The value of combination of dynamic contrast-enhanced magnetic resonance imaging and diffusion-weighted imaging in the evaluation of breast masses

Abstract

Aim of the study: The aim was to characterize benign and malignant breast lesions on the basis of their magnetic resonance imaging (MRI) morphology and dynamic contrast enhancement in combination with the diffusion-weighted imaging (DWI) and their apparent diffusion coefficient (ADC) values at 1.5 T MRI, along with histopathological correlation. Patients and Methods: In this prospective study, 56 patients with suspicious breast mass who underwent 1.5 T MRI and proved by histopathology were included. Morphology was studied depending on the MRI signal intensity and dynamic contrast-enhanced imaging plus kinetic curve of enhancement of breast lesions. DWI and ADC values were calculated at b values of 0, 600, and 850 s/mm. The ADC value and histopathology correlation were analyzed. Results: Out of the 56 lesions, 27 lesions were histologically malignant (48.2%) and 29 were histologically benign (51.8%), with age range between 25 and 75 years, with a mean of 54.1 years, and with a standard deviation of ±12.69 years. The MRI results found a sensitivity (SN) of 85.2%, a specificity (SP) of 72.4%, a positive predictive value (PPV) of 74.2%, a negative predictive value (NPV) of 84%, and an accuracy of 78.6%. The DWI findings were as follows: 100% SN, 82.8% SP, 84.4% PPV, 100% NPV, and 85.3% accuracy. The combined MRI interpretation and DWI and ADC findings were as follows: 100% SN, 92.1% SP, 71.1% PPV, 100% NPV, and 86.4% accuracy. All malignant lesions showed restriction at DWI, while only 17.2% of the benign lesions are restricted at DWI. The mean of ADC value was higher in benign cases as compared to the malignant lesions (0.815 vs. 1.287 × 10−3) with statistically significant difference (P = 0.001). Conclusions: The combination of contrast-enhanced breast MRI with DWI and ADC value increases the diagnostic accuracy and SP in the characterization of benign and malignant breast lesions.