Multi-parametric dynamic contrast enhanced MRI, diffusion-weighted MRI and proton-MRS in differentiation of benign and malignant breast lesions: Imaging interpretation and radiology-pathology correlation

Objectives: Comparing the diagnostic accuracy of different MRI techniques in characterization of breast lesions. Methods: The study was performed using 1.5T MRI and included 35 females with detected 47 breast lesions. Lesions were analyzed regarding their morphology, kinetic curve pattern, DWI and tCho peak measurement. The results of each MRI parameter were correlated to histo-pathology. Results: The study included 35 females with 47 breast lesions. Sensitivity and specificity were 87.5% and 93.3% using morphology alone. By using curve pattern, they were 96.9% and 73.3%. DWI was 96.9% sensitive, 66.7% specific, and MRS was 74.2% sensitive and 71.4% specific. The cut-off ADC value was 1.063 x 10(-3) mm(2)/s. Choline cut-off value was (0.36 mmol/l). Sensitivity and specificity were increased to 100% and 93.3% after combining either kinetic curve or DWI with morphology. Sensitivity was increased to 90.3%, after combining MRS with morphology, however this slightly reduced the specificity to 92.9%. Conclusion: MRI is very sensitive for detection of breast lesions, however it lacks specificity. Post-processing tools and functional MRI have improved the specificity. MRS has increased the sensitivity, however specificity has been slightly decreased. Advances in knowledge: Functional MRI is very helpful for characterization of different breast lesions, thus avoiding unnecessary intervention.