Three-Dimensional Turbo-Spin-Echo Amide Proton Transfer-weighted and Intravoxel Incoherent Motion Imaging MRI assessing the Triple-Negative Breast Cancer

Abstract Background： Accurate diagnosis of TNBC is essential before initiating therapeutic intervention.Intravoxel incoherent motion imaging (IVIM) MRI an alternative to breast biopsy for sub-typing of the triple-negative breast cancer (TNBC).amide proton transfer-weighted (APTw) MRI provides a new method for the diagnosis of TNBC.To investigate the potential of APTw MRI in assessing TNBC and to assess whether APTw MRI can enhance the diagnostic value of IVIM in breast MRI. Methods This prospective study involved 115 patients with suspected breast tumors who underwent both breast APTw and IVIM MRI. The APTw, diffusion coefficient (D), pseudo diffusion coefficient (D*), and perfusion fraction (f) values along with histological subtype, grade, and prognostic factors (Ki-67, estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor-2 (HER-2), lymph node metastasis, and maximum lesion diameter) were compared. APT values were further analyzed in relation to biological subtypes, Ki-67 labeling index, and nuclear grades (NGs). Results A total of 67 participants (mean age, 64 years, ranges 29-71) were included in the evaluation. The TNBC (3.52 ± 0.38%) exhibited significantly higher APT values compared to the luminal A-type cancers (2.16 ± 1.12%) (P = 0.04). The luminal B cancers showed significantly lower f and Dmax values than the TN-type cancers (P=0.007,0.010). The HER2 cancers showed significantly lower APT values than TN-type ones (P=0.010).The APT value were notably higher in high-Ki-67 (2.80±1.39%) than in low-Ki-67 cancers (2.20±1.88%) (P = 0.045). There are significant difference in APT value was observed between NG1, NG2 and NG3 cancers (P=0.049). And APT value was also significant difference in stages T1 cancers (P=0.027). The combined diagnostic efficiency between TNBC from Luminal A was 0.955. Conclusion The combination of APTw and IVIM MRI holds promise for distinguishing TNBC by discerning molecular subtypes of breast cancers.