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. 2014 Nov;24(11):2835-47. doi: 10.1007/s00330-014-3338-z. Epub 2014 Aug 9.

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/mm(2) and b value >600 s/mm(2) 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/mm(2) compared to >600 s/mm(2). 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/mm(2).

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/mm(2) 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.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Breast / pathology*
  • Breast Neoplasms / diagnosis*
  • Contrast Media*
  • Diffusion Magnetic Resonance Imaging / methods*
  • Female
  • Humans
  • Image Enhancement
  • Patient Admission*
  • Predictive Value of Tests
  • Reproducibility of Results

Substances

  • Contrast Media