Comparative Study of Diffusion-Weighted Imaging Versus Dynamic Contrast Enhanced-MRI in Diagnosis of Breast Tumors

Abstract

Background and Aim: Dynamic contrast-enhanced magnetic resonance imaging plays a significant role in the identification and characterization of breast tumors whereas Diffusion-weighted imaging (DWI) differentiates the benign lesions from malignant lesions. The present study aims to assess the diagnostic accuracy of dynamic contrast-enhanced MRI and diffusion-weighted imaging in the diagnosis of breast tumors. Methodology: This cross-sectional study was conducted on 92 suspicious breast tumors patients underwent Diffusion-weighted imaging (DWI) and Dynamic contrast-enhanced magnetic resonance imaging in the department of Radiology of Holy Family Hospital and Benazir Bhutto Hospital, Rawalpindi from November 2020 to August 2021.DCE-MRI with DWI combination was subjected to morphologic and kinetic analyses. These findings were compared with standard histopathological findings.DWI values were used to calculate apparent diffusion coefficients (ADC). We compared the ADCs of benign and malignant lesions. Morphologic kinetic features and ADCs were evaluated together for the combined MRI protocol. DCEMRI, DWI, and combined MRI diagnostic values were computed. SPSS version 23 was used for statistical analysis. Results:Out of 92 suspicious breast tumors, patients who underwent MRI, benign and malignant were 34 (37%) and 58 (63%) respectively. The overall mean age was 32.56±8.62 years with an age range of 20 to 70 years. Needle biopsy with percutaneous core was confirmed in all cases (BI-RADS≥3). The common malignant lesions were in upper outer quadrant 22 (37.9%), upper inner quadrant 11 (19%), lower outer quadrant 10 (17.2%), and lower inner quadrant 11 (19%). About 4 (6.9%) had malignant lesions in the retro areolar region. Based on quantitative diffusion coefficient measurement sensitivity, specificity, positive, and negative predictive value 94%, 81%, 89%, and 92% respectively for differentiating malignant tumors from benign. The sensitivity and specificity of DCE-MRI were 94% and 76% respectively. The combined sensitivity and specificity of DCE-MRI and DWI were 96% and 84% which was more significant than DCE-MRI and DWI alone. Conclusion: Our study found that benign or malignant breast lesions can be identified and characterized with high sensitive multi-parametric MRI of breast. DWI and breast DCE-MRI both has comparable sensitivity. However, ascompared to DWI and DCE-MRI alone, the breast MRI had higher sensitivity and specificity in distinguishing malignant breast lesions from benign lesions. Keywords: MRI breast, Dynamic Contrast-Enhanced (DCE)-MRI, Diffusion-Weighted Imaging (DWI)