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Diffusion weighted imaging of the normal breast: reproducibility of apparent diffusion coefficient measurements and variation with menstrual cycle and menopausal status

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Abstract

Objectives

To establish the reproducibility of apparent diffusion coefficient (ADC) measurements in normal fibroglandular breast tissue and to assess variation in ADC values with phase of the menstrual cycle and menopausal status.

Methods

Thirty-one volunteers (13 premenopausal, 18 postmenopausal) underwent magnetic resonance twice (interval 11–22 days) using diffusion-weighted MRI. ADCtotal and a perfusion-insensitive ADChigh (omitting b = 0) were calculated. Reproducibility and inter-observer variability of mean ADC values were assessed. The difference in mean ADC values between the two phases of the menstrual cycle and the postmenopausal breast were evaluated.

Results

ADCtotal and ADChigh showed good reproducibility (r% = 17.6, 22.4). ADChigh showed very good inter-observer agreement (kappa = 0.83). The intraclass correlation coefficients (ICC) were 0.93 and 0.91. Mean ADC values were significantly lower in the postmenopausal breast (ADCtotal 1.46 ± 0.3 × 10-3 mm2/s, ADChigh 1.33 ± 0.3 × 10-3 mm2/s) compared with the premenopausal breast (ADCtotal 1.84 ± 0.26 × 10-3 mm2/s, ADChigh 1.77 ± 0.26 × 10-3 mm2/s; both P < 0.001). No significant difference was seen in ADC values in relation to menstrual cycle (ADCtotal P = 0.2, ADChigh P = 0.24) or between postmenopausal women taking or not taking oestrogen supplements (ADCtotal P = 0.6, ADChigh P = 0.46).

Conclusions

ADC values in fibroglandular breast tissue are reproducible. Lower ADC values within the postmenopausal breast may reduce diffusion-weighted contrast and have implications for accurately detecting tumours.

Key Points

• ADC values from fibroglandular breast tissue are measured reproducibly by multiple observers.

• Mean ADC values were significantly lower in postmenopausal than premenopausal breast tissue.

• Mean ADC values did not vary significantly with menstrual cycle.

• Low postmenopausal ADC values may hinder tumour detection on DW-MRI.

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Acknowledgements

We would like to acknowledge the generous help of all of the volunteers for offering their time. We would also like to acknowledge Catherine Simpkin for her help with data acquisition and Maria Schmidt and Marco Borri for their support in setting up the imaging protocol. We would like to acknowledge the advice of David Collins during preparation of the manuscript and Rosy Grant for her secretarial assistance.

We acknowledge the support received from the CRUK and EPSRC Cancer Imaging Centre in association with the MRC and Department of Health (England) grant C1060/A10334, and NHS funding to the NIHR Biomedical Research Centre.

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Authors and Affiliations

  1. Clinical Magnetic Resonance Group, Cancer Research UK and ESPSRC Cancer Imaging Centre, Downs Road, Sutton, Surrey, UK, SM2 5PT

    Elizabeth A. M. O’Flynn, Veronica A. Morgan & Sharon L. Giles

  2. Clinical Magnetic Resonance Group, Institute of Cancer Research, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, UK, SM2 5PT

    Nandita M. deSouza

Authors
  1. Elizabeth A. M. O’Flynn
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  2. Veronica A. Morgan
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  3. Sharon L. Giles
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  4. Nandita M. deSouza
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Correspondence to Elizabeth A. M. O’Flynn.

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O’Flynn, E.A.M., Morgan, V.A., Giles, S.L. et al. Diffusion weighted imaging of the normal breast: reproducibility of apparent diffusion coefficient measurements and variation with menstrual cycle and menopausal status. Eur Radiol 22, 1512–1518 (2012). https://doi.org/10.1007/s00330-012-2399-0

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  • DOI: https://doi.org/10.1007/s00330-012-2399-0

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