الفهرس 
ANATOMY OF THE BREASTOnly 14 pages are availabe for public view
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Abstract
Being the most common invasive cancer affecting
females world-wide; early detection and proper treatment of
breast cancer has always taken a high priority in scientific
researches world-wide.
Despite the marked improvement in the screening
tools, in many cases histo-pathology is usually required. This
may be the result of relatively high false-positive results of
screening tools such as mammography. Despite its role in the
detection of bilateral/ multi-centric tumors, DCE-MRI has
considerable percentage of high false positive results.
Another reason is that DCE-MRI is not feasible in all
cases such as in cases of renal impairment since the injection
of gadolinium based contrast requires adequate renal functions
to avoid more serious renal impairment.
This has created a growing need for a sensitive and
specific screening and diagnostic imaging technique without
the need for contrast injection.
Conventional DWI (diffusion weighted imaging) with
ADC maps has been proposed to increase the specificity of MRI if used as an adjunct to DCE-MRI. As a result of fallacies
of diffusion, a new technique has been proposed which allows
generation of ADC maps at higher b-values as well as allows
suppression of the back-ground tissue of the breast depicting
lesions more clearly. The technique is called DWIBS;
diffusion weighted imaging with back-ground suppression.
In our thesis, we found that DCE-MRI and DWIBS
showed comparable results as regards to their sensitivity and
specificity. DWIBS however showed some limitation in the
characterization of cystic malignant lesion as well as lesions
of markedly small size.
DWIBS MRI sequence is an effective method for
detection of suspicious breast lesions . It has excellent
diagnostic accuracy in detection of such lesions and represents
a promising tool for tumor surveillance and metastatic workup
of the oncology patients. In addition, there is no hazards of
ionizing radiation or contrast media administration and also
has better spatial resolution. The relative availability of this
technique and local experience should first be taken in
consideration.
DWIBS is a technique that provides complementary
information to DCE-MRI exams and it represents a very useful screening tool when used alone as we proved in our study. It
has proven its value in single-center studies on lesion
characterization and response evaluation. Technical issues due
to standard echoplanar imaging are being solved but the
technique must be completely standardized and clear
interpretation guidelines must be issued in order for DWIBS
to become fully incorporated in breast cancer diagnosis and
response evaluation. Potential areas of growth include
detection with DWIBS without contrast agents, investigation
of additional biological properties through DWIBS modeling
and analysis of radiomics classifiers in order to better stratify
patients and enable a real precision medicine.
In summary, DWIBS MRI is a rapid, unenhanced
technique, which shows the potential to be employed in breast
cancer screening and can be used in the accurate differential
diagnosis of the breast lesions found in DCE MRI.
Standardized acquisition and interpretation protocols can
improve the image quality of DWIBS MRI and reduce the
variability in results. The results from ongoing prospective
clinical studies using standardized and optimized protocols
will facilitate the use of DWIBS MRI in unenhanced breast
cancer screening.
Further research on a larger number of patients is
needed to generalize the results on different histo-pathological
types; hence allowing DWIBS to be used as an alternative to
DCE-MRI in patients who can not tolerate the contrast and as
an adjunct to improve the specificity in patients with no
contra-indications to intra-venous contrast administration