الفهرس 
Anatomy of the breastOnly 14 pages are availabe for public view
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Abstract
Background:
To compare the value of contrast enhanced mammography and diffusion weighted breast MRI in dense breasts screening and accurate detection of the breast cancer with correlation of the findings to the histopathological results.
The study included 32 female patients having suspicious breast lesions and underwent digital mammography then scheduled for CESM and MRI DW imaging technique. The imaging findings were correlated to the histopathological findings.
Results:
The study was conducted by 40 breast lesions in 32 female patients having dense breasts; they were classified by the digital mammography into ACR C (59.4%) and ACR D (40.6%). By CESM, there were twenty three lesions (57.5%) as mass lesions and thirteen lesions (32.5%) as non-mass lesions. Four lesions (10%) showed no contrast enhancement. According to the lesion characteristics in diffusion weighted imaging, the breast lesions were classified into thirty three lesions (82.5%) with restricted diffusion and seven lesions (17.5%) with non restricted diffusion. The study showed a cutoff ADC value to detect the malignant lesions in the dense breasts ≤1.1 x10-3 mm2/s at b value of 1000 s/mm2 with a sensitivity of 96.77%, specificity of 66.67%, PPV of 96.77%, NPV of 55.55% and an overall total accuracy of 92.5%.
On comparing the diagnostic accuracy of the CESM to that of the DW MRI, the sensitivity of DW MRI (96.77%) was higher than that of CESM (90.32%). The specificity of DW MRI (66.67%) was higher than that of CESM (33.33%). Total accuracy of DW MRI was higher than that of CESM, they were 90% and 77.5% respectively. Also PPV and NPV of DW MRI were 90.91% and 85.71% as compared to 82.35% and 50.00% in CESM, respectively. When comparing the sensitivity of CESM to DW MRI in the detection of multiple breast lesions, they were 88.8% and 100%, respectively.
Conclusion:
CESM is a useful technique in identification of hidden lesions in mammographically dense breasts. DW MRI is a fast, unenhanced modality that can be used as a breast cancer screening modality. CESM and DWI demonstrated good overall diagnostic accuracy in dense breast patients, however, DW MRI has a higher diagnostic accuracy than CESM for the detection of malignant breast lesions and their multiplicity.