Intravoxel Incoherent Motion Diffusion-Weighted MRI at 3.0 T Differentiates Malignant Breast Lesions From Benign Lesions and Breast Parenchyma

Purpose: To study the differentiation of malignant breast lesions from benign lesions and fibroglandular tissue (FGT) using apparent diffusion coefficient (ADC) and intravoxel incoherent motion (IVIM) parameters. Materials and Methods: This retrospective study included 26 malignant and 14 benign breast lesions in 35 patients who underwent diffusion-weighted MRI at 3.0T and nine b-values (0-1000 s/mm(2)). ADC and IVIM parameters (perfusion fraction f(p), pseudodiffusion coefficient D-p, and true diffusion coefficient D-d) were determined in lesions and FGT. For comparison, IVIM was also measured in 16 high-risk normal patients. A predictive model was constructed using linear discriminant analysis. Lesion discrimination based on ADC and IVIM parameters was assessed using receiver operating characteristic (ROC) and area under the ROC curve (AUC). Results: In FGT of normal subjects, f(p) was 1.1 +/- 1.1%. In malignant lesions, f(p) (6.4 +/- 3.1%) was significantly higher than in benign lesions (3.1 +/- 3.3%, P = 0.0025) or FGT (1.5 +/- 1.2%, P < 0.001), and D-d ((1.29 +/- 0.28) x 10(-3) mm(2)/s) was lower than in benign lesions ((1.56 +/- 0.28) x 10(-3) mm(2)/s, P = 0.011) or FGT ((1.86 +/- 0.34) x 10(-3) mm(2)/s, P < 0.001). A combination of D-d and f(p) provided higher AUC for discrimination between malignant and benign lesions (0.84) or FGT (0.97) than ADC (0.72 and 0.86, respectively). Conclusion: The IVIM parameters provide accurate identification of malignant lesions.