Breast lesion morphology assessment with high and standard b values in diffusion-weighted imaging at 3 Tesla

Introduction: With increasing spatial resolution, diffusion-weighted imaging (DWI) may be suitable for morphologic lesion characterization in breast MRI - an area that has traditionally been occupied by dynamic contrast-enhanced imaging (DCE). This investigation compared DWI with b values of 800 and 1600 s/mm2 to DCE for lesion morphology assessment in high-resolution breast MRI at 3 Tesla. Material and methods: Multiparametric breast MRI was performed in 91 patients with 93 histopathologically proven lesions (31 benign, 62 malignant). Two radiologists independently evaluated three datasets per patient (DWIb800; DWIb1600; DCE) and assessed lesion visibility and BIRADS morphology criteria. Diagnostic accuracy was compared among readers and datasets using Cochran's Q test and pairwise post-hoc McNemar tests. BlandAltman analyses were conducted for lesion size comparisons. Results: Discrimination of carcinomas was superior compared to benign findings in both DWIb800 and DWIb1600 (p < 0.001) with no b value-dependent difference. Similarly, assessability of mass lesions was better than of nonmass lesions, irrespective of b value (p < 0.001). Intra-reader reliability for the analysis of morphologic BIRADS criteria among DCE and DWI datasets was at least moderate (Fleiss kappa >= 0.557), while at least substantial interreader agreement was ascertained over all assessed categories (kappa >= 0.776). In pairwise Bland-Altman analyses, the measurement bias between DCE and DWIb800 was 0.7 mm, whereas the difference between DCE and DWIb1600 was 2.8 mm. DWIb1600 allowed for higher specificity than DCE (p = 0.007/0.062). Conclusions: DWI can be employed for reliable morphologic lesion characterization in high-resolution breast MRI. High b values increase diagnostic specificity, while lesion size assessment is more precise with standard 800 s/ mm2 images.