• Sibel Kul, Yavuz Metin, Musa Kul, Nurgul Metin, Ilker Eyuboglu, and Oguzhan Ozdemir.
• Karadeniz Technical University, School of Medicine, Department of Radiology, Trabzon, Turkey.
• J Magn Reson Imaging. 2018 Dec 1; 48 (6): 1668-1677.

BackgroundDiffusion-weighted imaging (DWI) is a noncontrast-enhanced MRI technique. There are new promising studies on the use of DWI as a part of the enhanced or unenhanced abbreviated breast MRI protocols.PurposeTo evaluate the ability of breast DWI in the assessment of mass morphology and determine the contribution of this morphologic evaluation in their characterization.Study TypeRetrospective.PopulationIn all, 213 consecutive women were breast MR imaged and had a later confirmed diagnosis.Field Strength/SequenceBreast dynamic contrast-enhanced-MRI (DCE-MRI) and DWI at 1.5T.AssessmentAfter Institutional Review Board approval, two radiologists first independently, and later in consensus, evaluated the visibility and morphology of the 143 malignant, 70 benign masses on DWI and DCE-MRI in separate sessions, blindly. Shape, margin, and internal pattern of the masses were evaluated according to BI-RADS lexicon. Apparent diffusion coefficient (ADC) and tumor size were measured by one radiologist.Statistical TestsConsistency between imaging methods and readers was evaluated with Cohen's kappa statistics. Multivariate analysis was applied to find the best predictors of malignancy.ResultsTumor visibility on DWI was high to moderate in at least 88% of cases. Consistency between DWI and DCE-MRI was substantial (kappa ≥0.757) for shape and margin and moderate (kappa = 0.505) for internal pattern. Interobserver agreement was substantial to moderate for all morphologic parameters (kappa ≥0.596). Morphology evaluated on DWI provided 83-84% accuracy in discriminating malignant from benign masses. ADC alone provided 90-91% accuracy. Both morphologic parameters and ADC were significantly associated with malignancy on multivariate analysis and provided 91-93% accuracy.Data ConclusionDWI might be used not only for ADC evaluation but also for the morphological evaluation of breast masses to characterize them.Level Of Evidence3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;48:1668-1677.© 2018 International Society for Magnetic Resonance in Medicine.

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