMC article.
Differentiation of clinically benign and malignant breast lesions using diffusion-weighted imaging.
Yong Guo, You-Quan Cai, +5 authors, Jia-Hong Gao.
J Magn Reson Imaging, 2002 Aug 31; 16(2). PMID: 12203765
Highly Cited.
Effect of b value and pre-admission of contrast on diagnostic accuracy of 1.5-T breast DWI: a systematic review and meta-analysis.
Monique D Dorrius, Hildebrand Dijkstra, Matthijs Oudkerk, Paul E Sijens.
Eur Radiol, 2014 Aug 12; 24(11). PMID: 25103535
Systematic Review.
Improved diagnostic accuracy of breast MRI through combined apparent diffusion coefficients and dynamic contrast-enhanced kinetics.
S C Partridge, H Rahbar, +4 authors, C D Lehman.
Magn Reson Med, 2011 Jan 22; 65(6). PMID: 21254208    Free PMC article.
Diffusion-weighted imaging of breast tumours at 3 Tesla and 7 Tesla: a comparison.
S Gruber, L Minarikova, +7 authors, W Bogner.
Eur Radiol, 2015 Aug 28; 26(5). PMID: 26310582
European guidelines for quality assurance in breast cancer screening and diagnosis. Fourth edition--summary document.
N Perry, M Broeders, +3 authors, L von Karsa.
Ann Oncol, 2007 Nov 21; 19(4). PMID: 18024988
Highly Cited. Review.
StAR: a simple tool for the statistical comparison of ROC curves.
Ismael A Vergara, Tomás Norambuena, +2 authors, Francisco Melo.
BMC Bioinformatics, 2008 Jun 07; 9. PMID: 18534022    Free PMC article.
Tumour ADC measurements in rectal cancer: effect of ROI methods on ADC values and interobserver variability.
Doenja M J Lambregts, Geerard L Beets, +4 authors, Regina G H Beets-Tan.
Eur Radiol, 2011 Aug 09; 21(12). PMID: 21822946    Free PMC article.
MRI-only lesions: application of diffusion-weighted imaging obviates unnecessary MR-guided breast biopsies.
Claudio Spick, Katja Pinker-Domenig, +2 authors, Pascal A Baltzer.
Eur Radiol, 2014 Apr 08; 24(6). PMID: 24706105
Correlation of the apparent diffusion coefficiency values on diffusion-weighted imaging with prognostic factors for breast cancer.
S Y Choi, Y-W Chang, +3 authors, D Y Seo.
Br J Radiol, 2011 Dec 01; 85(1016). PMID: 22128125    Free PMC article.
Diffusion-Weighted Imaging in 3.0 Tesla Breast MRI: Diagnostic Performance and Tumor Characterization Using Small Subregions vs. Whole Tumor Regions of Interest.
Otso Arponen, Otso Arponent, +9 authors, Ritva Vanninen.
PLoS One, 2015 Oct 13; 10(10). PMID: 26458106    Free PMC article.
ADC mapping of benign and malignant breast tumors.
Reiko Woodhams, Keiji Matsunaga, +6 authors, Kazushige Hayakawa.
Magn Reson Med Sci, 2005 Aug 30; 4(1). PMID: 16127252
Assessment and quantification of sources of variability in breast apparent diffusion coefficient (ADC) measurements at diffusion weighted imaging.
E Giannotti, S Waugh, +3 authors, S Vinnicombe.
Eur J Radiol, 2015 Jun 17; 84(9). PMID: 26078100
Combined contrast-enhanced magnetic resonance and diffusion-weighted imaging reading adapted to the "Breast Imaging Reporting and Data System" for multiparametric 3-T imaging of breast lesions.
K Pinker, H Bickel, +8 authors, W Bogner.
Eur Radiol, 2013 Mar 19; 23(7). PMID: 23504036
Diffusion-weighted imaging of breast masses: comparison of diagnostic performance using various apparent diffusion coefficient parameters.
