ROLE OF DIFFUSION WEIGHTED IMAGING AND DYNAMIC CONTRAST ENHANCED MAGNETIC RESONANCE IMAGING IN CHARACTERIZING BENIGN AND MALIGNANT BREAST LESIONS
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Keywords
Breast cancer, Diffusion-weighted imaging, Dynamic contrast-enhanced MRI, Apparentdiffusion coefficient, Multiparametric MRI, Lesion characterization
Abstract
Background: Accurate differentiation between benign and malignant breast lesions is crucial for early diagnosis and optimal management. Multiparametric MRI, combining diffusion-weighted imaging (DWI) and dynamic contrast-enhanced MRI (DCE-MRI), offers both anatomical and functional assessment, potentially improving diagnostic accuracy.
Objective: To evaluate the role of DWI and DCE-MRI in characterizing benign and malignant breast lesions and to determine optimal ADC cut-off values for lesion differentiation.
Materials and Methods: This prospective, observational study included 100 female patients with breast lesions. All participants underwent mammography, ultrasound, and 3.0T MRI with DWI (b = 400, 800 s/mm²) and DCE sequences. Lesions were evaluated for morphology, size, margins, signal intensity, diffusion restriction, and contrast enhancement. ADC values were calculated, and MRI findings were correlated with histopathology or FNAC results. Statistical analysis included sensitivity, specificity, predictive values, accuracy, and ROC curve analysis for ADC thresholds.
Results: Malignant lesions demonstrated significantly lower ADC values compared to benign lesions (mean ADC: 0.93 ×10⁻³ mm²/s vs. 1.45 ×10⁻³ mm²/s, p < 0.001). DWI alone achieved 88.5% sensitivity and 81.3% specificity, while DCE-MRI showed 92.3% sensitivity and 79.2% specificity. Combined DWI and DCE-MRI improved sensitivity to 96.2%, specificity to 87.5%, and overall accuracy to 92.0%. ROC analysis identified a mean ADC cut-off ≤1.00 ×10⁻³ mm²/s with 92.3% sensitivity and 87.5% specificity. Higher BI-RADS categories and morphological features such as irregular shape and spiculated margins were strongly associated with malignancy.
Conclusion: Multiparametric MRI integrating DWI and DCE-MRI provides excellent diagnostic performance for differentiating benign and malignant breast lesions. ADC quantification enhances specificity, and combined imaging improves overall accuracy, supporting its use in routine clinical practice to optimize early detection and management of breast cancer.
References
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Somil Aggarwal
PG Resident, Department of Radiodiagnosis, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India.
Dr. Sukharam Bhamu
Associate Professor, Department of Radiodiagnosis, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India
Dr. Ravinder Kumar Kundu
Professor and Head, Department of Radiodiagnosis, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India
Dr. Akanksha Maheshwari
Associate Professor, Department of Radiodiagnosis, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India.
Dr. Sandeep Kumar
Assistant Professor, Department of Radiodiagnosis, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India
