Accelerated Breast Diffusion-weighted Imaging Using Multiband Sensitivity Encoding with the CAIPIRINHA Method: Clinical Experience at 3 T

Abstract

Purpose To examine the clinical value of multiband (MB) sensitivity encoding (SENSE)-accelerated diffusion-weighted imaging (DWI) for breast imaging by performing quantitative and qualitative comparisons with conventional diffusion-weighted echo-planar imaging, or conventional DWI (cDWI). Materials and Methods In this prospective study (ClinicalTrials.gov identifier NCT03607552), women with breast cancer were recruited from July 2018 to July 2019 to undergo additional MB SENSE DWI during clinical 3-T breast MRI examinations. The cDWI and MB SENSE DWI acquisitions were assessed both quantitatively and qualitatively. Regions of interest were defined for tumorous and normal tissue, and the tumor apparent diffusion coefficient (ADC), contrast-to-noise ratio (CNR), and signal index (SI) were calculated for both DWI methods. Three readers independently reviewed the two acquisitions side by side and provided relative image quality scores. Tumor ADC, CNR, and SI measures were compared between cDWI and MB SENSE DWI acquisitions by using a paired t test, and reader preferences were evaluated by using the sign test. Results The study included 38 women (median age, 48 years; range, 28-83 years). Overall agreement was good between cDWI and MB SENSE DWI tumor ADC measures (intraclass correlation coefficient, 0.87 [95% CI: 0.75, 0.94]), and no differences were evident in the ADC (median, 0.93 × 10-3 mm2/sec vs 0.87 ×10-3 mm2/sec; P = .50), CNR (2.2 vs 2.3; P = .17), or SI (9.2 vs 9.2; P = .23) measurements. The image quality of cDWI and MB SENSE DWI acquisitions were considered equal for 51% of images (58 of 114), whereas MB SENSE DWI was preferred more often than cDWI (37% [42 of 114] vs 12% [14 of 114]; P < .001). The preference for MB SENSE DWI was most often attributed to better fat suppression. Conclusion MB SENSE can be used to accelerate breast DWI acquisition times without compromising the image quality or the fidelity of quantitative ADC measurements. Keywords: MR-Diffusion-weighted Imaging, Breast, Comparative Studies, Technology Assessment Clinical trial registration no. NCT03607552 © RSNA, 2022.

Keywords: Breast; Comparative Studies; MR-Diffusion-weighted Imaging; Technology Assessment.

Conflict of interest statement

Disclosures of conflicts of interest: D.B. Support for present work from National Institutes of Health (NIH) (payments through institution), Philips Healthcare (in-kind support through institution), and Safeway Foundation (payments through institution). D.S.H. Support for present work from NIH grants (R01 CA207290, P30 CA015704) to institution; institution has grants from GE Healthcare, Philips Healthcare, Canon Medical Systems USA, and Siemens Healthineers. Y.W. No relevant relationships. M.R.D. In-kind support for present work from Philips Healthcare (use of the sequence); currently employed by Philips Healthcare (employment began after work on the present manuscript had concluded). M.Z. Research grant from GE Healthcare. J.R.S. Grants from Radiological Society of North America Global Oncology-Fred Hutchinson Cancer Research center and GE Healthcare, unrelated to the current work; leadership or fiduciary role in RAD-AID and Breast Health Global Initiative. H.R. Current work supported by NIH grant (R01CA207290), author is co-investigator; institution has grant from GE Healthcare, author is co-investigator, funding not related to this study. S.C.P. Current work supported by NIH grant (R01CA207290), author is principal investigator; institution has grant from GE Healthcare, author is co-investigator, funding not related to this study.

Figures

Figure 1:

Images in a bilateral breast diffusion-weighted imaging (DWI) phantom. Shown are T1-weighted axial and coronal cross-section views (top) and representative images obtained at DWI (b = 0 and 800 sec/mm2) that depict the tumor mimic (arrow 1) and the normal tissue mimic (arrow 2) vials in the left breast used for quantitation of the ADC, contrast-to-noise ratio, and signal index. Corresponding regions of interest used for quantitation are shown for tumor tissue (dotted line) and normal tissue (solid line) mimics. ADC = apparent diffusion coefficient, MB = multiband, SENSE = sensitivity encoding.

Figure 2:

Images obtained at diffusion-weighted imaging (DWI) by using conventional (left) and MB SENSE–accelerated (right) acquisitions in a 36-year-old participant with a 43-mm grade 3 invasive ductal carcinoma (arrow, outline). Good image quality was observed (shown areb = 0 and b = 800 sec/mm2 images) on images obtained by using both sequences (with two of three readers rating them equal [0] and one preferring MB SENSE [+1]), and the resulting apparent diffusion coefficient (ADC) maps (bottom) were also very similar both qualitatively and quantitatively. The tumor mean ADC values (within the outlined regions of interest shown) were closely matched, with ADC = 0.82 and 0.86 × 10–3 mm2/sec for conventional DWI and MB SENSE DWI, respectively. MB = multiband, SENSE = sensitivity encoding.

Figure 3:

Agreement between lesion diffusion-weighted imaging (DWI) measures by using multiband (MB) sensitivity encoding (SENSE) and conventional DWI (cDWI) techniques. Shown are Bland-Altman plots for (A)apparent diffusion coefficient (ADC) measures, (B)contrast-to-noise ratio (CNR) measures, and (C) signal index (SI) values. Bland-Altman analysis demonstrates no apparent systematic bias in the ADC, CNR, or SI measurements between the techniques. The dashed line indicates the mean ratio (MB SENSE DWI vs cDWI), and the dotted lines indicate the 95% limits of agreement.

Figure 4:

Example of differences in fat suppression observed on images obtained at MB SENSE diffusion-weighted imaging (DWI) compared with those obtained at conventional DWI. On the conventional DWI acquisition (left), unsuppressed fat signal is apparent in both anterior breasts, particularly at b = 800 sec/mm2 (arrows), which was not observed on the MB SENSE DWI acquisition (right), on which tissue contrast is higher. Two readers preferred the image quality of the MB SENSE DWI acquisition, whereas one reader rated them equally. MB = multiband, SENSE = sensitivity encoding.

Figure 5:

Example of differences in signal quality observed on images obtained by using MB SENSE compared with images obtained by using conventional diffusion-weighted imaging (DWI). Posterior fibroglandular tissue regions can be better evaluated on conventional DWI acquisition (left) than on the MB SENSE DWI acquisition (right) because of the reduced signal of the MB SENSE image, most apparent on b = 800 sec/mm2 (arrows). Reduced signal is also evident in the chest wall and sternum (arrowhead) for the MB SENSE acquisition compared with the conventional DWI acquisition. One reader preferred conventional DWI, whereas the other two rated the techniques as being equal. MB = multiband, SENSE = sensitivity encoding.