DWI of the Breast – Possibilities and Limitations

Abstract

Background The MRI of the breast is of great importance in the diagnosis of disorders of the breast. This can be stated for the primary diagnosis as well as the follow up. Of special interest is diffusion weighted imaging (DWI), which has an increasingly important role. The present review provides results regarding the diagnostic and prognostic relevance of DWI for disorders of the breast.

Methods Under consideration of the recently published literature, the clinical value of DWI of the breast is discussed. Several diagnostic applications are shown, especially for the primary diagnosis of unclear tumors of the breast, the prediction of the axillary lymph node status and the possibility of a native screening. Moreover, correlations between DWI and histopathology features and treatment prediction with DWI are provided.

Results Many studies have shown the diagnostic value of DWI for the primary diagnosis of intramammary lesions. Benign lesions of the breast have significantly higher apparent diffusion coefficients (ADC values) compared to malignant tumors. This can be clinically used to reduce unnecessary biopsies in clinical routine. However, there are inconclusive results for the prediction of the histological subtype of the breast cancer. DWI can aid in the prediction of treatment to neoadjuvant chemotherapy.

Conclusion DWI is a very promising imaging modality, which should be included in the standard protocol of the MRI of the breast. DWI can provide clinically value in the diagnosis as well as for prognosis in breast cancer.

Key Points: 

• DWI can aid in the discrimination between benign and malignant tumors of the breast and therefore avoiding unnecessary biopsies.

• The ADC value cannot discriminate between immunhistochemical subtypes of the breast cancer

• The ADC value of breast cancer increases under neoadjuvant chemotherapy and can by this aid in treatment prediction.

• There is definite need of standardisation for clinical translation

Citation Format

• Meyer HJ, Martin M, Denecke T. DWI of the Breast – Possibilities and Limitations. Fortschr Röntgenstr 2022; 194: 966 – 973

Key words

DWI - breast cancer - ADC

Publication History

Received: 12 March 2021

Accepted: 25 January 2022

Article published online:
19 April 2022

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