Related Experiment Video
Updated: Jun 19, 2026
Tracking the Mammary Architectural Features and Detecting Breast Cancer with Magnetic Resonance Diffusion Tensor Imaging
Published on: December 15, 2014
Mean Apparent Diffusion Coefficient Is a Sufficient Conventional Diffusion-weighted MRI Metric to Improve Breast MRI
Elizabeth S McDonald1, Justin Romanoff1, Habib Rahbar1
1From the Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (E.S.M., M.D.S.); Center for Statistical Sciences, Brown University, Providence, RI (J.R.); Department of Radiology, University of Washington, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109 (H.R., A.E.K., S.C.P.); Departments of Radiology and Radiological Sciences (S.M.H.) and Medicine (J.G.W.), Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt-Ingram Cancer Center, Nashville, Tenn (J.G.W.); Department of Biomedical Engineering, University of Texas, Austin, Tex (T.E.Y.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (W.B.D.); Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.E.D.); Department of Breast Imaging, MD Anderson Cancer Center, Houston, Tex (W.T.Y.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.W.); Department of Radiology and Biomedical Imaging, University of California, San Francisco School of Medicine, San Francisco, Calif (B.N.J., L.J.W., N.M.H.); Department of Radiology, Oregon Health and Science University, Portland, Ore (K.Y.O., L.A.T.); Department of Radiology/MRI, University of Michigan, Ann Arbor, Mich (C.H.N., D.I.M., T.L.C.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (C.E.C.).
Abstract:
Background The Eastern Cooperative Oncology Group and American College of Radiology Imaging Network Cancer Research Group A6702 multicenter trial helped confirm the potential of diffusion-weighted MRI for improving differential diagnosis of suspicious breast abnormalities and reducing unnecessary biopsies. A prespecified secondary objective was to explore the relative value of different approaches for quantitative assessment of lesions at diffusion-weighted MRI. Purpose To determine whether alternate calculations of apparent diffusion coefficient (ADC) can help further improve diagnostic performance versus mean ADC values alone for analysis of suspicious breast lesions at MRI. Materials and Methods This prospective trial (ClinicalTrials.gov identifier: NCT02022579) enrolled consecutive women (from March 2014 to April 2015) with a Breast Imaging Reporting and Data System category of 3, 4, or 5 at breast MRI. All study participants underwent standardized diffusion-weighted MRI (b = 0, 100, 600, and 800 sec/mm2). Centralized ADC measures were performed, including manually drawn whole-lesion and hotspot regions of interest, histogram metrics, normalized ADC, and variable b-value combinations. Diagnostic performance was estimated by using the area under the receiver operating characteristic curve (AUC). Reduction in biopsy rate (maintaining 100% sensitivity) was estimated according to thresholds for each ADC metric. Results Among 107 enrolled women, 81 lesions with outcomes (28 malignant and 53 benign) in 67 women (median age, 49 years; interquartile range, 41-60 years) were analyzed. Among ADC metrics tested, none improved diagnostic performance versus standard mean ADC (AUC, 0.59-0.79 vs AUC, 0.75; P = .02-.84), and maximum ADC had worse performance (AUC, 0.52; P < .001). The 25th-percentile ADC metric provided the best performance (AUC, 0.79; 95% CI: 0.70, 0.88), and a threshold using median ADC provided the greatest reduction in biopsy rate of 23.9% (95% CI: 14.8, 32.9; 16 of 67 BI-RADS category 4 and 5 lesions). Nonzero minimum b value (100, 600, and 800 sec/mm2) did not improve the AUC (0.74; P = .28), and several combinations of two b values (0 and 600, 100 and 600, 0 and 800, and 100 and 800 sec/mm2; AUC, 0.73-0.76) provided results similar to those seen with calculations of four b values (AUC, 0.75; P = .17-.87). Conclusion Mean apparent diffusion coefficient calculated with a two-b-value acquisition is a simple and sufficient diffusion-weighted MRI metric to augment diagnostic performance of breast MRI compared with more complex approaches to apparent diffusion coefficient measurement. © RSNA, 2020 Online supplemental material is available for this article.
Related Concept Videos
01:17Assessment of Diffusion and Perfusion
The Role of Diffusion in Respiration
Diffusion is the process by which molecules move from an area of higher concentration to an area of lower concentration. In the respiratory system, this principle...
01:24Magnetic Resonance Imaging