title: Intravoxel incoherent motion diffusion-weighted MRI at 3.0 T differentiates malignant breast lesions from benign lesions and breast parenchyma.
abstract: OBJECTIVE
  To study the differentiation of malignant breast lesions from benign lesions and fibroglandular tissue (FGT) using apparent diffusion coefficient (ADC) and intravoxel incoherent motion (IVIM) parameters.
  
  
  METHODS
  This retrospective study included 26 malignant and 14 benign breast lesions in 35 patients who underwent diffusion-weighted MRI at 3.0T and nine b-values (0-1000 s/mm(2) ). ADC and IVIM parameters (perfusion fraction fp , pseudodiffusion coefficient Dp , and true diffusion coefficient Dd ) were determined in lesions and FGT. For comparison, IVIM was also measured in 16 high-risk normal patients. A predictive model was constructed using linear discriminant analysis. Lesion discrimination based on ADC and IVIM parameters was assessed using receiver operating characteristic (ROC) and area under the ROC curve (AUC).
  
  
  RESULTS
  In FGT of normal subjects, fp was 1.1 ± 1.1%. In malignant lesions, fp (6.4 ± 3.1%) was significantly higher than in benign lesions (3.1 ± 3.3%, P = 0.0025) or FGT (1.5 ± 1.2%, P < 0.001), and Dd ((1.29 ± 0.28) × 10(-3) mm(2) /s) was lower than in benign lesions ((1.56 ± 0.28) × 10(-3) mm(2) /s, P = 0.011) or FGT ((1.86 ± 0.34) × 10(-3) mm(2) /s, P < 0.001). A combination of Dd and fp provided higher AUC for discrimination between malignant and benign lesions (0.84) or FGT (0.97) than ADC (0.72 and 0.86, respectively).
  
  
  CONCLUSIONS
  The IVIM parameters provide accurate identification of malignant lesions.
authors.affiliation: Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Louisa
authors.initials: L
authors.lastname: Bokacheva
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Kaplan
authors.forename: Dilip D
authors.initials: DD
authors.lastname: Giri
authors.forename: Sujata
authors.initials: S
authors.lastname: Patil
authors.forename: Merlin
authors.initials: M
authors.lastname: Gnanasigamani
authors.forename: C Gregory
authors.initials: CG
authors.lastname: Nyman
authors.forename: Joseph O
authors.initials: JO
authors.lastname: Deasy
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Morris
authors.forename: Sunitha B
authors.initials: SB
authors.lastname: Thakur
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000145:classification / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008875:Middle Aged; D009038:Motion; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D047368:Tumor Burden
keywords: benign breast lesions; breast cancer; diffusion-weighted imaging; intravoxel incoherent motion