Application of Diffusion Weighted Imaging Techniques for Differentiating Benign and Malignant Breast Lesions

Abstract

To explore the value of apparent diffusion coefficient (ADC), intravoxel incoherent motion (IVIM), and diffusional kurtosis imaging (DKI) based on diffusion weighted magnetic resonance imaging (DW-MRI) in differentiating benign and malignant breast lesions. A total of 215 patients with breast lesions were prospectively collected for breast MR examination. Single exponential, IVIM, and DKI models were calculated using a series of b values. Parameters including ADC, perfusion fraction (f), tissue diffusion coefficient (D), perfusion-related incoherent microcirculation (D*), average kurtosis (MK), and average diffusivity (MD) were compared between benign and malignant lesions. ROC curves were used to analyze the optimal diagnostic threshold of each parameter, and to evaluate the diagnostic efficacy of single and combined parameters. ADC, D, MK, and MD values were significantly different between benign and malignant breast lesions (P<0.001). Among the single parameters, ADC had the highest diagnostic efficiency (sensitivity 91.45%, specificity 82.54%, accuracy 88.84%, AUC 0.915) and the best diagnostic threshold (0.983 μm2/ms). The combination of ADC and MK offered high diagnostic performance (sensitivity 90.79%, specificity 85.71%, accuracy 89.30%, AUC 0.923), but no statistically significant difference in diagnostic performance as compared with single-parameter ADC (P=0.268). The ADC, D, MK, and MD parameters have high diagnostic value in differentiating benign and malignant breast lesions, and of these individual parameters the ADC has the best diagnostic performance. Therefore, our study revealed that the use of ADC alone should be useful for differentiating between benign and malignant breast lesions, whereas the combination of MK and ADC might improve the diagnostic performance to some extent.

Prediction of Prognostic Factors and Genotypes in Patients With Breast Cancer Using Multiple Mathematical Models of MR Diffusion Imaging

“…The region of interest (ROI) was delineated on the grayscale map with a b-value of 1,000 s/mm 2 (12), and then, the pseudocolor images of the IVIM and DKI parameters were merged with the grayscale map by using 3D SynchroView (GE Healthcare) (Figure 2). The ROI included as much of the solid region of the tumor as possible, while regions with large blood vessels, necrosis, or hemorrhage were avoided.…”

“…MRI has a greater sensitivity than mammography or ultrasound in the diagnosis of breast cancer (12). Both dynamic contrast-enhanced MRI (DCE-MRI) and diffusion-weighted imaging (DWI) can detect the microscopic features of tumors.…”

Diagnostic Performance of Diffusion Kurtosis Imaging for Benign and Malignant Breast Lesions: A Systematic Review and Meta-Analysis

“…In recent years, there have been many reports on the differential diagnosis of benign and malignant breast lesions using MK and MD values, which have reported improved sensitivity and accuracy in differentiating between benign and malignant breast lesions [ 1 , 2 , 14 ]. Nogueira et al [ 21 ] reported that MK was one of the representative parameters of DKI technology and a useful index to measure the complexity of organizational structure.…”

“…Recently, there has been an increasing interest in diffusion kurtosis imaging (DKI) to assess non-Gaussian diffusion behavior in diseases involving complex biological tissues such as breast cancer [ 11 – 13 ]. DKI technology has been shown to improve the sensitivity and accuracy for diagnosing benign and malignant breast lesions and is therefore regarded as a promising technique for the differential diagnosis of breast lesions [ 14 , 15 ]. DKI can measure molecular water movement via ADC values.…”

role of Bi-exponential diffusion-weighted model (IVIM) in breast cancer differentiation and comparison of curve fitting methods

“…IVIM assessment in the imaging of several organs has drawn increased attention in recent years, for instance, in the imaging of normal livers and livers with cirrhosis (11)(12)(13)(14) , kidney, (15)(16)(17) , and the prostate (10,18) There was, however, no established technique or ideal set of b-values to distinguish between the diffusion or perfusion effects. Instead, multiple ranges of b-values were employed in the clinical assessment of IVIM characteristics from various institutions (2,19,20) .…”