Utility of Echo-planar Imaging with Compressed Sensitivity Encoding (EPICS) in the Evaluation of Small Breast Cancers Using Diffusion-weighted Imaging with Background Suppression (DWIBS)

Purpose: High b-value acquisition and diffusion-weighted imaging with background suppression (DWIBS) are desirable in high-specificity breast cancer diagnosis on non-contrast-enhanced magnetic resonance imaging; however, this inherently results in a lower signal-to-noise ratio (SNR). Compressed sensitivity encoding (C-SENSE), which combines SENSE with compressed sensing, improves the SNR by reducing noise. Recent technological improvements allow us to incorporate this acceleration technique into echo-planar imaging, called echo-planar imaging with C-SENSE (EPICS). This study aimed to compare image quality and reliability of the apparent diffusion coefficient (ADC) between DWIBS obtained using SENSE and EPICS in patients with small breast cancers.

Methods: Thirty-seven patients with pathologically confirmed breast cancer underwent DWIBS, and images were reconstructed using both conventional SENSE (SENSE-DWIBS) and EPICS (EPICS-DWIBS). Two board-certified radiologists independently evaluated lesion conspicuity (LC) and noise using a 5-point grading scale. The same 2 radiologists independently measured SNR, contrast-to-noise ratio (CNR), and the mean cancer ADC. The Pearson coefficient and Bland-Altman plot were applied to assess the accuracy of ADCs.

Results: LC scores were higher with EPICS than with SENSE, reaching significance for one reviewer but not the other reviewer. Noise ratings on visual evaluation were significantly lower with EPICS than with SENSE (P < 0.001 for both reviewers). SNR was significantly higher with EPICS than with SENSE (P < 0.005 for both reviewers). CNR was significantly higher with EPICS than with SENSE (P < 0.001 for both reviewers). Bland-Altman plots of cancer ADCs using EPICS-DWIBS and SENSE-DWIBS showed excellent concordance, with a bias of 0.026 × 10^-3 mm²/s and limits of agreement ranging 0.054 × 10^-3 mm²/s; the Pearson's correlation coefficient was 0.997 (P < 0.0001).

Conclusion: EPICS enhances breast DWIBS image quality, with improved SNR and CNR and reduced noise levels. The ADCs of breast cancers obtained using EPICS were almost perfectly correlated with those obtained using conventional SENSE.