Evaluation of suspicious breast lesions with diffusion kurtosis MR imaging and connection with prognostic factors

Purpose: To investigate the additional value of DKI in discriminating suspicious breast lesions on DCE-MRI, as compared with conventional DWI; and to explore connection between DKI-parameters and prognostic factors of breast cancers. Methods: The institutional review board approved this retrospective study and written informed consent was waived. Totally, 300 women (mean age, 43.2 +/- 10.4 years) with suspicious breast lesions on DCE-MRI were enrolled from November 2014 to September 2019. With pathology as reference, performance of ADC, K-app and D-app in discriminating suspicious breast lesions were analyzed by receiver operating characteristic (ROC) analysis with area under ROC curve (AUC). The specificities of parameters were compared by Chi-square test. The ADC, K-app and D-app of breast cancers with different receptor status were compared using Student's t or Mann-Whitney U or Kruskal-Wallis test. Results: There were 344 suspicious breast lesions (220 malignant, 124 benign) in 300 women. No significant differences were found for AUCs of ADC and DKI-parameters in discriminating suspicious breast lesions (0.882 vs. 0.888, p = 0.480). The specificities were significantly higher with ADC and Dapp than that with DCE-MRI (p = 0.003 and 0.005). The ADC, K-app and D-app were correlated with HER2 expression and lymph node status, and ADC and K-app differed between ER-positive and negative tumors (all p < 0.05). Except K-app, DKI/DWI-parameters showed relation with Ki-67 expression. None of the DKI/DWI-parameters showed relation with lesion grade (all p > 0.05). Conclusion: The more complicated and time-consuming DKI is not superior to conventional DWI in differentiating suspicious breast lesions and reflecting prognostic information of breast cancer.

Automated summary

The study found that DKI is not superior to conventional DWI in differentiating suspicious breast lesions and reflecting prognostic information of breast cancer. The ADC, K-app and D-app were correlated with HER2 expression and lymph node status, and ADC and K-app differed between ER-positive and negative tumors.