Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Background Breast Parenchymal Signal During Menstrual Cycle on Diffusion-Weighted MRI: A Prospective Study in Healthy Premenopausal Women

  • Yeon Soo Kim (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Bo La Yun (Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • A Jung Chu (Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine) ;
  • Su Hyun Lee (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Hee Jung Shin (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Sun Mi Kim (Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Mijung Jang (Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Sung Ui Shin (Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Woo Kyung Moon (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine)
  • Received : 2024.03.31
  • Accepted : 2024.04.05
  • Published : 2024.06.01
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Abstract

Objective: To prospectively investigate the influence of the menstrual cycle on the background parenchymal signal (BPS) and apparent diffusion coefficient (ADC) of the breast on diffusion-weighted MRI (DW-MRI) in healthy premenopausal women. Materials and Methods: Seven healthy premenopausal women (median age, 37 years; range, 33-49 years) with regular menstrual cycles participated in this study. DW-MRI was performed during each of the four phases of the menstrual cycle (four examinations in total). Three radiologists independently assessed the BPS visual grade on images with b-values of 800 sec/mm2 (b800), 1200 sec/mm2 (b1200), and a synthetic 1500 sec/mm2 (sb1500). Additionally, one radiologist conducted a quantitative analysis to measure the BPS volume (%) and ADC values of the BPS (ADCBPS) and fibroglandular tissue (ADCFGT). Changes in the visual grade, BPS volume (%), ADCBPS, and ADCFGT during the menstrual cycle were descriptively analyzed. Results: The visual grade of BPS in seven women varied from mild to marked on b800 and from minimal to moderate on b1200 and sb1500. As the b-value increased, the visual grade of BPS decreased. On b800 and sb1500, two of the seven volunteers showed the highest visual grade in the early follicular phase (EFP). On b1200, three of the seven volunteers showed the highest visual grades in EFP. The BPS volume (%) on b800 and b1200 showed the highest value in three of the six volunteers with dense breasts in EFP. Three of the seven volunteers showed the lowest ADCBPS in the EFP. Four of the seven volunteers showed the highest ADCBPS in the early luteal phase (ELP) and the lowest ADCFGT in the late follicular phase (LFP). Conclusion: Most volunteers did not exhibit specific BPS patterns during their menstrual cycles. However, the highest BPS and lowest ADCBPS were more frequently observed in EFP than in the other menstrual cycle phases, whereas the highest ADCBPS was more common in ELP. The lowest ADCFGT was more frequent in LFP.

Keywords

Acknowledgement

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. NRF-2019R1F1A1062646) and Research Program 2021 funded by Seoul National University College of Medicine Research Foundation.

