Wang Hongjie¹, Wang Weiwei², Dou Weiqiang³, Lv Siqiang¹, Zhu Laimin², Chen Yueqin², and Sun Zhanguo^2
1Clinical Medical College of Jining Medical University, Jining, China, ²Department of Medical Imaging, Affiliated Hospital of Jining Medical University, Jining, China, ³MR Research China, GE Healthcare, Beijing, China

Accurate preoperative prediction of benign and malignant breast lesions is essential in clinical practice. Currently, the diagnostic specificity of DCE-MRI is relatively low for breast lesions with time-intensity-curve (TIC) type-II. Different diffusion-weighted models, including mono-exponential diffusion-weighted imaging (DWI), intravoxel-incoherent-motion diffusion-weighted imaging (IVIM) and diffusion kurtosis imaging (DKI), have been previously reported effective in the differential diagnosis of overall breast lesions. In this study, we found that, compared with DWI alone, combined DWI, IVIM and DKI can better differentiate malignant from benign breast TIC type-II lesions, with IVIM parameter of D and DKI parameter of MK as demonstrated independent influencing factors.

Jieying Chen¹, Xiaolian Su¹, Tingting Xu¹, Qifeng Luo², Jilei Zhang³, Lin Zhang¹, and Guangyu Tang^1
1Department of Radiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China, ²Department of General Surgery, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China, ³Philips Healthcare, Shanghai, China

Assessment of axillary lymph node metastasis burden before surgery in breast cancer patients is warranted for axillary management. This study developed a simple model based on the standard breast MRI features of breast tumor and axillary lymph node to differentiate patients with no, low or heavy axillary metastasis burden. With the help of this model, patients and clinicians would make more rational decision when to choose omitting surgery, sentinel lymph node biopsy or axillary lymph node dissection for axilla management.

Xiaofeng Chen¹, Jiada Yang¹, Nina Fan¹, Zhiqi Yang¹, Ruibin Huang², Yue Li¹, Cuixia Wan¹, Junhao Gong¹, Yuting Liao³, Guijin Li⁴, Mengzhu Wang⁵, Fengyan Cheng¹, Xiangguang Chen¹, Zhuozhi Dai⁶, and Weixiong Fan^1
1Meizhou People's Hospital, Meizhou, China, ²First Affiliated Hospital of Shantou University Medical College, Shantou, China, ³GE Healthcare, Guangzhou, China, ⁴Siemens Healthineers, Shanghai, China, ⁵Siemens Healthineers, Guangzhou, China, ⁶Shantou Central Hospital, Shantou, China

This study developed and validated a point-based scoring system (PSS) for stratifying the axillary lymph node (ALN) metastasis risk of breast cancer (BC) based on preoperative clinicopathological and MRI features compared with MRI-reported ALN status model and to explore its prognostic significance. The PSS in our study provides an easy tool for surgeons to assess breast cancer patients' risk for ALN metastasis prior to surgery. And the results showed that PSS had a relatively better performance than MRI-reported ALN status model (P=0.045),with a higher AUC, accuracy, and specificity, suggesting that PSS can be routinely used in axillary nodal staging.

Zhiqi Yang¹, Tianfu Lai², Xiaofeng Chen¹, Ruibin Huang³, Weichao Yang¹, Yuting Liao⁴, Mengzhu Wang⁵, Guijin Li⁶, Zhuozhi Dai⁷, and Xiangguang Chen^1
1Meizhou People’s Hospital, Meizhou, China, ²Department of Radiology, Meizhou People’s Hospital, Meizhou, China, ³First Affiliated Hospital of Shantou University Medical College, Shantou, China, ⁴GE Healthcare, Guangzhou, China, ⁵Siemens Healthineers, Guangzhou, China, ⁶Siemens Healthineers, Shanghai, China, ⁷Shantou Central Hospital, Shantou, China

The optimal biomarkers for the diagnosis of breast lymphovascular invasion have not yet been found. DCE-MRI features can evaluate the tumor microenvironment which is related to LVI. This study explored the independent predictor of LVI, as well as developed and validated the parametric combined prediction model for the diagnosis of lymphovascular invasion in breast cancer using quantitative analysis of DCE-MRI. The prediction model based on K_ep and N stage could improve the performance of LVI prediction, compared to clinicopathological or magnetic resonance parameters.