Maki Hirano, Hiroko Satake, +3 authors, Shinji Naganawa.
AJR Am J Roentgenol, 2012 Feb 24; 198(3). PMID: 22358015
Assessment of tumor morphology on diffusion-weighted (DWI) breast MRI: Diagnostic value of reduced field of view DWI.
Maarten W Barentsz, Valentina Taviani, +6 authors, Bruce L Daniel.
J Magn Reson Imaging, 2015 Apr 29; 42(6). PMID: 25914178    Free PMC article.
Magnetic resonance imaging of the breast: recommendations from the EUSOMA working group.
Francesco Sardanelli, Carla Boetes, +20 authors, Robin Wilson.
Eur J Cancer, 2010 Mar 23; 46(8). PMID: 20304629
Highly Cited.
Diffusion tensor magnetic resonance imaging of the breast: a pilot study.
Pascal A T Baltzer, Anja Schäfer, +4 authors, Werner A Kaiser.
Eur Radiol, 2010 Jul 30; 21(1). PMID: 20668860
Diffusion-weighted imaging of malignant breast tumors: the usefulness of apparent diffusion coefficient (ADC) value and ADC map for the detection of malignant breast tumors and evaluation of cancer extension.
Reiko Woodhams, Keiji Matsunaga, +5 authors, Kazushige Hayakawa.
J Comput Assist Tomogr, 2005 Sep 16; 29(5). PMID: 16163035
Apparent diffusion coefficients of breast tumors: clinical application.
Masamitsu Hatakenaka, Hiroyasu Soeda, +5 authors, Hiroshi Honda.
Magn Reson Med Sci, 2008 May 08; 7(1). PMID: 18460845
Diffusion-weighted magnetic resonance imaging of breast lesions: first experiences at 3 T.
Gladys G Lo, Victor Ai, +6 authors, Daisy Chien.
J Comput Assist Tomogr, 2009 Feb 04; 33(1). PMID: 19188787
Semi-automated quantitative intravoxel incoherent motion analysis and its implementation in breast diffusion-weighted imaging.
Hildebrand Dijkstra, Monique D Dorrius, +4 authors, Paul E Sijens.
J Magn Reson Imaging, 2015 Nov 13; 43(5). PMID: 26558851
Correlations between apparent diffusion coefficient values and prognostic factors of breast cancer.
Takeshi Kamitani, Yoshio Matsuo, +10 authors, Hiroshi Honda.
Magn Reson Med Sci, 2013 Jul 17; 12(3). PMID: 23857151
Differential diagnosis of benign and malignant breast masses using diffusion-weighted magnetic resonance imaging.
Qinghua Min, Kangwei Shao, +4 authors, Jun Yang.
World J Surg Oncol, 2015 Apr 19; 13. PMID: 25889380    Free PMC article.
Improving outcomes of screening breast MRI with practice evolution: initial clinical experience with 3T compared to 1.5T.
Ana P Lourenco, Linda Donegan, Hanan Khalil, Martha B Mainiero.
J Magn Reson Imaging, 2013 May 31; 39(3). PMID: 23720144
DWI in the Assessment of Breast Lesions.
Savannah C Partridge, Nita Amornsiripanitch.
Top Magn Reson Imaging, 2017 Sep 30; 26(5). PMID: 28961569    Free PMC article.
How to use the Kaiser score as a clinical decision rule for diagnosis in multiparametric breast MRI: a pictorial essay.
Matthias Dietzel, Pascal A T Baltzer.
Insights Imaging, 2018 Apr 05; 9(3). PMID: 29616496    Free PMC article.
Diffusion-Weighted Imaging With Apparent Diffusion Coefficient Mapping for Breast Cancer Detection as a Stand-Alone Parameter: Comparison With Dynamic Contrast-Enhanced and Multiparametric Magnetic Resonance Imaging.