References

  1. Lee SH, Shin HJ, Moon WK. Diffusion-weighted magnetic resonance imaging of the breast: standardization of image acquisition and interpretation. Korean J Radiol 2021;22:9-22 https://doi.org/10.3348/kjr.2020.0093
  2. Amornsiripanitch N, Bickelhaupt S, Shin HJ, Dang M, Rahbar H, Pinker K, et al. Diffusion-weighted MRI for unenhanced breast cancer screening. Radiology 2019;293:504-520 https://doi.org/10.1148/radiol.2019182789
  3. Okazawa A, Iima M, Kataoka M, Okumura R, Takahara S, Noda T, et al. Diagnostic utility of an adjusted DWI lexicon using multiple b-values to evaluate breast lesions in combination with BI-RADS. Magn Reson Med Sci 2023 May 26 [Epub]. https://doi.org/10.2463/mrms.mp.2022-0056
  4. Shin HJ, Lee SH, Park VY, Yoon JH, Kang BJ, Yun B, et al. Diffusion-weighted magnetic resonance imaging for breast cancer screening in high-risk women: design and imaging protocol of a prospective multicenter study in Korea. J Breast Cancer 2021;24:218-228 https://doi.org/10.4048/jbc.2021.24.e19
  5. Shin HJ, Moon WK, Amornsiripanitch N, Partridge SC. Diffusion MRI as a stand-alone unenhanced approach for breast imaging and screening. In: Iima M, Partridge S, Bihan DL, eds. Diffusion MRI of the breast. Philadelphia: Elsevier, 2023:86-107
  6. Kim JJ, Kim JY. Fusion of high b-value diffusion-weighted and unenhanced T1-weighted images to diagnose invasive breast cancer: factors associated with false-negative results. Eur Radiol 2021;31:4860-4871
  7. Hahn SY, Ko ES, Han BK, Lim Y, Gu S, Ko EY. Analysis of factors influencing the degree of detectability on diffusion-weighted MRI and diffusion background signals in patients with invasive breast cancer. Medicine (Baltimore) 2016;95:e4086
  8. O'Flynn EA, Morgan VA, Giles SL, deSouza NM. Diffusion weighted imaging of the normal breast: reproducibility of apparent diffusion coefficient measurements and variation with menstrual cycle and menopausal status. Eur Radiol 2012;22:1512-1518 https://doi.org/10.1007/s00330-012-2399-0
  9. Partridge SC, McKinnon GC, Henry RG, Hylton NM. Menstrual cycle variation of apparent diffusion coefficients measured in the normal breast using MRI. J Magn Reson Imaging 2001;14:433-438 https://doi.org/10.1002/jmri.1204
  10. Kim JY, Suh HB, Kang HJ, Shin JK, Choo KS, Nam KJ, et al. Apparent diffusion coefficient of breast cancer and normal fibroglandular tissue in diffusion-weighted imaging: the effects of menstrual cycle and menopausal status. Breast Cancer Res Treat 2016;157:31-40 https://doi.org/10.1007/s10549-016-3793-0
  11. Morris E, Comstock C, Lee C, Lehman C, Ikeda D, Newstead G. ACR BI-RADS® magnetic resonance imaging. ACR BI-RADS® atlas, breast imaging reporting and data system. Reston: American College of Radiology, 2013
  12. Shin S, Ko ES, Kim RB, Han BK, Nam SJ, Shin JH, et al. Effect of menstrual cycle and menopausal status on apparent diffusion coefficient values and detectability of invasive ductal carcinoma on diffusion-weighted MRI. Breast Cancer Res Treat 2015;149:751-759 https://doi.org/10.1007/s10549-015-3278-6
  13. Benomar A, Zarour E, Letourneau-Guillon L, Raymond J. Measuring interrater reliability. Radiology 2023;309:e230492
  14. Reed BG, Carr BR. The normal menstrual cycle and the control of ovulation. In: Feingold KR, Anawalt B, Blackman MR, Boyce A, Chrousos G, Corpas E, et al., eds. Endotxt. South Dartmouth: MDText.com, Inc., 2000
  15. Vollman RF. The menstrual cycle. Major Probl Obstet Gynecol 1977;7:1-193
  16. Amarosa AR, McKellop J, Klautau Leite AP, Moccaldi M, Clendenen TV, Babb JS, et al. Evaluation of the kinetic properties of background parenchymal enhancement throughout the phases of the menstrual cycle. Radiology 2013;268:356-365 https://doi.org/10.1148/radiol.13121101
  17. Bauer E, Levy MS, Domachevsky L, Anaby D, Nissan N. Background parenchymal enhancement and uptake as breast cancer imaging biomarkers: a state-of-the-art review. Clin Imaging 2022;83:41-50 https://doi.org/10.1016/j.clinimag.2021.11.021
  18. Dontchos BN, Rahbar H, Partridge SC, Lehman CD, DeMartini WB. Influence of menstrual cycle timing on screening breast MRI background parenchymal enhancement and diagnostic performance in premenopausal women. J Breast Imaging 2019;1:205-211 https://doi.org/10.1093/jbi/wbz022
  19. Kang SS, Ko EY, Han BK, Shin JH, Hahn SY, Ko ES. Background parenchymal enhancement on breast MRI: influence of menstrual cycle and breast composition. J Magn Reson Imaging 2014;39:526-534 https://doi.org/10.1002/jmri.24185
  20. Kuhl CK, Bieling HB, Gieseke J, Kreft BP, Sommer T, Lutterbey G, et al. Healthy premenopausal breast parenchyma in dynamic contrast-enhanced MR imaging of the breast: normal contrast medium enhancement and cyclical-phase dependency. Radiology 1997;203:137-144 https://doi.org/10.1148/radiology.203.1.9122382
  21. Al Rashidi N, Waiter G, Redpath T, Gilbert FJ. Assessment of the apparent diffusion coefficient (ADC) of normal breast tissue during the menstrual cycle at 3T using image segmentation. Eur J Radiol 2012;81(Suppl 1):S1-S3 https://doi.org/10.1016/S0720-048X(12)70001-3
  22. Clendenen TV, Kim S, Moy L, Wan L, Rusinek H, Stanczyk FZ, et al. Magnetic resonance imaging (MRI) of hormone-induced breast changes in young premenopausal women. Magn Reson Imaging 2013;31:1-9 https://doi.org/10.1016/j.mri.2012.06.022
  23. Hoda SA. Anatomy and physiologic morphology. In: Hoda SA, Rosen PP, Brogi E, Koerner FC. eds. Rosen's breast pathology. Philadelphia, Lippincott Wiliams, 2020
  24. Norddin N, Power C, Watson G, Cowin G, Kurniawan ND, Gluch L, et al. Microscopic diffusion properties of fixed breast tissue: preliminary findings. Magn Reson Med 2015;74:1733-1739 https://doi.org/10.1002/mrm.25555
  25. Bickel H, Polanec SH, Wengert G, Pinker K, Bogner W, Helbich TH, et al. Diffusion-weighted MRI of breast cancer: improved lesion visibility and image quality using synthetic b-values. J Magn Reson Imaging 2019;50:1754-1761 https://doi.org/10.1002/jmri.26809
  26. Choi BH, Baek HJ, Ha JY, Ryu KH, Moon JI, Park SE, et al. Feasibility study of synthetic diffusion-weighted MRI in patients with breast cancer in comparison with conventional diffusion-weighted MRI. Korean J Radiol 2020;21:1036-1044 https://doi.org/10.3348/kjr.2019.0568
  27. Daimiel Naranjo I, Lo Gullo R, Saccarelli C, Thakur SB, Bitencourt A, Morris EA, et al. Diagnostic value of diffusion-weighted imaging with synthetic b-values in breast tumors: comparison with dynamic contrast-enhanced and multiparametric MRI. Eur Radiol 2021;31:356-367 https://doi.org/10.1007/s00330-020-07094-z
  28. Mihm M, Gangooly S, Muttukrishna S. The normal menstrual cycle in women. Anim Reprod Sci 2011;124:229-236 https://doi.org/10.1016/j.anireprosci.2010.08.030