Characterization of Breast Tumors Using Diffusion Kurtosis Imaging (DKI)

Aim: The aim of this study was to investigate and evaluate the role of magnetic resonance (MR) diffusion kurtosis imaging (DKI) in characterizing breast lesions. Materials and Methods: One hundred and twenty-four lesions in 103 patients (mean age: 57 +/- 14 years) were evaluated by MR DKI performed with 7 b-values of 0, 250, 500, 750, 1,000, 1,500, 2,000 s/mm(2) and dynamic contrast-enhanced (DCE) MR imaging. Breast lesions were histologically characterized and DKI related parameters-mean diffusivity (MD) and mean kurtosis (MK)-were measured. The MD and MK in normal fibroglandular breast tissue, benign and malignant lesions were compared by One-way analysis of variance (ANOVA) with Tukey's multiple comparison test. Receiver operating characteristic (ROC) analysis was performed to assess the sensitivity and specificity of MD and MK in the diagnosis of breast lesions. Results: The benign lesions (n = 42) and malignant lesions (n = 82) had mean diameters of 11.4 +/- 3.4 mm and 35.8 +/- 20.1 mm, respectively. The MK for malignant lesions (0.88 +/- 0.17) was significantly higher than that for benign lesions (0.47 +/- 0.14) (P < 0.001), and, in contrast, MD for benign lesions (1.97 +/- 0.35 (10(-3) mm(2)/s)) was higher than that for malignant lesions (1.20 +/- 0.31 (10(-3) mm(2)/s)) (P < 0.001). At a cutoff MD/MK 1.58 (10(-3) mm(2)s)/0.69, sensitivity and specificity of MD/MK for the diagnosis of malignant were 79.3%/84.2% and 92.9%/92.9%, respectively. The area under the curve (AUC) is 0.86/0.92 for MD/MK. Conclusions: DKI could provide valuable information on the diffusion properties related to tumor microenvironment and increase diagnostic confidence of breast tumors.