title: Quantitative non-Gaussian diffusion and intravoxel incoherent motion magnetic resonance imaging: differentiation of malignant and benign breast lesions.
abstract: OBJECTIVE
  The purpose of this study was to explore the potential of non-Gaussian diffusion and perfusion magnetic resonance imaging (MRI) using intravoxel incoherent motion (IVIM) MRI for the diagnosis of breast lesions.
  
  
  METHODS
  This study included 26 women with breast lesions. Diffusion-weighted images were acquired using 16 b values up to 2500 s/mm and analyzed using a kurtosis diffusion model (apparent diffusion coefficient [ADC0] and kurtosis [K]) for the diffusion component and IVIM model (perfusion fraction [fIVIM] and pseudodiffusion coefficient [D*]) for the perfusion component. Diagnostic performance of diffusion and perfusion parameters was evaluated from receiver operating characteristic analyses.
  
  
  RESULTS
  The ADC0 in malignant lesions was significantly lower than that in benign lesions and normal tissue (P < 0.001, P < 0.001), whereas K was significantly higher (P < 0.05, P < 0.001), as well as fIVIM (P < 0.05, P < 0.01). No significant difference was found in D*. The receiver operating characteristic analysis gave high area under the curve values for ADC0, K, and fIVIM for distinguishing malignant from benign lesions (0.99, 0.85, and 0.82, respectively). The ADC0 allowed benign tumors to be identified with 100% negative predictive value and malignant tumors with 100% sensitivity. The malignant/benign diagnosis thresholds were 1.4 × 10 mm/s as well as 0.6 and 7%, respectively, for ADC0, K, and fIVIM.
  
  
  CONCLUSIONS
  With a proper methodological framework, IVIM MRI can provide valuable information on tissue structure and microvasculature beneficial for the diagnosis of breast cancer lesions.
authors.affiliation: From the *Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto; †Information Science and Technology, Osaka Institute of Technology, Osaka; ‡Kyoto University Faculty of Medicine, Kyoto; §Siemens Japan K.K., Tokyo; ∥Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan; and ¶NeuroSpin, CEA-Saclay, Gif-sur-Yvette, France.
authors.forename: Mami
authors.initials: M
authors.lastname: Iima
authors.forename: Kojiro
authors.initials: K
authors.lastname: Yano
authors.forename: Masako
authors.initials: M
authors.lastname: Kataoka
authors.forename: Masaki
authors.initials: M
authors.lastname: Umehana
authors.forename: Katsutoshi
authors.initials: K
authors.lastname: Murata
authors.forename: Shotaro
authors.initials: S
authors.lastname: Kanao
authors.forename: Kaori
authors.initials: K
authors.lastname: Togashi
authors.forename: Denis
authors.initials: D
authors.lastname: Le Bihan
mesh_terms: D000328:Adult; D000368:Aged; D001940:Breast / Q000473:pathology; D001943:Breast Neoplasms / Q000175:diagnosis*; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009038:Motion; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity