Assessment of breast mass morphology with diffusion‐weighted MRI: Beyond apparent diffusion coefficient

BACKGROUND: Diffusion-weighted imaging (DWI) is a noncontrast-enhanced MRI technique. There are new promising studies on the use of DWI as a part of the enhanced or unenhanced abbreviated breast MRI protocols. PURPOSE: To evaluate the ability of breast DWI in the assessment of mass morphology and determine the contribution of this morphologic evaluation in their characterization. STUDY TYPE: Retrospective. POPULATION: In all, 213 consecutive women were breast MR imaged and had a later confirmed diagnosis. FIELD STRENGTH/SEQUENCE: Breast dynamic contrast-enhanced-MRI (DCE-MRI) and DWI at 1.5T. ASSESSMENT: After Institutional Review Board approval, two radiologists first independently, and later in consensus, evaluated the visibility and morphology of the 143 malignant, 70 benign masses on DWI and DCE-MRI in separate sessions, blindly. Shape, margin, and internal pattern of the masses were evaluated according to BI-RADS lexicon. Apparent diffusion coefficient (ADC) and tumor size were measured by one radiologist. STATISTICAL TESTS: Consistency between imaging methods and readers was evaluated with Cohen's kappa statistics. Multivariate analysis was applied to find the best predictors of malignancy. RESULTS: Tumor visibility on DWI was high to moderate in at least 88% of cases. Consistency between DWI and DCE-MRI was substantial (kappa ≥0.757) for shape and margin and moderate (kappa = 0.505) for internal pattern. Interobserver agreement was substantial to moderate for all morphologic parameters (kappa ≥0.596). Morphology evaluated on DWI provided 83-84% accuracy in discriminating malignant from benign masses. ADC alone provided 90-91% accuracy. Both morphologic parameters and ADC were significantly associated with malignancy on multivariate analysis and provided 91-93% accuracy. DATA CONCLUSION: DWI might be used not only for ADC evaluation but also for the morphological evaluation of breast masses to characterize them. LEVEL OF EVIDENCE: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;48:1668-1677.