IVIM combined with DCE-MRI characterize architectural distortion detected on mammography: A pilot study

To evaluate the diagnostic value of intravoxel incoherent motion (IVIM) combined with dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in patients with architectural distortion (AD) changes on mammography.

Data were collected from patients who underwent breast MRI after being diagnosed with AD changes on mammography between April 2019 and February 2022. After applying the inclusion and exclusion criteria, a total of 80 patients were ultimately included in this study. Two independent radiologists recorded DCE-MRI lesion characteristics and IVIM parameters. The final outcomes were determined using pathology results from biopsy or surgical excision or at least two years of clinical and radiological follow-up.

In 33 (41.25 %) patients, no lesions were detected on MRI. Among the remaining 47 (58.75 %) patients, 17 (36.17 %) had benign lesions, while 30 (63.83 %) had malignant lesions. Among the 80 patients included in the study, the sensitivity, specificity, negative predictive value, and positive predictive value of MRI to distinguish benign and malignant AD changes were 100 %, 92 %, 100 %, and 88.2 %, respectively, and the overall accuracy was estimated to be 95 %. Regarding DCE-MRI characteristics of patients with positive MRI findings, lesion diameter, shape and margin of mass enhancement, distribution of non-mass enhancement, internal enhancement and time signal intensity curve (TIC) exhibited significant differences between benign and malignant AD (P < 0.05). Among these, internal enhancement and TIC were identified as independent risk predictors, with a combined area under curve (AUC) of 0.969. In terms of IVIM parameters, ADC, D, D*, and f values demonstrated significant differences between benign and malignant AD (all P < 0.05), with AUC values of 0.908, 0.831, 0.680, and 0.761, respectively. ADC and D* were identified as independent risk predictors, with a combined AUC of 0.925. Combined DCE-MRI and IVIM provided the highest AUC, reaching 0.984.

IVIM combined with DCE-MRI is a reliable predictive tool for the classification of AD changes with high diagnostic efficacy. Also, a negative breast MRI in patients with AD changes can be used to exclude malignancy.