• Jung Hyun Park, YunBo LaB0000-0002-5457-7847Department of Radiology, Seoul National University Bundang Hospital, Nam, Gyeongi-do, Republic of Korea., Mijung Jang, Hye Shin Ahn, Sun Mi Kim, Soo Hyun Lee, Eunyoung Kang, Eun-Kyu Kim, and So Yeon Park.
• Department of Radiology, Seoul National University Bundang Hospital, Nam, Gyeongi-do, Republic of Korea.
• J Magn Reson Imaging. 2019 Mar 1; 49 (3): 857-863.

BackgroundAcquired high b-value (>1000 s/mm2 ) diffusion-weighted imaging (DWI) has its strength in lesion detection. However, it is not easily used, due to a lower signal-to-noise ratio, eddy current distortions, and prolonged acquisition times. Synthetic DWI does not have these disadvantages because it is based on indirect acquisition, calculated in a voxel-wise manner.PurposeTo compare the diagnostic performance of synthetic and acquired high b-value (1500 s/mm2 ) DWI in women with breast cancer.Study TypeRetrospective.PopulationA total of 108 patients (median age 49 years [range 32-77]) with 133 breast cancers.Field Strength/Sequence3T, echo-planar imaging.AssessmentThree radiologists independently reviewed image sets of both synthetic (S-b1500) and acquired (A-b1500) high b-value DWI. Malignancy confidence of the lesion was scored using a 6-point Likert-type scale.Statistical TestJack-knife alternative free-response receiver-operating characteristic 1 (JAFROC1) analysis was used. Sensitivity and positive predictive value (PPV) were compared using generalized estimating equations. An independent t-test was used to compare the confidence. An intraclass correlation coefficient was calculated to compare interobserver agreement.ResultsThe JAFROC1 figures of merit values were 0.816 and 0.808 in S-b1500 and A-b1500, respectively, with no statistically significant difference (P = 0.637). Sensitivity was higher in synthetic than in A-b1500 for readers 2 (P = 0.015) and 3 (P = 0.037). Although sensitivity was higher in S-b1500 than in A-b1500 for reader 1, the difference was not significant (P = 0.487). The PPV of S-b1500 was not significantly different from that of A-b1500 (P = 0.397). The malignancy confidence of true-positive tumors was higher in S-b1500 than in A-b1500 (P = 0.013). Interobserver agreement was good for both sequences.Data ConclusionsThe synthetic high b-value DWI may improve the diagnostic sensitivity for breast cancer detection without affecting PPV compared with acquired high b-value DWI.Level Of Evidence3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:857-863.© 2018 International Society for Magnetic Resonance in Medicine.

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