Investigation of Synthetic Relaxometry and Diffusion Measures in the Differentiation of Benign and Malignant Breast Lesions as Compared to BI-RADS

Background Breast cancer is the most common malignant tumor in women and a quantitative contrast-free method is highly desirable for its diagnosis. Purpose To investigate the performance of quantitative MRI in differentiating malignant from benign breast lesions and to compare with the Breast Imaging Reporting and Data System (BI-RADS). Study Type Retrospective. Subjects Eighty patients (56 with malignant lesions and 24 with benign lesions). Field Strength/Sequence Diffusion-weighted imaging (DWI) with a single-shot echo planar sequence and synthetic MRI with magnetic resonance image compilation (MAGiC) were performed at 3T. Assessment T-1 relaxation time (T-1), T-2 relaxation time (T-2), and proton density (PD) from synthetic MRI and apparent diffusion coefficient (ADC) from DWI were analyzed by two radiologists (Reader A, Reader B). Univariable and multivariable models were developed to optimize differentiation between malignant and benign lesions and their performances compared to BI-RADS. Statistical Tests The diagnostic performance was evaluated using multivariate logistic regression analysis and area under the receiver operating characteristic (ROC) curves (AUC). Results T-2, PD, and ADC values for malignant lesions were significantly lower than those in benign breast lesions for both radiologists (all P < 0.05). The combined T-2, PD, and ADC model had the best performance for differentiating malignant and benign lesions with AUC, sensitivity, specificity, positive predictive value, and negative predictive values of 0.904, 94.6%, 87.5%, 94.6%, and 87.5%, respectively. The corresponding results for BI-RADS were no AUC, 94.6%, 75.0%, 89.8%, and 85.7%, respectively. Data Conclusion The approach that combined synthetic MRI and DWI outperformed BI-RADS in the differential diagnosis of malignant and benign breast lesions and was achieved without contrast agents. This approach may serve as an alternative and effective strategy for the improvement of breast lesion differentiation. Level of Evidence 3. Technical Efficacy Stage 3.