Katja Pinker, Linda Moy, +8 authors, Thomas H Helbich.
Invest Radiol, 2018 Apr 06; 53(10). PMID: 29620604    Free PMC article.
Diffusion kurtosis imaging in the characterisation of rectal cancer: utilizing the most repeatable region-of-interest strategy for diffusion parameters on a 3T scanner.
Yiqun Sun, Qin Xiao, +9 authors, Yajia Gu.
Eur Radiol, 2018 May 26; 28(12). PMID: 29797056
Diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) mapping as a quantitative imaging biomarker for prediction of immunohistochemical receptor status, proliferation rate, and molecular subtypes of breast cancer.
Joao V Horvat, Blanca Bernard-Davila, +11 authors, Katja Pinker.
J Magn Reson Imaging, 2019 Feb 28; 50(3). PMID: 30811717    Free PMC article.
Limited role of DWI with apparent diffusion coefficient mapping in breast lesions presenting as non-mass enhancement on dynamic contrast-enhanced MRI.
Daly Avendano, Maria Adele Marino, +10 authors, Katja Pinker.
Breast Cancer Res, 2019 Dec 06; 21(1). PMID: 31801635    Free PMC article.
Breast MRI in the era of diffusion weighted imaging: do we still need signal-intensity time curves?
Matthias Dietzel, Stephan Ellmann, +4 authors, Pascal A T Baltzer.
Eur Radiol, 2019 Jul 31; 30(1). PMID: 31359125    Free PMC article.
Diffusion-weighted MRI for Unenhanced Breast Cancer Screening.
Nita Amornsiripanitch, Sebastian Bickelhaupt, +4 authors, Savannah C Partridge.
Radiology, 2019 Oct 09; 293(3). PMID: 31592734    Free PMC article.
Diffusion-weighted imaging of the breast-a consensus and mission statement from the EUSOBI International Breast Diffusion-Weighted Imaging working group.
Pascal Baltzer, Ritse M Mann, +11 authors, EUSOBI international Breast Diffusion-Weighted Imaging working group.
Eur Radiol, 2019 Dec 02; 30(3). PMID: 31786616    Free PMC article.
Utility of Diffusion-weighted Imaging to Decrease Unnecessary Biopsies Prompted by Breast MRI: A Trial of the ECOG-ACRIN Cancer Research Group (A6702).
Habib Rahbar, Zheng Zhang, +17 authors, Savannah C Partridge.
Clin Cancer Res, 2019 Jan 17; 25(6). PMID: 30647080    Free PMC article.
Risk stratification of ductal carcinoma in situ using whole-lesion histogram analysis of the apparent diffusion coefficient.
Jin You Kim, Jin Joo Kim, +6 authors, Robert Grimm.
Eur Radiol, 2018 Aug 04; 29(2). PMID: 30073498
The MRI characteristics of non-mass enhancement lesions of the breast: associations with malignancy.
Hale Aydin.
Br J Radiol, 2019 Jan 24; 92(1096). PMID: 30673299    Free PMC article.
Semi-automatic segmentation from intrinsically-registered 18F-FDG-PET/MRI for treatment response assessment in a breast cancer cohort: comparison to manual DCE-MRI.
Maren Marie Sjaastad Andreassen, Pål Erik Goa, +7 authors, Neil Peter Jerome.
MAGMA, 2019 Sep 29; 33(2). PMID: 31562584    Free PMC article.
Diffusion-weighted imaging with simultaneous multi-slice echo-planar technique for the diagnosis of breast magnetic resonance imaging.
Youichi Machida, Kyoko Nomura, +3 authors, Eisuke Fukuma.
Jpn J Radiol, 2020 Jan 16; 38(4). PMID: 31938960
Combination of an ultrafast TWIST-VIBE Dixon sequence protocol and diffusion-weighted imaging into an accurate easily applicable classification tool for masses in breast MRI.
Sandra C Peter, Evelyn Wenkel, +6 authors, Stephan Ellmann.
