Diffusion Kurtosis at 3.0T as an in vivo Imaging Marker for Breast Cancer Characterization: Correlation With Prognostic Factors

BACKGROUND: Diffusion-kurtosis imaging (DKI) has preliminarily shown promise as a relatively new MRI technique to provide useful information regarding breast lesions, but the diagnostic performance of DKI has not been fully evaluated. PURPOSE: To compare the diagnostic accuracy of DKI, diffusion-weighted imaging (DWI), dynamic contrast-enhanced (DCE)-MRI) and proton MR spectroscopy (1 H-MRS) in differentiating malignant from benign breast lesions independently or jointly, and explore the correlation between DKI-derived parameters and prognostic factors. STUDY TYPE: Prospective. SUBJECTS: Seventy-one patients with breast lesions (50 malignant, 26 benign). SEQUENCE: DKI, DWI, DCE-MRI, and 1 H-MRS were performed at 3.0T. ASSESSMENT: Mean kurtosis (MK), mean diffusivity (MD), apparent diffusion coefficient (ADC), BI-RADS category, and choline peaks were analyzed by two experienced radiologists. STATISTICAL TESTS: Student's t-test was used for continuous variables; receiver operating characteristic (ROC) analysis for assessing the diagnostic accuracy of imaging parameters; Spearman or Pearson correlations for assessing the associations between imaging parameters and prognostic factors. RESULTS: MK exhibited higher area under the curves (AUCs) for differentiating malignant from benign lesions than did MD, ADC, DCE, and tCho (0.979 vs. 0.928, 0.911, 0.777, and 0.833, respectively, P < 0.05). MK showed a positive association with Ki-67 expression (r = 0.508) and histologic grades (r = 0.551), whereas MD and ADC were negatively correlated with Ki-67 expression (r = -0.416 and r = -0.458) and histologic grades (r = -0.411 and r = -0.319). Moreover, MK showed relatively higher AUCs compared with MD and ADC in detecting breast cancers with lymph nodal involvement, histologic grades, and Ki-67 expression. DATA CONCLUSION: MK has higher diagnostic accuracy compared with ADC, DCE, and tCho regarding detection of breast cancer. Moreover, DKI shows promise as a quantitative imaging technique for characterizing breast lesions, highlighting the potential utility of MK as a promising imaging marker for predicting tumor aggressiveness. LEVEL OF EVIDENCE: 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:845-856.