Editorial for "Contrasts Between Diffusion-Weighted Imaging and Dynamic Contrast-Enhanced MR in Diagnosing Malignancies of Breast Nonmass Enhancement Lesions Based on Morphologic Assessment".
Editorial for "Contrasts Between Diffusion-Weighted Imaging and Dynamic Contrast-Enhanced MR in Diagnosing Malignancies of Breast Nonmass Enhancement Lesions Based on Morphologic Assessment".
复制标题
“基于形态学评估的弥散加权成像与动态对比增强 MR 诊断乳腺非肿块增强病变恶性肿瘤的对比”的社论。
DOI：
10.1002/jmri.28620
复制
发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Kazerouni,AnumS
中科院分区：
文献类型：
--
作者：
Partridge,SavannahC;Kazerouni,AnumS
众所周知，对比增强MRI在乳腺癌检测方面比其他成像方式具有上级灵敏度，但也导致许多良性活检。为了支持更广泛地利用MRI进行乳腺筛查，人们对提高特异性和减少假阳性的策略非常感兴趣。特别是，非肿块增强（NME）型病变，在动态对比增强（DCE）MRI上识别为缺乏病灶或肿块特征的增强区域，存在独特的诊断挑战。恶性NME可能难以与正常背景实质增强（BPE）区分，并且恶性和良性NME病变之间的DCE-MRI特征明显重叠。2 NME的活检通常显示良性增生性病变（例如纤维囊性变化），但高达三分之一是恶性的，原位导管癌和弥漫性浸润性癌（例如浸润性小叶癌）通常表现为NME。2，3目前，没有明确的标准来降低可疑的NME和活检组织的级别。弥散加权成像（DWI）已成为筛查和诊断乳腺癌的一种有用的辅助成像技术，许多研究显示恶性肿瘤表现出扩散受阻，表观扩散系数（ADC）值低于正常或良性乳腺组织。虽然DWI显示出提高MR特异性的前景，但其对NME病变诊断的实用性尚不清楚。5越来越多的证据表明，与肿块相比，NME的ADC测量在识别恶性肿瘤方面更具挑战性和不可靠性，5-7主要归因于NME的弥漫性或分布性生长模式以及DWI的空间分辨率限制，导致部分体积平均效应增加。
It is well established that contrast-enhanced MRI provides superior sensitivity for breast cancer detection over other imaging modalities but also results in many benign biopsies. To support wider utilization of MRI for breast screening, there is great interest in strategies to improve specificity and reduce false positives. In particular, non-mass enhancement (NME) type lesions, identified on dynamic contrast-enhanced (DCE) MRI as enhancing regions lacking features of a focus or a mass, present unique diagnostic challenges. Malignant NME can be difficult to distinguish from normal background parenchymal enhancement (BPE), and DCE-MRI features overlap significantly between malignant and benign NME lesions. 2 Biopsy of NME most often reveals benign proliferative pathologies (eg, fibrocystic changes), but up to one-third are malignant, with ductal carcinoma in situ and diffuse invasive cancers (eg, invasive lobular carcinoma) commonly manifesting as NME. 2, 3 Currently, there are no clear criteria to downgrade suspicious NMEs and obviate biopsy.Diffusion-weighted imaging (DWI) has emerged as a useful supplemental imaging technique for screening and diagnosis of breast cancer, with many studies showing malignancies exhibit hindered diffusion and lower apparent diffusion coefficient (ADC) values than normal or benign breast tissues. 4 While DWI has shown promise to improve MR specificity, its utility for diagnosis of NME lesions is less clear. 5 Mounting evidence suggests ADC measures of NMEs to be more challenging and unreliable for identifying malignancy compared to masses, 5–7 attributed primarily to the diffuse or distributed growth pattern of NME combined with spatial resolution limitations of DWI leading to increased partial volume averaging effects.