Eur Radiol, 2020 Feb 01; 30(5). PMID: 32002644
Test-retest repeatability and reproducibility of ADC measures by breast DWI: Results from the ACRIN 6698 trial.
David C Newitt, Zheng Zhang, +18 authors, ACRIN Trial Team and I-SPY 2 TRIAL Investigators.
J Magn Reson Imaging, 2018 Oct 24; 49(6). PMID: 30350329    Free PMC article.
Diagnostic performance of breast tumor tissue selection in diffusion weighted imaging: A systematic review and meta-analysis.
M Wielema, M D Dorrius, +4 authors, P E Sijens.
PLoS One, 2020 May 07; 15(5). PMID: 32374781    Free PMC article.
Systematic Review.
A multiparametric [18F]FDG PET/MRI diagnostic model including imaging biomarkers of the tumor and contralateral healthy breast tissue aids breast cancer diagnosis.
Doris Leithner, Joao V Horvat, +13 authors, Katja Pinker.
Eur J Nucl Med Mol Imaging, 2019 Jun 15; 46(9). PMID: 31197455    Free PMC article.
Clinical relevance of total choline (tCho) quantification in suspicious lesions on multiparametric breast MRI.
Claudia Sodano, Paola Clauser, +5 authors, Pascal Andreas Baltzer.
Eur Radiol, 2020 Feb 18; 30(6). PMID: 32065286    Free PMC article.
Discrimination of benign from malignant breast lesions in dense breasts with model-based analysis of regions-of-interest using directional diffusion-weighted images.
Alan I Penn, Milica Medved, +7 authors, Hiroyuki Abe.
BMC Med Imaging, 2020 Jun 11; 20(1). PMID: 32517657    Free PMC article.
Diffusion-Weighted MRI of the Breast in Women with a History of Mantle Radiation: Does Radiation Alter Apparent Diffusion Coefficient?
Punam Bajaj, Chiara Iacconi, David D Dershaw, Elizabeth A Morris.
J Breast Imaging, 2019 Sep 21; 1(3). PMID: 31538143    Free PMC article.
Diffusion-weighted imaging of the breast: current status as an imaging biomarker and future role.
Julia Camps-Herrero.
BJR Open, 2019 Mar 08; 1(1). PMID: 33178933    Free PMC article.
[Contrast agent-free breast MRI : Advantages and potential disadvantages].
P A T Baltzer, P Kapetas, +4 authors, P Clauser.
Radiologe, 2019 Apr 20; 59(6). PMID: 31001650
Diffusion-Weighted Magnetic Resonance Imaging of the Breast: Standardization of Image Acquisition and Interpretation.
Su Hyun Lee, Hee Jung Shin, Woo Kyung Moon.
Korean J Radiol, 2020 Sep 10; 22(1). PMID: 32901461    Free PMC article.
Diffusion weighted imaging of the breast: Performance of standardized breast tumor tissue selection methods in clinical decision making.
M Wielema, P E Sijens, +7 authors, M Oudkerk.
PLoS One, 2021 Jan 26; 16(1). PMID: 33493230    Free PMC article.
q-Space Imaging Yields a Higher Effect Gradient to Assess Cellularity than Conventional Diffusion-weighted Imaging Methods at 3.0 T: A Pilot Study with Freshly Excised Whole-Breast Tumors.
Nicholas Senn, Yazan Masannat, +3 authors, Jiabao He.
Radiol Imaging Cancer, 2019 Sep 27; 1(1). PMID: 33778671    Free PMC article.
Multidimensional Diffusion Magnetic Resonance Imaging for Characterization of Tissue Microstructure in Breast Cancer Patients: A Prospective Pilot Study.
Isaac Daimiel Naranjo, Alexis Reymbaut, +7 authors, Katja Pinker-Domenig.
Cancers (Basel), 2021 Apr 04; 13(7). PMID: 33807205    Free PMC article.