Effectivity of combined diffusion-weighted imaging and contrast-enhanced MRI in malignant and benign breast lesions

Mammography is the most commonly used diagnostic test for breast lesion detection and evaluation, but in dense breast parenchyma it lowers its sensitivity to detect small lesions. Sensitivity and specificity improves with combined use of contrast-enhanced magnetic resonance imaging (CE-MRI) and diffusion-weighted imaging (DWI) in differentiating benign and malignant breast lesions. The aim of the study was to evaluate the effectivity of combined dynamic CE-MRI and DWI in differentiating benign and malignant lesions, and to calculate the apparent diffusion coefficient (ADC) values of malignant and benign lesions of the breast.

Fifty-seven patients with 68 lesions were included in the study. MRI of breast using different sequences was acquired on 1.5 Tesla Machine with dedicated breast coils. Dynamic CE-MRI along with DWI was acquired for each patient. Histopathological reports were accepted as the standard of reference.

Out of 68 lesions, 37 were malignant on biopsy (54.4%) and 31 were benign (45.5%). The sensitivity of CE-MRI was 92%, specificity 84.21%, positive predictive values (PPV) 88.46 %, and negative predictive values (NPP) 88.89%. The sensitivity of DWI-MRI was 91.6%, specificity was 90.6%, PPV 91.6%, and NPP 90.6%. The sensitivity of combined DWI-MRI and CE-MRI was 95.0%, specificity was 96.43%, PPV 97.44%, and NPP 93.10%. Mean ADCs of benign lesions (b = 800) was 1.905 ± 0.59 × 10^-3 mm (2)/s, which was significantly higher than those of malignant lesions (b = 800) 1.014 ± 0.47 × 10^-3 mm (2)/s.

Multi-parametric MRI is an excellent non-invasive modality with high sensitivity and specificity to differentiate malignant from benign breast lesions.