Yuan Jiang¹, Ke Xue², Yongming Dai², Dongmei Wu³, Junzhe Yang¹, Naishan Qin¹, and Jianxing Qiu^1
1Peking university first hospital, Beijing, China, ²Central Research Institute, United Imaging Healthcare, Shanghai, China, ³Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronics Science, East China Normal University, Shanghai, China

The high b-value DWI with a CTRW Model is useful in classification of benign and malignant proliferative breast lesions. The identification model using the combinations of CTRW parameters, D_m and β, has a moderate efficiency.
 

Han Zhou¹, Wan Tang^1,2, Tianhong Quan³, Xiaoyan Chen¹, Huanian Zhang¹, Zijie Fu¹, Renhua Wu¹, and Yan Lin^1
1Radiology Department, Second Affiliated Hospital of Shantou University Medical College, Shantou, China, ²Institute of Health Monitoring,Inspection and Protection,Hubei Provincial Center for Disease Control and Prevention,Hubei Provincial Key Laboratory for Applied Toxicology, Wuhan, China, ³Shantou University，College Of Engineering, Shantou, China

This study demonstrated that MK derived from DKI was performed better than MD, ADC, V_e, K_ep and K_trans for differentiating between benign and malignant BLs. Also, MK has great potentialities in predict histological grades, lymph node status and Ki-67 expression of BCs. Finally, a XGboost model was constructed by combining MD, MK, age, shape and menstrual status, which exhibited superior diagnostic performance for BC characterization and an improved assessment of BLs. The findings of current study will aid the development of a novel noninvasive approach for BC screening and clinical diagnosis, therefore reducing unnecessary biopsies and patient`s anxiety.

Lingsong Meng¹, Xin Zhao¹, Jinxia Guo², Lin Lu¹, Qingna Xing¹, Yafei Guo¹, Honglei Shang¹, Penghua Zhang¹, Yongbing Sun¹, and Xiaoan Zhang^1
1The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China, ²MR Research, GE Healthcare, Beijing, China

Early detection and accurate characterization can reduce significantly the death rates of breast cancer patients. Kaiser score (KS) demonstrates robust and wonderful performance in the assessment of breast lesions. Nevertheless, this scoring system lacks quantitative parameters, which may lead to false negatives, especially for breast cancers exhibiting atypical morphological features. In this study, the quantitative value from Synthetic MRI was added to the KS assessment to improve the differentiation of the malignant and benign breast lesions.

Jie Ding¹, Zhen Zhang¹, Yishi Wang², Xiuzheng Yue², Rongrong Zhu¹, and Ruoshui Ha^1
1Medical Imaging Center, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China, ²Philips Healthcare, Beijing, China

The investigation of time dependent diffusion imaging techniques such as IMPULSED is emerging for clinical research since recently made available on 3T scanners. IMPULSED requires the acquisition of diffusion images at different diffusion times and diffusion weightings. In this study, we proposed to use Multiband to accelerate the data acquisition for IMPULSED and compared the ADC spectrum for two protocols. Our results showed the consistency in ADC calculation for the Multiband accelerated protocol with the result without using Multiband.

Youfan Zhao¹, Zhongwei Chen¹, Jiejie Zhou¹, Haiwei Miao¹, Shuxin Ye¹, Huiru Liu¹, Meihao Wang¹, and Min-Ying Su^2
1Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China, ²Department of Radiological Sciences, University of California, Irvine, CA, United States

318 patients (331 breast lesions) with DCE-MRI and clinical features were analyzed to establish a nomogram for diagnosis of breast cancer. The dataset was split to 233 (145 malignant 88 benign) for training, and 98 (61 malignant 37 benign) for testing. Radiomics features were extracted from DCE-MRI and selected to calculate the radiomics score. The clinical features were analyzed by univariate and multivariate analyses. Then a nomogram was established based on clinical features and rad-score. When applying cut-off values with ≥95% sensitivity, the nomogram can reduce 59.5% to 65.9% unnecessary biopsies, which was higher than that of BI-RADS.

