Eur Radiol: What are the advantages and disadvantages of APT and DKI in diagnosing breast cancer?

Breast cancer is the most common malignant tumor in women.
Magnetic Resonance Imaging (MRI) as a soft tissue high-resolution non-invasory examination method, widely used in breast cancer diagnosis, treatment and prognosis assessment.
, however, all commonly used breast scan sequences have certain limitations.
, for example, although the sweep sequence can reflect macro characteristics such as the size and morphology of the lesions, it is not available to effectively assess microscopic information at the cellular level.
diffusion kurtosis imaging (DKI) is a diffusion imaging technique proposed by Jenson et al. that reflects the microstructital complexity of the tissue.
APTWI is a molecular imaging technique that measures free protein and peptide levels in tissues without the use of exogenous imaging agents.
compared to DKI, APTWI's ability to reflect lesions does not depend on detecting the diffusion of water molecules within the tissue, but rather on detecting the chemical exchange rate between alamide protons and water quality protons.
breast cancer is a highly heterogeneic malignancies whose diagnosis, treatment and prognosis are influenced by a variety of factors, including differences in pathological types and classifications, expression of different biodegradation factors (e.g. estrogen ligands (ER), tumor diameter, etc.
the relationship between relevant DKI and APTWI parameters and the above-mentioned prognosm factors has been studied, but no consistent conclusions have been reached.
Recently, a study published in the Journal of European Radiology compared the effects of DKI and APTWI in identifying breast health and malignant lesions, and analyzed the correlation between derivative parameters and breast cancer prognosis factors, providing new ideas for breast cancer diagnosis, treatment and prognosis.
135 female patients under APTWI and DKI scans.
The magnetization transfer ratio asymmetry (MTRasym (3.5 ppm), the superficial peak coefficient (Kapp), and non-Gaussian diffusion coefficient (Dapp) are calculated based on histological subtypes, grading, and factors affecting prognosis (Ki-67, estrogen-like (ER), progesterone-like (PR), human skin growth factor-2 (HER-2), lymph node transfer, and maximum lesion diameter.
the differences, efficacy and correlation between the parameters.
the malignant group Kapp value was higher than the benign group, and the Dapp and MTRasym (3.5 ppm) values were lower than the benign group (p.lt; 0.001; AUC (Kapp) = 0.913, AUC (Dapp) = 0.910, AUC (MTRasym (3.5 ppm)) = 0.796)。
the AUC differences between Kapp and MTRasym (3.5 ppm) and Dapp and MTRasym (3.5 ppm) are statistically significant (p s 0.023, 0.046).
Kapp is moderately associated with pathological grading (|r| s 0.724) and mildly related to Ki-67, HER-2 expression (|r| s 0.454, 0.333).
Dapp is moderately associated with pathological grading (|r| s 0.648) and mildly related to Ki-67 expression (|r| s 0.400).
MTRasym (3.5 ppm) is only slightly related to pathological grading (|r| 0.468).
a-f: female, 45 years old, right breast immersion catheter cancer (arrow, level 2, ER-positive, 70% ;P R-positive, 50%; HER-2 negative, 1 plus, Ki-6 7 positive, 20%), MTRasym (3.5 ppm) s 4.73%, Dapp s 0.99×10-3 mm2 / s, Kapp s 0.802; Figure g-i: Female, 29 years old, right breast fibroid (arrow), MTRasym (3.5 ppm) s 5.68%, Dapp s 1.33×10-3 mm2 / s, Kapp s 0.787.
the characteristics of basic information and lesions in patients.
59 cases of benign lesions, including 40 cases of mastitis and 5 cases of papilloma in the catheter.
76 cases of malignant lesions, including 57 cases of infusion catheter cancer, 8 cases of catheter in place, 6 cases of infusional small leaf cancer, 3 cases of neuroendocrine cancer, 2 cases of mucus adenocarcinoma.
this study shows that DKI is superior to APT-weighted imaging in distinguishing between benign and malignant breast lesions.
, each parameter is related to some prognosm factors to some extent.