Fat fractions from high-resolution 3D radial Dixon MRI for predicting metastatic axillary lymph nodes in breast cancer patients. (2020)

• Record Type: Journal Article
• Authors: Buus, Thomas Winther; Sivesgaard, Kim; Fris, Tanja Linde; Christiansen, Peer Michael; Jensen, Anders Bonde; Pedersen, Erik Morre
• Is Part Of: European journal of radiology open. Volume 7(2020)
• Publication Date: 2020
• Subjects: ADC apparent diffusion coefficient -- ALND axillary lymph node dissection -- AUC area under the ROC curve -- DWI diffusion-weighted imaging -- F fat -- FF fat fraction -- IDC invasive ductal carcinoma -- ILC invasive lobular carcinoma -- IP in-phase -- LN lymph node -- NPV negative predictive value -- OP opposed-phase -- PPV positive predictive value -- ROC receiver operating characteristics -- ROI region of interest -- SLNB sentinel lymph node biopsy -- SPAIR spectral attenuated inversion recovery -- STIR short tau inversion recovery -- TE echo time -- TR repetition time -- US ultrasonography -- W water; Breast neoplasms -- Axilla -- Lymphatic metastasis -- Magnetic resonance imaging; Medical radiology -- Periodicals; 616.075705
• DOI: 10.1016/j.ejro.2020.100284
• Languages: English
• ISSNs: 2352-0477

Abstract

Highlights: High-Resolution 3D radial Dixon MRI allows for the creation of quantitative fat fraction images. Lymph node fat fractions improves diagnostic performance of MRI to detect axillary lymph node metastases. Lymph node fat fractions are a promising quantitative indicator of metastases in axillary lymph nodes. Abstract: Purpose: To assess diagnostic performance of fat fractions (FF) from high-resolution 3D radial Dixon MRI for differentiating metastatic and non-metastatic axillary lymph nodes in breast cancer patients. Method: High-resolution 3D radial Dixon MRI was prospectively performed on 1.5 T in 70 biopsy-verified breast cancer patients. 35 patients were available for analysis with histopathologic and imaging data. FF images were calculated as fat / in-phase. Two radiologists measured lymph node FF and assessed morphological features in one ipsilateral and one contralateral lymph node in consensus. Diagnostic performance of lymph node FF and morphological criteria were compared using histopathology as reference. Results: 22 patients had metastatic axillary lymph nodes. Mean lymph node FF were 0.20 ± 0.073, 0.31 ± 0.079, and 0.34 ± 0.15 (metastatic, non-metastatic ipsi- and non-metastatic contralateral lymph nodes, respectively). Metastatic lymph node FF were significantly lower than non-metastatic ipsi- ( p < 0.001) and contralateral lymph nodes ( p < 0.001). Area under the receiver operating characteristics curve for lymph node FF was 0.80 compared to 0.76 for morphological criteria ( p = 0.29). Lymph node FF yielded sensitivity 0.91, specificity 0.69, positive predictive value (PPV) 0.83, and negative predictive value (NPV) 0.82, while morphological criteria yielded sensitivity 0.91, specificity 0.62, PPV 0.80, and NPV 0.80 ( p = 0.71). Combining lymph node FF and morphological criteria increased diagnostic performance with sensitivity 1.00, specificity 0.67, PPV 0.86, NPV 1.00, and AUC 0.83. Conclusions: Lymph node FF from high-resolution 3D Dixon images are a promising quantitative indicator of metastases in axillary lymph nodes.