Mu Du¹, Da Zou², Yanzhen Hou¹, Liyun Zheng², Dongmei Wu³, Yongming Dai², and Yubao Liu^1
1Medical Imaging Center, Shenzhen Hospital, Southern Medical University, Shenzhen, China, ²United Imaging Healthcare, Shanghai, China, ³Shanghai Key Laboratory of Magnetic Resonance, Department of Physics, East China Normal University, Shanghai, China

Magnetic resonance imaging (MRI) is an important diagnostic method for the breast cancer. However, for conventional MRI techniques such as diffusion-weighted imaging (DWI), it ignores the non-Gaussian behaviors of the water diffusion caused by the restriction of tissue microstructure, thus the conventional method is insensitive to microstructural and heterogeneity changes in breast tumor. This study explores the feasibility of applying a continuous-time random-walk (CTRW) non-Gaussian diffusion model to the differentiation and assessment of malignant and benign breast tumors. The correlations between CTRW parameters and breast tumor immunohistochemical features such as oestrogen receptor (ER), progesterone receptor (PR) and Ki67 expression status are studied. The CTRW model has potential in future applications of breast tumor malignancy and therapeutic efficacy evaluation.

Ting Liang¹, Xianjun Li¹, and Jian Yang^1
1Department of Radiology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China

Preoperative accurate differential diagnosis of benign and malignant breast tumors is very important to avoid unnecessary surgical treatment. This study aims to evaluate the potential efficacy of the virtual elastography (vMRE) method in the differential diagnosis of IDC and FA, and help guide clinical management. Our results suggested that mean virtual stiffness obtained by this vMRE method can accurately distinguish the hardness difference between FA and IDC.

Xiang Zhang¹, Wei Jiang¹, Mengzhu Wang², Zehong Yang¹, Xu Yan², Guang Yang³, Chunping Mao¹, and Jun Shen^1
1Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China, ²MR Scientific Marketing, Siemens Healthineers, Guangzhou, China, ³Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East China Normal University, Shanghai, China

Mean apparent propagator (MAP)-MRI establishes a robust analytical framework based on the random motion distribution of natural water molecules. This study investigated the application of quantitative parameters derived from MAP-MRI in patients with breast cancer and determined whether MAP-MRI can be adopted as a better method than apparent diffusion coefficient (ADC) from conventional DWI to preoperative diagnosis tumor-stromal ratio. The results suggested that quantitative assessment with MAP-MRI showed superior predictive performance than conventional DWI for preoperative diagnosis of tumor-stromal ratio in patients with breast cancer.

jinrui liu¹, mengyin xu¹, zhihao li², jialiang ren³, and zhaohui an^1
1General Hospital of Ningxia Medical University, Yinchuan, China, ²GE Healthcare China, Xi’an, China, ³GE Healthcare China, Beijing, China

In this study, an evaluation was proposed based on the clinical value of synthetic MRI parameters in distinguishing benign and malignant breast lesions. From conclusion, the T2-pre values and PD-pre values were statistically significant different between benign and malignant lesion. The combined T2-pre, PD-pre with BI-RADS outperformed BI-RADS only in discriminating malignant and benign lesions, which has potential clinical value for improving diagnostic accuracy of breast lesions.

Zhou Liu¹, Jie Wen¹, Meng Wang¹, Ya Ren¹, Qian Yang¹, Long Qian², Honghong Luo¹, Cuiju He¹, Yin Wu³, and Dehong Luo^1
1National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China, ²MR Research, GE Healthcare, Beijing, China, ³Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China

To date, great efforts have been made to investigate the performance of APT imaging in breast cancer diagnosis and prognosis, but with discrepant findings. Hence, this study aims to investigate the diagnostic performance and association of APT imaging with clinical-pathologic characteristics of breast cancer in a relatively large cohort of patients at 3T. Results showed significantly higher APTw signals in malignant lesions than that in benign ones, and high histologic grade, T stage and proliferation Ki-67 index in breast cancer patients. The results confirm the usefulness of APT imaging in the differentiation of lesion malignancy and the prediction of prognosis.

Qi Wu¹, lina zhang², qingwei song², ailian liu², liangjie lin³, xiaoxiao zhang³, and xiaofang xu^3
1The First Affiliated Hospital of Dalian Medical University, daLian, China, ²The First Affiliated Hospital of Dalian Medical University, dalian, China, ³philips Healthcare, Beijing, China

Sclerosing adenosis (SA) of the breast is the late development stage of breast adenosis which is difficult to diagnose. Because its imaging manifestations are similar to malignant lesions of the breast, which often needs pathological diagnosis. Intravoxel incoherent motion(IVIM ) imaging is an MR method to separate diffusion and perfusion effects by fitting a double exponential model of signal attenuation and can accurately display the diffusion movement of water molecules. This study confirmed that some parameters of IVIM can be used in the identification of early breast adenosis and SA. Therefore, IVIM is of great value in the diagnosis of breast adenosis.