The Importance of Diffusion Weighted Imaging in Breast MRI

Abstract Background Breast cancer is the most prevalent cancer among females. Dynamic contrast-enhanced MRI (DCE-MRI) breast is highly sensitive (90%) in the detection of breast cancer. Despite its high sensitivity in detecting breast cancer, its specificity (72%) is moderate. Owing to 3-T breast MRI which has the advantage of a higher signal to noise ratio and shorter scanning time rather than the 1.5-T MRI, the adding of new techniques as diffusion tensor imaging (DTI) to breast MRI became more feasible. Diffusion-weighted imaging (DWI) which tracks the diffusion of the tissue water molecule as well as providing data about the integrity of the cell membrane has been used as a valuable additional tool of DCE-MRI to increase its specificity. Based on DWI, more details about the microstructure could be detected using diffusion tensor imaging. The DTI applies diffusion in many directions so apparent diffusion coefficient (ADC) will vary according to the measured direction raising its sensitivity to microstructure elements and cellular density. This study aimed to investigate the diagnostic accuracy of DTI in the assessment of breast lesions in comparison to DWI. Results By analyzing the data of the 50 cases (31 malignant cases and 19 benign cases), the sensitivity and specificity of DWI in differentiation between benign and malignant lesions were about 90% and 63% respectively with PPV 90% and NPV 62%, while the DTI showed lower sensitivity and specificity about 81% and 51.7%, respectively, with PPV 78.9% and NPV 54.8% (P-value ≤ 0.05). Conclusion While the DWI is still the most established diffusion parameter, DTI may be helpful in the further characterization of tumor microstructure and differentiation between benign and malignant breast lesions.

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Correction: Diffusion-Weighted Imaging in 3.0 Tesla Breast MRI: Diagnostic Performance and Tumor Characterization Using Small Subregions vs. Whole Tumor Regions of Interest

PLoS ONE ◽

10.1371/journal.pone.0141833 ◽

2015 ◽

Vol 10 (10) ◽

pp. e0141833 ◽

Cited By ~ 1

Author(s):

Keyword(s):

Diffusion Weighted Imaging ◽

Diagnostic Performance ◽

Breast Mri ◽

Regions Of Interest ◽

3.0 Tesla ◽

Tumor Characterization ◽

Diffusion Weighted

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Role of diffusion-weighted imaging as an adjunct to contrast-enhanced breast MRI in evaluating residual breast cancer following neoadjuvant chemotherapy

European Journal of Radiology ◽

10.1016/j.ejrad.2013.10.023 ◽

2014 ◽

Vol 83 (2) ◽

pp. 283-288 ◽

Cited By ~ 27

Author(s):

Soo Yeon Hahn ◽

Eun Young Ko ◽

Boo-Kyung Han ◽

Jung Hee Shin ◽

Eun Sook Ko

Keyword(s):

Breast Cancer ◽

Neoadjuvant Chemotherapy ◽

Diffusion Weighted Imaging ◽

Breast Mri ◽

Diffusion Weighted ◽

Contrast Enhanced

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Abstract P4-01-10: High-resolution diffusion weighted imaging for the separation of benign from malignant BI-RADS 4/5 lesions found on breast MRI at 3 Tesla

10.1158/0008-5472.sabcs12-p4-01-10 ◽

2012 ◽

Author(s):

DJ Wisner ◽

N Rogers ◽

VS Deshpande ◽

DN Newitt ◽

GA Laub ◽

...

Keyword(s):

High Resolution ◽

Diffusion Weighted Imaging ◽

Breast Mri ◽

3 Tesla ◽

Diffusion Weighted

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Utility of Diffusion-weighted Imaging to Decrease Unnecessary Biopsies Prompted by Breast MRI: A Trial of the ECOG-ACRIN Cancer Research Group (A6702)

Clinical Cancer Research ◽

10.1158/1078-0432.ccr-18-2967 ◽

2019 ◽

Vol 25 (6) ◽

pp. 1756-1765 ◽

Cited By ~ 18

Author(s):

Habib Rahbar ◽

Zheng Zhang ◽

Thomas L. Chenevert ◽

Justin Romanoff ◽

Averi E. Kitsch ◽

...

Keyword(s):

Cancer Research ◽

Research Group ◽

Diffusion Weighted Imaging ◽

Breast Mri ◽

Diffusion Weighted

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Advances in breast MRI: diffusion-weighted imaging of the breast

Breast Cancer ◽

10.1007/s12282-008-0050-3 ◽

2008 ◽

Vol 15 (3) ◽

pp. 212-217 ◽

Cited By ~ 48

Author(s):

Yoshifumi Kuroki ◽

Katsuhiro Nasu

Keyword(s):

Diffusion Weighted Imaging ◽

Breast Mri ◽

Diffusion Weighted

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Diffusion-weighted imaging of the breast—a consensus and mission statement from the EUSOBI International Breast Diffusion-Weighted Imaging working group

European Radiology ◽

10.1007/s00330-019-06510-3 ◽

2019 ◽

Vol 30 (3) ◽

pp. 1436-1450 ◽

Cited By ~ 23

Author(s):

Pascal Baltzer ◽

◽

Ritse M. Mann ◽

Mami Iima ◽

Eric E. Sigmund ◽

...

Keyword(s):

Quality Assurance ◽

Clinical Application ◽

Spatial Resolution ◽

Working Group ◽

Diffusion Weighted Imaging ◽

Breast Mri ◽

Adc Value ◽

Fat Saturation ◽

Diffusion Weighted ◽

Consensus Statements

Abstract The European Society of Breast Radiology (EUSOBI) established an International Breast DWI working group. The working group consists of clinical breast MRI experts, MRI physicists, and representatives from large vendors of MRI equipment, invited based upon proven expertise in breast MRI and/or in particular breast DWI, representing 25 sites from 16 countries. The aims of the working group are (a) to promote the use of breast DWI into clinical practice by issuing consensus statements and initiate collaborative research where appropriate; (b) to define necessary standards and provide practical guidance for clinical application of breast DWI; (c) to develop a standardized and translatable multisite multivendor quality assurance protocol, especially for multisite research studies; (d) to find consensus on optimal methods for image processing/analysis, visualization, and interpretation; and (e) to work collaboratively with system vendors to improve breast DWI sequences. First consensus recommendations, presented in this paper, include acquisition parameters for standard breast DWI sequences including specifications of b values, fat saturation, spatial resolution, and repetition and echo times. To describe lesions in an objective way, levels of diffusion restriction/hindrance in the breast have been defined based on the published literature on breast DWI. The use of a small ROI placed on the darkest part of the lesion on the ADC map, avoiding necrotic, noisy or non-enhancing lesion voxels is currently recommended. The working group emphasizes the need for standardization and quality assurance before ADC thresholds are applied. The working group encourages further research in advanced diffusion techniques and tailored DWI strategies for specific indications. Key Points • The working group considers breast DWI an essential part of a multiparametric breast MRI protocol and encourages its use. • Basic requirements for routine clinical application of breast DWI are provided, including recommendations on b values, fat saturation, spatial resolution, and other sequence parameters. • Diffusion levels in breast lesions are defined based on meta-analysis data and methods to obtain a reliable ADC value are detailed.

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