title: Advanced MRI Techniques in the Evaluation of Complex Cystic Breast Lesions.
abstract: OBJECTIVE
  The purpose of this research work was to evaluate complex cystic breast lesions by advanced MRI techniques and correlating imaging with histologic findings.
  
  
  METHODS
  In a cross-sectional design from September 2013 to August 2015, 50 patients having sonographically detected complex cystic lesions of the breast were included in the study. Morphological characteristics were assessed. Dynamic contrast-enhanced MRI along with diffusion-weighted imaging and MR spectroscopy were used to further classify lesions into benign and malignant categories. All the findings were correlated with histopathology.
  
  
  RESULTS
  Of the 50 complex cystic lesions, 32 proved to be benign and 18 were malignant on histopathology. MRI features of heterogeneous enhancement on CE-MRI (13/18), Type III kinetic curve (13/18), reduced apparent diffusion coefficient (18/18), and tall choline peak (17/18) were strong predictors of malignancy. Thirteen of the 18 lesions showed a combination of Type III curve, reduced apparent diffusion coefficient value, and tall choline peak.
  
  
  CONCLUSIONS
  Advanced MRI techniques like dynamic imaging, diffusion-weighted sequences, and MR spectroscopy provide a high level of diagnostic confidence in the characterization of complex cystic breast lesion, thus allowing early diagnosis and significantly reducing patient morbidity and mortality. From our study, lesions showing heterogeneous contrast enhancement, Type III kinetic curve, diffusion restriction, and tall choline peak were significantly associated with malignant complex cystic lesions of the breast.
authors.affiliation: Department of Radiological Imaging, Institute of Nuclear Medicine and Allied Sciences, Delhi, India.
authors.forename: Manju Bala
authors.initials: MB
authors.lastname: Popli
authors.affiliation: Department of Radiological Imaging, Institute of Nuclear Medicine and Allied Sciences, Delhi, India.
authors.forename: Pranav
authors.initials: P
authors.lastname: Gupta
authors.affiliation: Department of Radiological Imaging, Institute of Nuclear Medicine and Allied Sciences, Delhi, India.
authors.forename: Devraj
authors.initials: D
authors.lastname: Arse
authors.affiliation: Department of Radiological Imaging, Institute of Nuclear Medicine and Allied Sciences, Delhi, India.
authors.forename: Pawan
authors.initials: P
authors.lastname: Kumar
authors.affiliation: Department of Radiological Imaging, Institute of Nuclear Medicine and Allied Sciences, Delhi, India.
authors.forename: Prabhjot
authors.initials: P
authors.lastname: Kaur
keywords: MRI; breast; complex; cyst