A survey by the European Society of Breast Imaging on the implementation of breast diffusion-weighted imaging in clinical practice

Roberto Lo Gullo; Varadan Sevilimedu; Pascal Baltzer; Denis Le Bihan; Julia Camps-Herrero; Paola Clauser; Fiona J Gilbert; Mami Iima; Ritse M Mann; Savannah C Partridge; Andrew Patterson; Eric E Sigmund; Sunitha Thakur; Fabienne E Thibault; Laura Martincich; Katja Pinker; EUSOBI International Breast Diffusion-Weighted Imaging working group

doi:10.1007/s00330-022-08833-0

A survey by the European Society of Breast Imaging on the implementation of breast diffusion-weighted imaging in clinical practice

Eur Radiol. 2022 Oct;32(10):6588-6597. doi: 10.1007/s00330-022-08833-0. Epub 2022 May 4.

Authors

Roberto Lo Gullo¹, Varadan Sevilimedu², Pascal Baltzer³, Denis Le Bihan^{4

5

6}, Julia Camps-Herrero⁷, Paola Clauser³, Fiona J Gilbert⁸, Mami Iima^{9

10}, Ritse M Mann^{11

12}, Savannah C Partridge¹³, Andrew Patterson⁸, Eric E Sigmund¹⁴, Sunitha Thakur^{1

15}, Fabienne E Thibault¹⁶, Laura Martincich^#¹⁷, Katja Pinker^#^{18

19}; EUSOBI International Breast Diffusion-Weighted Imaging working group

Affiliations

¹ Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA.
² Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 485 Lexington Ave, NY, New York, 10017, USA.
³ Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Structural Preclinical Imaging, Medical University of Vienna/Vienna General Hospital, Wien, Austria.
⁴ NeuroSpin/Joliot, CEA-Saclay Center, Paris-Saclay University, Gif-sur-Yvette, France.
⁵ Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan.
⁶ National Institute for Physiological Sciences, Okazaki, Japan.
⁷ Ribera Salud Hospitals, Valencia, Spain.
⁸ Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK.
⁹ Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
¹⁰ Institute for Advancement of Clinical and Translational Science (iACT), Kyoto University Hospital, Kyoto, Japan.
¹¹ Department of Diagnostic Imaging, Radboud University Medical Centre, Nijmegen, Netherlands.
¹² Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands.
¹³ Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA.
¹⁴ Department of Radiology, NYU Langone Health, 6, 60 1st Avenue, New York, NY, 10016, USA.
¹⁵ Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA.
¹⁶ Department of Medical Imaging, Institut Curie, 26 Rue d'Ulm, F-75005, Paris, France.
¹⁷ Unit of Radiodiagnostics, Ospedale Cardinal G. Massaia -ASL AT, Via Conte Verde 125, 14100, Asti, Italy.
¹⁸ Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA. pinkerdk@mskcc.org.
¹⁹ Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Structural Preclinical Imaging, Medical University of Vienna/Vienna General Hospital, Wien, Austria. pinkerdk@mskcc.org.

^# Contributed equally.

Abstract

Objectives: To perform a survey among all European Society of Breast Imaging (EUSOBI) radiologist members to gather representative data regarding the clinical use of breast DWI.

Methods: An online questionnaire was developed by two board-certified radiologists, reviewed by the EUSOBI board and committees, and finally distributed among EUSOBI active and associated (not based in Europe) radiologist members. The questionnaire included 20 questions pertaining to technical preferences (acquisition time, magnet strength, breast coils, number of b values), clinical indications, imaging evaluation, and reporting. Data were analyzed using descriptive statistics, the Chi-square test of independence, and Fisher's exact test.

Results: Of 1411 EUSOBI radiologist members, 275/1411 (19.5%) responded. Most (222/275, 81%) reported using DWI as part of their routine protocol. Common indications for DWI include lesion characterization (using an ADC threshold of 1.2-1.3 × 10^-3 mm²/s) and prediction of response to chemotherapy. Members most commonly acquire two separate b values (114/217, 53%), with b value = 800 s/mm² being the preferred value for appraisal among those acquiring more than two b values (71/171, 42%). Most did not use synthetic b values (169/217, 78%). While most mention hindered diffusion in the MRI report (161/213, 76%), only 142/217 (57%) report ADC values.

Conclusion: The utilization of DWI in clinical practice among EUSOBI radiologists who responded to the survey is generally in line with international recommendations, with the main application being the differentiation of benign and malignant enhancing lesions, treatment response assessment, and prediction of response to chemotherapy. Report integration of qualitative and quantitative DWI data is not uniform.

Key points: • Clinical performance of breast DWI is in good agreement with the current recommendations of the EUSOBI International Breast DWI working group. • Breast DWI applications in clinical practice include the differentiation of benign and malignant enhancing, treatment response assessment, and prediction of response to chemotherapy. • Report integration of DWI results is not uniform.

Keywords: Breast neoplasms; Magnetic resonance imaging; Surveys and questionnaires.

MeSH terms

Breast / diagnostic imaging
Breast / pathology
Breast Neoplasms* / diagnostic imaging
Breast Neoplasms* / pathology
Diffusion Magnetic Resonance Imaging* / methods
Female
Humans
Magnetic Resonance Imaging / methods
Sensitivity and Specificity
Surveys and Questionnaires

Abstract

MeSH terms

Grants and funding