Diffusion-weighted Imaging of the Breast: Principles and Clinical Applications

Abstract

Diffusion-weighted imaging provides a novel contrast mechanism in magnetic resonance (MR) imaging and has a high sensitivity in the detection of changes in the local biologic environment. A significant advantage of diffusion-weighted MR imaging over conventional contrast material-enhanced MR imaging is its high sensitivity to change in the microscopic cellular environment without the need for intravenous contrast material injection. Approaches to the assessment of diffusion-weighted breast imaging findings include assessment of these data alone and interpretation of the data in conjunction with T2-weighted imaging findings. In addition, the analysis of apparent diffusion coefficient (ADC) value can be undertaken either in isolation or in combination with diffusion-weighted and T2-weighted imaging. Most previous studies have evaluated ADC value alone; however, overlap in the ADC values of malignant and benign disease has been observed. This overlap may be partly due to selection of b value, which can influence the concomitant effect of perfusion and emphasize the contribution of multicomponent model influences. The simultaneous assessment of diffusion-weighted and T2-weighted imaging data and ADC value has the potential to improve specificity. In addition, the use of diffusion-weighted imaging in a standard breast MR imaging protocol may heighten sensitivity and thereby improve diagnostic accuracy. Standardization of diffusion-weighted imaging parameters is needed to allow comparison of multicenter studies and assessment of the clinical utility of diffusion-weighted imaging and ADC values in breast evaluation.

The role of apparent diffusion coefficient values in the differential diagnosis of breast lesions in diffusion-weighted MRI

“…Echoplanar DWI, the most common image acquisition scheme used for DWI, can result in image distortion due to eddy currents. Geometric distortion, signal loss, and image-blurring artifacts in EPI are caused by magnetic field inhomogeneities (6,7,12). These artifacts could impair ADC measurements (4,6,17).…”

Differentiation between Graves' disease and painless thyroiditis by diffusion-weighted imaging, thyroid iodine uptake, thyroid scintigraphy and serum parameters

“…The ADC value can be calculated by assessing the signal attenuation that occurs in DWI performed at different b values. Usually, low ADC values indicate restricted diffusion (high cellular density), while high ADC values indicate more free diffusion (low tissue cellularity) (30)(31)(32).…”

“…It has primarily been used clinically for brain disorders, particularly for the early detection of ischemic stroke or infarction (33)(34)(35)(36). Numerous studies have put forward DWI as a new and valuable cancer imaging biomarker for detection, diagnosis, staging, detecting metastasis or relapse, and assessing treatment response (30)(31)(32)(37)(38)(39)(40)(41)(42)(43)(44). Studies have also demonstrated that, for malignancy imaging, the quantitative analysis of ADC and the standard uptake value (SUV) in fluorodeoxyglucose positron emission tomography (FDG PET)/CT are inversely correlated (37)(38)(39)(40)(41)(42).…”

Differentiation between Benign and Malignant Breast Lesions Using ADC on Diffusion-Weighted Imaging at 3.0 T

“…DWI measures the random movement of water molecules in tissues, which is detected as the attenuation of the measured signal intensity [11] on Diffusion weighted MRI (DWI). Diffusion can be quantified by using the apparent diffusion coefficient (ADC) value to increase the specificity of DWI [12]. The movement of water molecules is much more restricted in tissues with a higher cellular content and associated with numerous intact cell membranes [13] [14] as seen in malignant breast lesion.…”