Intravoxel incoherent motion magnetic resonance imaging for breast cancer: A comparison with benign lesions and evaluation of heterogeneity in different tumor regions with prognostic factors and molecular classification

Abstract

The objective of the present study was to compare the differentiation between breast cancer and benign breast lesions and study regional distribution characteristics in various subtypes of breast cancer using intravoxel incoherent motion (IVIM) parameters. This retrospective study involved 119 patients with breast cancer and 22 patients with benign breast lesions, who underwent 3.0T breast magnetic resonance imaging examinations. The apparent diffusion coefficient (ADC) and IVIM parameters (slow ADC, fast ADC and fraction of fast ADC) were obtained from patients with breast cancer and benign lesions using diffusion-weighted imaging (DWI) with b-values of 0, 50, 100, 150, 200, 400, 500, 1,000 and 1,500 sec/mm2. Compared with patients with benign breast lesions, patients with breast cancer exhibited decreased ADC (P<0.001), slow ADC (P<0.001) and fast ADC (P<0.001) values, and higher fraction of fast ADC (P<0.001) values. Tumors with metastatic axillary lymph nodes demonstrated increased fraction of fast ADC values (P<0.001) and decreased slow ADC values (P<0.001) compared with tumors without metastatic axillary lymph nodes. The Fast ADC values of tumor tissues in estrogen receptor (ER) and progesterone receptor (PR) negative groups were higher than in positive groups (P<0.001), and the slow ADC values of tumor tissues were lower in ER and PR negative groups than positive groups (P<0.001). Luminal B (HER2- negative) tumor (P<0.001) and peritumor (P<0.001) tissues exhibited decreased fraction of fast ADC values, in comparison with other subtypes. Triple-negative breast cancer (TNBC) tumor tissue exhibited increased fast ADC (P<0.001) and fraction of fast ADC values (P<0.001), and decreased slow ADC values (P<0.001), when compared with other subtypes. The TNBC tumor edge tissues had increased fraction of fast ADC values compared with other subtypes (P<0.01) and TNBC tumor tissues (P<0.05). Therefore, the IVIM parameters of tumor, tumor edge and peritumor tissues in various subtypes of breast cancer may be useful for differentiation of breast cancer subtypes and to assess the invasive extent of the tumors.

Dynamic contrast enhanced-MRI and diffusion-weighted image as predictors of lymphovascular invasion in node-negative invasive breast cancer

“…DWI and the ADC are effective for discriminating benign and malignant tissue, improving the diagnosis of breast cancer when combined with dynamic contrast-enhanced MRI (DCE-MRI), and they are effective for response monitoring after neoadjuvant chemotherapy [ 12 , 13 ]. ADC values have been associated with classical and molecular prognostic factors, as well as treatment response [ 14 – 16 ]. However, the results are discordant, with no standard value identified and limited reproducibility between the different machines, conditions, or protocols used.…”

Diffusion Weighted Imaging of Different Breast Cancer Molecular Subtypes. A Systematic Review and Meta Analysis.

“…Thirdly, the study investigated the widely used DWI technique using 2 b-values. However, more advanced MRI sequences, such as intravoxel incoherent motion and diffusion kurtosis imaging might show a better accuracy in discriminating BC phenotypes [57,58]. Yet, there are few studies using these sequences and thus no comprehensive analysis can be made.…”

Predicting the pathological response to chemoradiotherapy of non-mucinous rectal cancer using pretreatment texture features based on intravoxel incoherent motion diffusion-weighted imaging

“…Intratumor heterogeneity is a feature closely associated with therapeutic response [18]. The IVIM-related micro-environment features, such as cellularity, necrosis, and microcirculation, obviously vary across different regions of malignant tumors [30]. However, analysis based on mean IVIM-DWI parametric values cannot describe the underlying spatial distribution [16,31], and therefore cannot reflect intratumor heterogeneity.…”