Diffusion-weighted imaging versus dynamic contrast-enhanced MRI: a new horizon for characterisation of suspicious...

To investigate the value of new diffusion-weighted imaging applications in the characterisation of suspicious breast lesions with emphasis on diffusion tensor imaging (DTI) and fibre tractography (FT).

The present prospective study included 40 female patients with suspicious breast lesions according to sono-mammography American College of Radiologists' classification. All patients underwent conventional magnetic resonance imaging (MRI), diffusion-weighted imaging (DWI), DTI, and FT after meeting the inclusion criteria. Dynamic contrast-enhanced MRI was performed as the reference standard for radiological evaluation. The study was conducted between August 2018 and January 2019. The final diagnosis was confirmed histopathologically.

Malignant lesions were diagnosed in 32/40 (80%) patients and 8/40 (20%) patients had benign lesions. Apparent diffusion coefficient (ADC) values of malignant lesions were statistically lower than that of benign lesions (p<0.001) using a cut-off value of 0.99±0.07×10^-3 mm²/s. Fractional anisotropy (FA) values were lower in malignant lesions than in benign lesions with a cut-off value for malignancy of 0.19±0.05 and were statistically significant (p<0.005). The sensitivity, specificity, and accuracy of combined DTI and FT were similar to DCE MRI (p<0.001).

DTI and FT are new applications of DWI. They show promising results for the evaluation of suspicious breast masses and can distinguish between benign and malignant breast lesions with statistical significance approaching contrast-enhanced MRI, which is considered the imaging reference standard for characterising breast lesions.