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. 2024 Mar 6;30(2):91-98.
doi: 10.4274/dir.2023.232466. Epub 2023 Oct 27.

Diagnostic value of synthetic diffusion-weighted imaging on breast magnetic resonance imaging assessment: comparison with conventional diffusion-weighted imaging

Ebru Yılmaz  1 , Nilgün Güldoğan  1 , Sıla Ulus  2 , Ebru Banu Türk  1 , Mustafa Enes Mısır  3 , Aydan Arslan  4 , Mustafa Erkin Arıbal  3
Affiliations

Diagnostic value of synthetic diffusion-weighted imaging on breast magnetic resonance imaging assessment: comparison with conventional diffusion-weighted imaging

Ebru Yılmaz et al. Diagn Interv Radiol. .

Abstract

Purpose: To compare images generated by synthetic diffusion-weighted imaging (sDWI) with those from conventional DWI in terms of their diagnostic performance in detecting breast lesions when performing breast magnetic resonance imaging (MRI).

Methods: A total of 128 consecutive patients with 135 enhanced lesions who underwent dynamic MRI between 2018 and 2021 were included. The sDWI and DWI signals were compared by three radiologists with at least 10 years of experience in breast radiology.

Results: Of the 82 malignant lesions, 91.5% were hyperintense on sDWI and 73.2% were hyperintense on DWI. Of the 53 benign lesions, 71.7% were isointense on sDWI and 37.7% were isointense on DWI. sDWI provides accurate signal intensity data with statistical significance compared with DWI (P < 0.05). The diagnostic performance of DWI and sDWI to differentiate malignant breast masses from benign masses was as follows: sensitivity 73.1% [95% confidence interval (CI): 62-82], specificity 37.7% (95% CI: 24-52); sensitivity 91.5% (95% CI: 83-96), specificity 71.7% (95% CI: 57-83), respectively. The diagnostic accuracy of DWI and sDWI was 59.2% and 83.7%, respectively. However, when the DWI images were evaluated with apparent diffusion coefficient mapping and compared with the sDWI images, the sensitivity was 92.68% (95% CI: 84-97) and the specificity was 79.25% (95% CI: 65-89) with no statistically significant difference. The inter-reader agreement was almost perfect (P < 0.001).

Conclusion: Synthetic DWI is superior to DWI for lesion visibility with no additional acquisition time and should be taken into consideration when conducting breast MRI scans. The evaluation of sDWI in routine MRI reporting will increase diagnostic accuracy.

Keywords: Breast tumors; diagnostic imaging; diffusion magnetic resonance imaging; echo-planar imaging; image analysis.

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Conflict of interest statement

Conflict of interest disclosure

The authors declared no conflicts of interest.

Figures

Figure 1
Figure 1
A 44-year-old female patient with a diagnosis of invasive ductal cancer in the inner part of the left breast. In the dynamic contrast-enhanced image (a), there is an irregular mass with heterogeneous enhancement. Synthetic diffusion-weighted image (b) showed markedly hyperintense mass, and conventional diffusion-weighted image (c, d) showed homogeneous diffusion restriction in the mass (hyperintense on DWI and hypointense on ADC map). The ADC values were measured at least three times. The average ADC value was 0.769 x 10-3 mm2/sec, which is below the cut-off value (1.189 x 10-3 mm2/sec). DWI, diffusion-weighted imaging; ADC, apparent diffusion coefficient.
Figure 2
Figure 2
A 64-year-old female patient with a diagnosis of Luminal B IDC in the axillary tail of the left breast is observed. In the dynamic contrast-enhanced image (a), there is an enhanced non-mass lesion, which is a potential malignancy. Synthetic diffusion-weighted image (b) showed lesion isointense. Conventional diffusion-weighted image (c) showed lesion isointense and DWI was evaluated with ADC map (d) there is diffusion restriction in the lesion. The average ADC value was 1.003 x 10-3 mm2/sec, which is below the cut-off value (1.189 x 10-3 mm2/sec). IDC, invasive ductal carcinoma; DWI, diffusion-weighted imaging; ADC, apparent diffusion coefficient.
Figure 3
Figure 3
A 42-year-old female patient with a diagnosis of stromal fibrosis in the outer part of the right breast was observed. Structural distortion was observed on routine annual mammography and MRI was suggested. In the dynamic contrast-enhanced image (a), there was an enhanced lesion with an irregular shape, which indicates malignancy. The synthetic diffusion-weighted image (b) showed lesion isointense. The conventional diffusion-weighted image (c) showed a hyperintense signal but when DWI was evaluated with an ADC map (d) there was no diffusion restriction in the lesion. The average ADC value was 1.429 x 10-3 mm2/sec, which is above the cut-off value (1.189 x 10-3 mm2/sec). MRI, magnetic resonance imaging; DWI, diffusion-weighted imaging; ADC, apparent diffusion coefficient.
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