Role of diffusion weighted imaging with background body signal suppression (DWIBS) in diagnosis of breast masses and correlation with histopathological findings

Background Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is the important tool in breast imaging. However, two major limitations are represented by its specificity and by the injection of contrast material. Diffusion weighted imaging (DWI) provides important functional information without the need for contrast material. A newly introduced diffusion weighted imaging with background suppression (DWIBS) sequence is an accurate and rapid tool for the identification and characterization of breast lesions, with its short examination time, high lesion-to-background contrast and lack of need for intravenous contrast agents. Objective To assess the role of DWIBS sequence in the evaluation of indeterminate and suspicious breast masses and to compare its accuracy with DCE-MRI in correlation with histopathological findings. Methods Thirty-five patients were included in the study, referred from sono-mammography clinic to MRI unit for further MRI assessment of probably benign, suspicious and malignant looking breast masses (BIRADS 3, BIRADS 4 & BIRADS 5) on sono-mammography imaging results. MRI breast protocol which included DCE-MRI and DWIBS sequences were obtained for characterization and were verified by core needle biopsy or excisional biopsy. The results were statistically analyzed. Sensitivity, specificity, diagnostic accuracy (DA), positive predictive value (PPV) and negative predictive value (NPV) were calculated for DCE-MRI and DWIBS. Apparent diffusion co-efficient (ADC) values were calculated with ADC ≤ 1.2 × 10 −3 mm 2 /s was considered suspicious for malignancy. The results were then compared with the histological findings. Results Thirty-five female patients had 39 breast masses included in our study. By DCE-MRI, 8 (20.5%) masses were categorized as benign and 31(79.5%) masses were categorized as malignant. By DWIBS sequence, 7 (17.9%) masses were categorized as benign and 32 (82.1%) masses were categorized as malignant. By histopathology, 14 (35.9%) masses were benign and 25 (64.1%) masses were malignant. DCE-MRI obtained accuracy, sensitivity, specificity, PPV and NPV values of 84.6, 100, 57.1, 80.6 and 100%, respectively. DWIBS sequences obtained accuracy, sensitivity, specificity, PPV and NPV values of 82.1, 100, 50, 78.1and 100%, respectively. Conclusions DWIBS can be added to DCE-MRI, as complementary tool to make radiologist more confident about the diagnosis. It can also be used instead of DCE-MRI sequences in certain circumstance