Quantitative diffusion imaging in breast cancer: A clinical prospective study

Purpose: To study the correlation between apparent diffusion coefficient (ADC) and pathology in patients with undefined breast lesion, to validate how accurately ADC is related to histology, and to define a threshold value of ADC to distinguish malignant from benign lesions. Materials and Methods: Seventy-eight patients (110 lesions) were referred for positive or dubious findings. Three-dimensional fast low-angle shot (3D-FLASH) with contrast injection was applied. EPI diffusion-weighted imagin (DWI) with fat saturation was performed, and ROIs were selected on subtraction 3D-FLASH images before and after contrast injection, and copied on an ADC map. Inter- and intraobserver analyses were performed. Results: At pathology 22 lesions were benign, 65 were malignant, and 23 were excluded. The ADCs of malignant and benign lesions were statistically different. In malignant tumors the ADC was (mean +/- SEM) 0.95 +/- 0.027 x 10(-3) mm(2)/second, and in benign tumors it was 1.51 +/- 0.068 x 10(-3) mm(2)/second. According to receiver operating characteristic (ROC) curves, we found a threshold between malignant and benign lesions for highest sensitivity and specificity (both 86%) around 1.13 +/- 0.10 x 10(-3) mm(2)/second. For a threshold of 0.95 +/- 0.10 x 10(-3) mm(2)/second, specificity was 100% but sensitivity was very low. Inter- and intraobserver studies showed good reproducibility. Conclusion: The ADC may help to differentiate benign and malignant lesions with good specificity, and may increase the overall specificity of breast MRI.