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

Objectives: To evaluate the influence of post-processing systems, intra- and inter-reader agreement on the variability of apparent diffusion coefficient (ADC) measurements in breast lesions.

Methods: Forty-one patients with 41 biopsy-proven breast lesions gave their informed consent and were included in this prospective IRB-approved study. Magnetic resonance imaging (MRI) examinations were performed at 1.5 T using an EPI-DWI sequence, with b-values of 0 and 1000 s/mm(2). Two radiologists (R1, R2) reviewed the images in separate sessions and measured the ADC for lesion, using MRI-workstation (S-WS), PACS-workstation (P-WS) and a commercial DICOM viewer (O-SW). Agreement was evaluated using the intraclass correlation coefficient (ICC), Bland-Altman plots and coefficient of variation (CV).

Results: Thirty-one malignant, two high-risk and eight benign mass-like lesions were analysed. Intra-reader agreement was almost perfect (ICC-R1 = 0.974; ICC-R2 = 0.990) while inter-reader agreement was substantial (ICC from 0.615 to 0.682). Bland-Altman plots revealed a significant bias in ADC values measured between O-SW and S-WS (P = 0.025), no further systematic differences were identified. CV varied from 6.8 % to 7.9 %.

Conclusion: Post-processing systems may have a significant, although minor, impact on ADC measurements in breast lesions. While intra-reader agreement is high, the main source of ADC variability seems to be caused by inter-reader variation.

Key Points: • ADC provides quantitative information on breast lesions independent from the system used. • ADC measurement using different workstations and software systems is generally reliable. • Systematic, but minor, differences may occur between different post-processing systems. • Inter-reader agreement of ADC measurements exceeded intra-reader agreement.