Additional diagnostic value of lesion visibility on diffusion-weighted imaging for differentiating BI-RADS category 4 MRI-detected breast lesions
Year: 2026
Type: article
Study design: Observational Study
Abstract: Purpose This study aimed to evaluate whether adding diffusion-weighted imaging (DWI) to dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) improves the differentiation between nonmalignant and malignant MRI-detected lesions. Materials and methods A total of 36 patients with 40 Breast Imaging-Reporting and Data System (BI-RADS) category 4 MRI-detected lesions were analyzed. Two readers independently evaluated lesion visibility on two b -value DWIs ( b = 800 s/mm 2 , DWI 800 and b = 1500 s/mm 2 , DWI 1500 ) using a five-point scale (from 0 = poor to 4 = excellent) and measured the apparent diffusion coefficient (ADC) values. DWI visibility scores and ADC values were compared between nonmalignant and malignant lesions. For the diagnostic performance analysis, lesions were classified as DWI-positive (scores 2–4, suggestive of malignancy) or DWI-negative (scores 0–1, suggestive of benignity). Results The inter-observer agreement of the DWI visibility score was substantial for both DWI 800 (κ = 0.923) and DWI 1500 (κ = 0.864). The lesion visibility score was higher on DWI 1500 than on DWI 800 . The score was significantly higher for malignant than for nonmalignant MRI-detected lesions on both DWI 800 (reader 1: 2.74 vs. 1.57, p = 0.012; reader 2: 2.95 vs. 1.81, p = 0.020) and DWI 1500 (reader 1: 3.11 vs 2.24, p = 0.048; reader 2: 3.00 vs. 1.95, p = 0.038). For mass lesions, both DWI 800 and DWI 1500 achieved 100% sensitivity and a negative predictive value for both readers, whereas all DWI-negative malignant lesions demonstrated non-mass enhancement. Overall, the mean and minimum ADC values did not differ significantly between nonmalignant and malignant lesions. Conclusion The present findings suggest that DWI visibility provides additional value for distinguishing between nonmalignant and malignant BI-RADS category 4 MRI-detected breast lesions. Particularly for mass lesions, DWI-negative MRI-detected lesions were associated with nonmalignant pathology, indicating a potential role for DWI in reducing unnecessary biopsies.
Source: Japanese Journal of Radiology
Institution: Kyoto Prefectural University of Medicine
Language: English
Topic: MRI in cancer diagnosis
Subfield: Radiology, Nuclear Medicine and Imaging
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,090
OpenAlex ID: W7153318259