Diagnostic Performance Of Diffusion Tensor Imaging Parameters In Breast Tumors Comparing To Diffusion Weighted Imaging And Dynamic Mri Imaging

Abstract

Background: Diffusion tensor imaging (DTI) is a new technique that uses additional gradients to detect the degree of diffusion in multiple directions (at least six). It measures the full diffusion tensor describing the degree of anisotropic water diffusion in the tissue, quantified with the parameters mean diffusivity (MD) and fractional anisotropy (FA). Similar to the ADC, MD reflects the average anisotropy, and FA describes the degree of anisotropy.

Aim: The current study aimed to explore the value of diffusion tensor imaging (DTI) parameters to differentiate between benign and malignant breast lesions compared to diffusion weighted MRI and Dynamic Contrast Enhanced imaging.

Patients and methods: The study involved 64 patients, who presented with a total of 68 breast lesions, including multicentric and multifocal disease. This prospective study was designed to assess whether DTI could provide superior diagnostic accuracy in distinguishing between benign and malignant lesions.

Results: Contrast MRI gives a sensitivity of (94.83%) specificity (80.0%) and accuracy (92.65%). ADC values were significantly lower in malignant (1.054±0.284× 10−3 mm2/s) than in benign lesions (1.388±0.228× 10−3 mm2/s), with a cut-of value of 1.21× 10−3 mm2/s; this gives a sensitivity of (87.93%) specificity (80.0%) and accuracy (86.76%). FA values significantly higher in malignant (0.29±0.453× 10−3 mm2 /s) than benign lesions (0.129±0.032× 10−3 mm2/s) with a cut-of value of 0.15 × 10−3 mm² /s. Mean FA may significantly predict malignant pathology sensitivity (98.28%), specificity (90.0%) and accuracy (97.06%). Concerning the results of MD measurements, the current work showed lower values in malignant tumors (0.29±0.453× 10−3 mm2 /s) than benign lesions (1.75±0.670× 10−3 mm2/s) with a cut-of value of 1.5 × 10−3 mm2 /s. This gives sensitivity (96.55%), specificity (90.0%) and accuracy (95.59%). DTI achieved a higher specificity than DCE-MRI and Diffusion, the combined techniques increased the sensitivity to 100% and specificity to 94 %.

Conclusion: DTI can be used as an adjuvant sequence in diagnostic CE-MRI breast. While the DWI is still the most established diffusion parameter for differentiation between benign and malignant breast lesions, DTI may be helpful in further characterization of tumor microstructure which definitely needs further investigations. Values of FA was significantly higher in malignant than benign lesions, values of ADC and MD were significantly lower in malignant than benign breast lesions, breast DTI is a noninvasive method that demonstrated a high potential utility for cancer detection and serving as a stand alone techniques in conjunction with DCE-MRI, the discriminating values of FA were high.