{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T18:09:36Z","timestamp":1793210976529,"version":"4.5.0"},"reference-count":31,"publisher":"Springer Science and Business Media LLC","issue":"8","license":[{"start":{"date-parts":[[2023,5,11]],"date-time":"2023-05-11T00:00:00Z","timestamp":1683763200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,5,11]],"date-time":"2023-05-11T00:00:00Z","timestamp":1683763200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100005788","name":"Medical University of Vienna","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100005788","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Radiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To develop an intuitive and generally applicable system for the reporting, assessment, and documentation of ADC to complement standard BI-RADS criteria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This was a multicentric, retrospective analysis of 11 independently conducted institutional review board\u2013approved studies from seven institutions performed between 2007 and 2019. Breast Apparent Diffusion coefficient (ADC-B) categories comprised ADC-B0 (ADC non-diagnostic), ADC-B1 (no enhancing lesion), and ADC-B2-5. The latter was defined by plotting ADC versus cumulative malignancy rates. Statistics comprised ANOVA with post hoc testing and ROC analysis.\n                      <jats:italic>p<\/jats:italic>\n                      values\u2009\u2264\u20090.05 were considered statistically significant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 1625 patients (age: 55.9\u00a0years (\u00b1\u200913.8)) with 1736 pathologically verified breast lesions were included. The mean ADC (\u00d7\u200910\n                      <jats:sup>\u22123<\/jats:sup>\n                      mm\n                      <jats:sup>2<\/jats:sup>\n                      \/s) differed significantly between benign (1.45, SD .40) and malignant lesions (.95, SD .39), and between invasive (.92, SD .22) and in situ carcinomas (1.18, SD .30) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.001). The following ADC-B categories were identified: ADC-B0\u2014ADC cannot be assessed; ADC-B1\u2014no contrast-enhancing lesion; ADC-B2\u2014ADC\u2009\u2265\u20091.9 (cumulative malignancy rate\u2009&lt;\u20090.1%); ADC-B3\u2014ADC 1.5 to\u2009&lt;\u20091.9 (0.1\u20131.7%); ADC-B4\u2014ADC 1.0 to &lt;\u20091.5 (10\u201324.5%); and ADC-B5\u2014ADC &lt;\u20091.0 (&gt;\u200924.5%). At the latter threshold, a positive predictive value of 95.8% (95% CI 0.94\u20130.97) for invasive versus non-invasive breast carcinomas was reached.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The breast apparent diffusion coefficient system (ADC-B) provides a simple and widely applicable categorization scheme for assessment, documentation, and reporting of apparent diffusion coefficient values in contrast-enhancing breast lesions on MRI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical relevance statement<\/jats:title>\n                    <jats:p>The ADC-B system, based on diverse MRI examinations, is clinically relevant for stratifying breast cancer risk via apparent diffusion coefficient measurements, and complements BI-RADS for improved clinical decision-making and patient outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:italic>\u2022 The breast apparent diffusion coefficient category system (ADC-B) is a simple tool for the assessment, documentation, and reporting of ADC values in contrast-enhancing breast lesions on MRI.<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:italic>\u2022 The categories comprise ADC-B0 for non-diagnostic examinations, ADC-B1 for examinations without an enhancing lesion, and ADC-B2-5 for enhancing lesions with an increasing malignancy rate.<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:italic>\u2022 The breast apparent diffusion coefficient category system may be used to complement BI-RADS in clinical decision-making.<\/jats:italic>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-023-09675-0","type":"journal-article","created":{"date-parts":[[2023,5,11]],"date-time":"2023-05-11T06:33:41Z","timestamp":1683786821000},"page":"5400-5410","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Introduction of a breast apparent diffusion coefficient category system (ADC-B) derived from a large multicenter MRI database"],"prefix":"10.1007","volume":"33","author":[{"given":"Hubert","family":"Bickel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Clauser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katja","family":"Pinker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Helbich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iva","family":"Biondic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boris","family":"Brkljacic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Dietzel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gordana","family":"Ivanac","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Krug","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Moschetta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor","family":"Neuhaus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus","family":"Preidler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascal","family":"Baltzer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,5,11]]},"reference":[{"key":"9675_CR1","doi-asserted-by":"publisher","first-page":"632","DOI":"10.1148\/radiol.2019182510","volume":"291","author":"GC