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Diffusion-Weighted Imaging With Apparent Diffusion Coefficient Mapping for Breast Cancer Detection as a Stand-Alone Parameter: Comparison With Dynamic Contrast-Enhanced and Multiparametric Magnetic Resonance Imaging

Pinker, Katja, MD, PhD*†; Moy, Linda, MD; Sutton, Elizabeth J., MD*; Mann, Ritse M., MD, PhD§; Weber, Michael, PhD; Thakur, Sunitha B., PhD*; Jochelson, Maxine S., MD*; Bago-Horvath, Zsuzsanna, MD, PhD; Morris, Elizabeth A., MD*; Baltzer, Pascal AT, MD*; Helbich, Thomas H., MD

doi: 10.1097/RLI.0000000000000465
Original Articles

Purpose The aims of this study were to compare dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) with apparent diffusion coefficient mapping as a stand-alone parameter without any other supportive sequence for breast cancer detection and to assess its combination as multiparametric MRI (mpMRI) of the breast.

Materials and Methods In this institutional review board–approved single-center study, prospectively acquired data of 106 patients who underwent breast MRI from 12/2010 to 09/2014 for an imaging abnormality (Breast Imaging Reporting and Data System 0, 4/5) were retrospectively analyzed. Four readers independently assessed DWI and DCE as well as combined as mpMRI. Breast Imaging Reporting and Data System categories, lesion size, and mean apparent diffusion coefficient values were recorded. Histopathology was used as the gold standard. Appropriate statistical tests were used to compare diagnostic values.

Results There were 69 malignant and 41 benign tumors in 106 patients. Four patients presented with bilateral lesions. Dynamic contrast-enhanced MRI was the most sensitive test for breast cancer detection, with an average sensitivity of 100%. Diffusion-weighted imaging alone was less sensitive (82%; P < 0.001) but more specific than DCE-MRI (86.8% vs 76.6%; P = 0.002). Diagnostic accuracy was 83.7% for DWI and 90.6% for DCE-MRI. Multiparametric MRI achieved a sensitivity of 96.8%, not statistically different from DCE-MRI (P = 0.12) and with a similar specificity as DWI (83.8%; P = 0.195), maximizing diagnostic accuracy to 91.9%. There was almost perfect interreader agreement for DWI (κ = 0.864) and DCE-MRI (κ = 0.875) for differentiation of benign and malignant lesions.

Conclusion Dynamic contrast-enhanced MRI is most sensitive for breast cancer detection and thus still indispensable. Multiparametric MRI using DCE-MRI and DWI maintains a high sensitivity, increases specificity, and maximizes diagnostic accuracy, often preventing unnecessary breast biopsies. Diffusion-weighted imaging should not be used as a stand-alone parameter because it detects significantly fewer cancers in comparison with DCE-MRI and mpMRI.

From the *Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY;

Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria;

Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York University of Medicine;

§Department of Radiology, Radboud University Nijmegen, Nijmegen, the Netherlands; and

Department of Pathology, Medical University of Vienna, Vienna, Austria.

Received for publication October 31, 2017; and accepted for publication, after revision, February 13, 2018.

Conflicts of interest and sources of funding: Funding was provided by the Austrian Nationalbank “Jubiläumsfond” project no. 16219, the 2020 Research and Innovation Framework Programme (PHC-11-2015 no. 667211-2), and seed grants from Siemens Austria, Novomed, Medicor Austria, and Guerbet, France. This research was also funded in part through the National Institute of Health/National Cancer Institute Cancer Center Support Grant P30 CA008748.

Correspondence to: Katja Pinker, MD, PhD, Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065. E-mail: pinkerdk@mskcc.org.

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