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Rofo 2022; 194(09): 966-974
DOI: 10.1055/a-1775-8572
Review

Diffusionsbildgebung der Mamma – Möglichkeiten und Limitationen der DWI

Article in several languages: English | deutsch
Hans Jonas Meyer 
  Diagnostic and Interventional Radiology, University of Leipzig Faculty of Medicine, Leipzig, Germany
,
Mireille Martin
  Diagnostic and Interventional Radiology, University of Leipzig Faculty of Medicine, Leipzig, Germany
,
Timm Denecke
  Diagnostic and Interventional Radiology, University of Leipzig Faculty of Medicine, Leipzig, Germany
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Zusammenfassung

Hintergrund Die MRT-Untersuchung der Mamma ist von zentraler Bedeutung in der Diagnostik der Erkrankungen der Mamma. Dies gilt sowohl für die Primärdiagnostik als auch die Verlaufsbeurteilung. Obwohl dabei die frühe Kontrastmittelanreicherung derzeit die wichtigste diagnostische Sequenz darstellt, erlangt vor allem die Diffusionswichtung (DWI) eine zunehmende Bedeutung in der Bildgebung, nicht zuletzt aufgrund ihrer Unabhängigkeit von einer Kontrastmittelgabe. Die vorliegende Übersichtsarbeit stellt die diagnostische und prognostische Relevanz der DWI bei Erkrankungen der Mamma vor.

Methoden Unter Berücksichtigung der veröffentlichten Literatur stellt dieser Übersichtsartikel den möglichen klinisch relevanten Nutzen der DWI der Mamma dar. Es werden verschiedene diagnostische Anwendungen erläutert, insbesondere zur Primärdiagnostik von unklaren Raumforderungen der Mamma, und der Möglichkeit eines nativen Screenings. Weiterhin werden Korrelationen mit histopathologischen Eigenschaften und die Vorhersage des Therapieansprechens der neoadjuvanten Chemotherapie diskutiert.

Ergebnisse Viele Studien zeigten den diagnostischen Wert der DWI in der primären Dignitätseinschätzung von intramammären Herdbefunden. Benigne Läsionen der Mamma weisen signifikant höhere „Apparent diffusion coefficients“ (ADC-Werte) auf als maligne Tumoren. Dies kann klinisch genutzt werden, um unnötige Biopsien zu reduzieren. Zur Differenzierung der Subtypen des Mammakarzinoms wurden hingegen inkonklusive Ergebnisse veröffentlicht, sodass die DWI nicht sicher den immunhistochemischen Subtyp vorhersagen kann. Die DWI kann jedoch helfen, durch ein Ansteigen des ADC-Werts das Ansprechen der neoadjuvanten Chemotherapie vorherzusagen.

Schlussfolgerung Die DWI ist eine vielversprechende Untersuchungstechnik, die zum Standardprotokoll der Mamma-MRT gehören sollte. Sie kann vor allem bei der Diagnosestellung klinisch relevante Zusatzinformationen liefern. Bezüglich der prognostischen Relevanz, der Vorhersage von Subtypen oder dem Proliferationsindex gibt es jedoch keine Evidenz für einen Zusatznutzen. Die Technik benötigt vor allem noch vermehrte Standardisierung, um den ADC-Wert als klinischen Biomarker reliabel verwenden zu können.

Kernaussagen: 

  • Die DWI kann helfen, zwischen benignen und malignen Tumoren der Mamma zu unterscheiden und damit unnötige Biopsien zu vermeiden.

  • Der ADC-Wert kann nicht zwischen den immunhistochemischen Subtypen des Mammakarzinoms unterscheiden.

  • Der ADC-Wert steigt unter der neoadjuvanten Chemotherapie des Mammakarzinoms an und kann damit helfen, ein Therapieansprechen frühzeitig vorherzusagen.

  • Für die klinische Translation ist eine weitere Standardisierung der Technik vonnöten.

Zitierweise

  • Meyer HJ, Martin M, Denecke T. DWI of the Breast – Possibilities and Limitations. Fortschr Röntgenstr 2022; 194: 966 – 974

Key words

DWI - breast cancer - ADC


Publication History

Received: 12 March 2021

Accepted: 25 January 2022

Article published online:
19 April 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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