title: Accuracy of diffusion kurtosis imaging in characterization of breast lesions.
abstract: OBJECTIVE
  The aim of this study was to evaluate the accuracy of diffusion kurtosis in the characterization and differentiation of breast lesions.
  
  
  METHODS
  49 females with 53 breast lesions underwent breast MRI. The MRI magnetic field is 1.5 T, and the protocol is standard MRI sequences, dynamic sequences pre- and post-contrast agent administration and diffusion images. Diffusion kurtosis imaging (DKI) was applied as part of our standard breast MRΙ protocol. Two experienced radiologists on breast MRI, blinded to the final diagnosis, reviewed the parametric maps and placed a volume of interest on all slices including each lesion. Kurtosis [K apparent (Kapp)] and corrected apparent diffusion coefficient [D apparent (Dapp)] median values were then calculated from the whole-lesion histogram analysis. Receiver-operating characteristic analysis was used to determine the most effective cut-off values for the differentiation between benign and malignant pathologies. Histological analysis of the breast lesions was performed, and further comparative analysis of the results was performed to investigate the accuracy of the method.
  
  
  RESULTS
  Benign (n = 19) and malignant lesions (n = 34) had mean diameters of 20.8 mm (10.1-31.5 mm) and 26.4 mm (10.5-42.3 mm), respectively. The lowest and the highest kurtosis values (Kapp) of malignant lesions were significantly higher than those of benign lesions. A cut-off of 0.71 provided specificity of 93.7% and sensitivity 97.1%, and the area under the curve (AUC) was 0.976 (p < 0.0001). The lowest and the highest Dappvalues of malignant lesions were lower than those of benign lesions. A cut-off value of 1.57 × 10-3mm2s-1provided specificity of 93.7% and sensitivity of 91.2% with AUC of 0.949 (p < 0.0001).
  
  
  CONCLUSIONS
  DKI is an accurate additional tool for the characterization and differentiation of breast lesions with high Kappand Dappsensitivity and specificity rates. Advances in knowledge: DKI is able to distinguish benign from malignant breast pathologies. DKI increases the specificity of breast MRI.
authors.affiliation: 1 Department of Medical Imaging, Doncaster and Bassetlaw Hospitals NHS Foundation Trust, Doncaster, UK.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Christou
authors.affiliation: 2 Department of Medical Imaging, Director and owner of Global Teleradiology Services, Athens, Greece.
authors.forename: Abraham
authors.initials: A
authors.lastname: Ghiatas
authors.affiliation: 3 Department of Medical Imaging, at Iaso Maternity Hospital, Athens, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Priovolos
authors.affiliation: 4 Department of Medical Imaging, at Chatzikosta General Hospital of Ioannina, Ioannina, Greece.
authors.forename: Konstantia
authors.initials: K
authors.lastname: Veliou
authors.affiliation: 5 Department of Medical Imaging, University Hospital of Ioannina, Ioannina, Greece.
authors.forename: Haralambos
authors.initials: H
authors.lastname: Bougias
mesh_terms: D000328:Adult; D000368:Aged; D001940:Breast / Q000000981:diagnostic imaging; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D003287:Contrast Media; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media