Diffusion-Weighted Magnetic Resonance Imaging of the Breast: Standardization of Image Acquisition and Interpretation

Abstract

Diffusion-weighted (DW) magnetic resonance imaging (MRI) is a rapid, unenhanced imaging technique that measures the motion of water molecules within tissues and provides information regarding the cell density and tissue microstructure. DW MRI has demonstrated the potential to improve the specificity of breast MRI, facilitate the evaluation of tumor response to neoadjuvant chemotherapy and can be employed in unenhanced MRI screening. However, standardization of the acquisition and interpretation of DW MRI is challenging. Recently, the European Society of Breast Radiology issued a consensus statement, which described the acquisition parameters and interpretation of DW MRI. The current article describes the basic principles, standardized acquisition protocols and interpretation guidelines, and the clinical applications of DW MRI in breast imaging.

Detection of Contralateral Breast Cancer Using Diffusion-Weighted Magnetic Resonance Imaging in Women with Newly Diagnosed Breast Cancer: Comparison with Combined Mammography and Whole-Breast Ultrasound

“…In addition, DW MRI has a higher AIR than combined mammography and US. However, false-positive readings can be drastically reduced with more training on standardized DW MRI interpretation algorithms and readings combined with pre-contrast T1- and T2-weighted images [ 20 24 26 ]. A recently published review article provided an updated DW MRI interpretation algorithm for breast cancer screening [ 20 ].…”

“…However, false-positive readings can be drastically reduced with more training on standardized DW MRI interpretation algorithms and readings combined with pre-contrast T1- and T2-weighted images [ 20 24 26 ]. A recently published review article provided an updated DW MRI interpretation algorithm for breast cancer screening [ 20 ]. Lastly, two 3T scanners with dedicated 16- or 18-channel breast coils and different echo-planar imaging sequences with b-values of 1000 sec/mm 2 were used for DW MRI acquisition in our study.…”

“…Our results suggest that DW MRI has the potential as a screening tool for breast cancer detection, especially in women who are contraindicated to gadolinium-based contrast agents and cannot tolerate long MRI scan times. To better determine the role of DW MRI as a screening tool, multicenter prospective trials using standardized acquisition and interpretation protocols are needed in women with various breast cancer risk levels [ 16 20 ]. Currently, ongoing prospective clinical trials are investigating the role of DW MRI in screening high-risk women ( NCT03835897 , NCT04619186 ) or women with dense breasts ( NCT03607552 ).…”

“…Diffusion-weighted (DW) MRI is a fast, widely available, unenhanced technique that has shown promise for the detection and characterization of breast cancers [ 16 17 18 19 ]. Due to the restricted or hindered diffusion of water molecules within tissues, breast cancers appear hyperintense on high b-value DW MRI and have lower apparent diffusion coefficient (ADC) values than normal tissue or benign tumors [ 20 ]. There is emerging evidence that DW MRI can be part of a multiparametric or non-contrast-enhanced approach for local staging of the affected breast in women with breast cancer [ 21 22 ].…”

Radiomics and Machine Learning with Multiparametric Breast MRI for Improved Diagnostic Accuracy in Breast Cancer Diagnosis

“…Diffusion-weighted imaging (DWI) has emerged as a useful technique to compensate for the lack of DCE-MRI specificity [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. Thus, more and more breast MRI protocols are currently including DWI to increase specificity and reduce unnecessary benign breast biopsies [ 13 , 15 , 16 , 17 , 21 , 22 , 23 , 24 , 25 ]. Radiomics and machine learning (ML) have recently gained momentum to aid in the differentiation of breast lesions.…”