Diffusion kurtosis imaging as a biomarker of breast cancer

Abstract

Diffusion kurtosis imaging (DKI) is a diffusion-weighted imaging method that describes non-Gaussian signal behavior using a relatively simple mathematical model. A parameter, kurtosis K, describes the deviation of the diffusion signal decay from a gaussian pattern. The deviation reflects the complexity of the tissue microstructure affecting water diffusion. Several studies have investigated the diagnostic performance of DKI in distinguishing malignant from benign breast lesions. DKI has been reported to correlate with subtypes and with several molecular and other factors related to the treatment and prognosis of breast cancer. Some technical considerations remain to be resolved for the clinical application of DKI in the breast. Advances in knowledge: DKI, which increases the sensitivity to complex tissue microstructure compared to standard DWI, has been applied in the breast, allowing to increase clinical performance in distinguishing malignant from benign lesions and in predicting prognosis or treatment response in breast cancer.

Multiparametric Approach to Breast Cancer With Emphasis on Magnetic Resonance Imaging in the Era of Personalized Breast Cancer Treatment

“…50,62 More advanced modeling methods and parameters have been proposed to fully exploit the information from DWI when evaluating breast cancer characteristics. Advanced DWI methods include IVIM, DKI from non-Gaussian DWI 15,16,63 (Fig. 2), and diffusion tensor imaging (DTI).…”

“…13 In contrast, diffusion kurtosis quantifies the deviation from Gaussian diffusion observed at high b values. 15,16 High K values (>0.7) are generally found in malignant breast lesions, which can be explained by the increased microstructural complexity in cancer tissue. Using carefully planned scanning and analysis, IVIM, ADC, and kurtosis can be obtained from a single series of DWI acquisitions with multiple b values.…”

“…IVIM MRI uses signal from low b value images and reflects microcapillary perfusion, demonstrated as the flowing blood volume fraction (f or f IVIM ), in addition to the true diffusion coefficient, D. Malignant breast tumors have lower D (<1.5 × 10 −3 mm 2 /s) and higher f (approximately 10%) than nonmalignant tumors 13 . In contrast, diffusion kurtosis quantifies the deviation from Gaussian diffusion observed at high b values 15,16 . High K values (>0.7) are generally found in malignant breast lesions, which can be explained by the increased microstructural complexity in cancer tissue.…”

“…Diffusion-weighted imaging enables identification of cancer as an area of hindered or restricted water diffusion. 12 Advanced DWI techniques, including intravoxel incoherent motion (IVIM), diffusion kurtosis imaging (DKI), and time-dependent diffusion MRI, are associated with tissue microperfusion and microstructure [13][14][15][16] and provide new ways of evaluating tissues at the microscale. T2-weighted imaging (T2WI) reflects the percentage of water in tissue and thus reflects peritumoral edema, which is linked to tumor aggressiveness.…”