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@ARTICLE{Bickelhaupt:119234,
      author       = {S. Bickelhaupt$^*$ and J. Tesdorff$^*$ and F. Laun$^*$ and
                      T. A. Kuder$^*$ and W. Lederer and S. Teiner and K.
                      Maier-Hein$^*$ and H. Daniel and A. Stieber$^*$ and S.
                      Delorme$^*$ and H.-P. Schlemmer$^*$},
      title        = {{I}ndependent value of image fusion in unenhanced breast
                      {MRI} using diffusion-weighted and morphological
                      {T}2-weighted images for lesion characterization in patients
                      with recently detected {BI}-{RADS} 4/5 x-ray mammography
                      findings.},
      journal      = {European radiology},
      volume       = {27},
      number       = {2},
      issn         = {1432-1084},
      address      = {Berlin},
      publisher    = {Springer},
      reportid     = {DKFZ-2017-00024},
      pages        = {562 - 569},
      year         = {2017},
      abstract     = {The aim of this study was to evaluate the accuracy and
                      applicability of solitarily reading fused image series of
                      T2-weighted and high-b-value diffusion-weighted sequences
                      for lesion characterization as compared to sequential or
                      combined image analysis of these unenhanced sequences and to
                      contrast- enhanced breast MRI.This IRB-approved study
                      included 50 female participants with suspicious breast
                      lesions detected in screening X-ray mammograms, all of which
                      provided written informed consent. Prior to biopsy, all
                      women underwent MRI including diffusion-weighted imaging
                      (DWIBS, b = 1500s/mm(2)). Images were analyzed as
                      follows: prospective image fusion of DWIBS and T2-weighted
                      images (FU), side-by-side analysis of DWIBS and T2-weighted
                      series (CO), combination of the first two methods (CO+FU),
                      and full contrast-enhanced diagnostic protocol (FDP).
                      Diagnostic indices, confidence, and image quality of the
                      protocols were compared by two blinded readers.Reading the
                      CO+FU (accuracy 0.92; NPV $96.1 \%;$ PPV $87.6 \%)$ and
                      the CO series (0.90; $96.1 \%;$ $83.7 \%)$ provided a
                      diagnostic performance similar to the FDP (0.95; $96.1 \%;$
                      $91.3 \%;$ p > 0.05). FU reading alone significantly
                      reduced the diagnostic accuracy (0.82; $93.3 \%;$
                      $73.4 \%;$ p = 0.023).MR evaluation of suspicious
                      BI-RADS 4 and 5 lesions detected on mammography by using a
                      non-contrast-enhanced T2-weighted and DWIBS sequence
                      protocol is most accurate if MR images were read using the
                      CO+FU protocol.• Unenhanced breast MRI with additional
                      DWIBS/T2w-image fusion allows reliable lesion
                      characterization. • Abbreviated reading of fused
                      DWIBS/T2w-images alone decreases diagnostic confidence and
                      accuracy. • Reading fused DWIBS/T2w-images as the sole
                      diagnostic method should be avoided.},
      cin          = {E010 / E020 / E132},
      ddc          = {610},
      cid          = {I:(DE-He78)E010-20160331 / I:(DE-He78)E020-20160331 /
                      I:(DE-He78)E132-20160331},
      pnm          = {315 - Imaging and radiooncology (POF3-315)},
      pid          = {G:(DE-HGF)POF3-315},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:27193776},
      doi          = {10.1007/s00330-016-4400-9},
      url          = {https://inrepo02.dkfz.de/record/119234},
}