Baxter","year":"2019","unstructured":"Baxter GC, Graves MJ, Gilbert FJ, Patterson AJ (2019) A meta-analysis of the diagnostic performance of diffusion MRI for breast lesion characterization. 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Paola Clauser and Katja Pinker are members of the <i>European Radiology<\/i> Scientific Editorial Board. They have not taken part in the review or selection process of this article.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"One of the authors (Pascal Baltzer) has significant statistical expertise.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statistics and biometry"}},{"value":"For this retrospective study, data from multiple previous prospective studies were analyzed. In the course of these previous studies, written informed consent was obtained from all included subjects (patients).","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"Institutional review board approval was obtained.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Since this is a retrospective analysis of multiple study populations, some of the original data analyzed in this study have, at least in part, already been analyzed and published with different research questions.The according most recent publications are referenced below:-Bickel, H. et al Quantitative apparent diffusion coefficient as a noninvasive imaging biomarker for the differentiation of invasive breast cancer and ductal carcinoma in situ. <i>Investigative Radiology<\/i> 50, 95\u2013100,\n                      \n                      (2015).-Clauser, P. et al Is there a systematic bias of apparent diffusion coefficient (ADC) measurements of the breast if measured on different workstations? An inter- and intra-reader agreement study. Eur Radiol,\n                      \n                      (2015).-Dietzel, M. et al A multicentric comparison of apparent diffusion coefficient mapping and the Kaiser score in the assessment of breast lesions. <i>Investigative Radiology<\/i> 56, 274-282,\n                      \n                      (2021).-Spick, C., Pinker-Domenig, K., Rudas, M., Helbich, T. H. & Baltzer, P. A. MRI-only lesions: application of diffusion-weighted imaging obviates unnecessary MR-guided breast biopsies. Eur Radiol 24, 1204-1210,\n                      \n                      (2014).-Clauser, P. et al Diffusion-weighted imaging allows for downgrading MR BI-RADS 4 lesions in contrast-enhanced MRI of the breast to avoid unnecessary biopsy. <i>Clinical Cancer Research<\/i>, 1941-1948,\n                      \n                      (2021).-Marino, M. A. et al A simple scoring system for breast MRI interpretation: does it compensate for reader experience? Eur Radiol 26, 2529-2537,\n                      \n                      (2016)-Molinari, C. et al MR mammography using diffusion-weighted imaging in evaluating breast cancer: a correlation with proliferation index. Radiol Med 120, 911-918,\n                      \n                      (2015).-Baltzer, A., Dietzel, M., Kaiser, C. G. & Baltzer, P. A. Combined reading of contrast enhanced and diffusion weighted magnetic resonance imaging by using a simple sum score. <i>European Radiology<\/i> 26, 884-891,\n                      \n                      (2016).-Baltzer, P. A. T. et al Diffusion-weighted imaging (DWI) in MR mammography (MRM): clinical comparison of echo planar imaging (EPI) and half-Fourier single-shot turbo spin echo (HASTE) diffusion techniques. Eur Radiol 19, 1612-1620 (2009).-Dietzel, M. et al Breast MRI in the era of diffusion weighted imaging: do we still need signal-intensity time curves? Eur Radiol 30, 47-56,\n                      \n                      (2020).-Moschetta, M., Telegrafo, M., Rella, L., Stabile Ianora, A. A. & Angelelli, G. Effect of gadolinium injection on diffusion-weighted imaging with background body signal suppression (DWIBS) imaging of breast lesions. Magn Reson Imaging 32, 1242-1246,\n                      \n                      (2014).As opposed to these previous publications, we conjugated the original data from the different imaging centers to develop an easily and generally applicable ADC categorization system (bADC).","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}},{"value":"\u2022 retrospective\u2022 cross sectional\u2022 multicenter study","order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}