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Effect of b value and pre-admission of contrast on diagnostic accuracy of 1.5-T breast DWI: a systematic review and meta-analysis

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Abstract

Objectives

To evaluate the effect of the choice of b values and prior use of contrast medium on apparent diffusion coefficients (ADCs) of breast lesions derived from diffusion-weighted imaging (DWI), and on the discrimination between benign and malignant lesions.

Methods

A literature search of relevant DWI studies was performed. The accuracy of DWI to characterize lesions by using b value ≤600 s/mm2 and b value >600 s/mm2 was presented as pooled sensitivity and specificity, and the ADC was calculated for both groups. Lesions were pooled as pre- or post-contrast DWI.

Results

Of 198 articles, 26 met the inclusion criteria. Median ADCs were significantly higher (13.2–35.1 %, p < 0.001) for the group of b values ≤600 s/mm2 compared to >600 s/mm2. The sensitivity in both groups was similar (91 % and 89 %, p = 0.495) as well as the specificity (75 % and 84 %, p = 0.237). Contrast medium had no significant effects on the ADCs (p ≥ 0.08). The differentiation between benign and malignant lesions was optimal (58.4 %) for the combination of b = 0 and 1,000 s/mm2.

Conclusions

The wide variety of b value combinations applied in different studies significantly affects the ADC of breast lesions and confounds quantitative DWI. If only a couple of b values are used, those of b = 0 and 1,000 s/mm2 are recommended for the best improvement of differentiating between benign and malignant lesions.

Key Points

• The choice of b values significantly affects the ADC of breast lesions.

• Sensitivity and specificity are not affected by the choice of b values.

• b values 0 and 1,000 s/mm 2 are recommended for optimal differentiation between benign and malignant lesions.

• Contrast medium prior to DWI does not significantly affect the ADC.

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Acknowledgements

The scientific guarantor of this publication is Prof. M. Oudkerk. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. No complex statistical methods were necessary for this paper. Institutional review board approval was not required because this study was a meta-analysis. Written informed consent was not required for this study because this study was a meta-analysis. No study subjects or cohorts have been previously reported. Methodology: meta-analysis.

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Authors and Affiliations

  1. University Medical Center Groningen, Center for Medical Imaging – North East Netherlands, University of Groningen, Groningen, The Netherlands

    Monique D. Dorrius, Hildebrand Dijkstra & Matthijs Oudkerk

  2. Department of Radiology, EB44, University of Groningen / University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands

    Monique D. Dorrius, Hildebrand Dijkstra & Paul E. Sijens

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  1. Monique D. Dorrius
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  2. Hildebrand Dijkstra
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Correspondence to Monique D. Dorrius.

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Monique D. Dorrius and Hildebrand Dijkstra contributed equally

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Dorrius, M.D., Dijkstra, H., Oudkerk, M. et al. Effect of b value and pre-admission of contrast on diagnostic accuracy of 1.5-T breast DWI: a systematic review and meta-analysis . Eur Radiol 24, 2835–2847 (2014). https://doi.org/10.1007/s00330-014-3338-z

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  • DOI: https://doi.org/10.1007/s00330-014-3338-z

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