Three-compartment spectral diffusion analysis for breast cancer magnetic resonance imaging.

RATIONALE AND OBJECTIVES: To examine the diagnostic performance of a three-compartment diffusion model with the fixed cut-off diffusion coefficient (D) using magnetic resonance spectral diffusion analysis for differentiating between invasive ductal carcinoma (IDC) and ductal carcinoma in situ (DCIS) and compare the conventional apparent D (ADC), and mean kurtosis (MK), with the tissue D (DIVIM ), perfusion D (D*IVIM ), and perfusion fraction (fIVIM ) calculated by conventional intravoxel incoherent motion.

PATIENTS AND METHODS: This retrospective study included women who underwent breast MRI with eight b-value diffusion-weighted imaging between February 2019 and March 2022. Spectral diffusion analysis was performed; very-slow, cellular, and perfusion compartments were defined using cut-off Ds of 0.1 × 10-3 and 3.0 × 10-3  mm2 /s (static water D). The mean D (Ds , Dc , Dp , respectively) and fraction F (Fs , Fc , Fp , respectively) for each compartment were calculated. ADC and MK values were also calculated; receiver operating characteristic analyses were performed.

RESULTS: Histologically confirmed 132 ICD and 62 DCIS (age range 31-87 [53 ± 11] years) were evaluated. The areas under the curve (AUCs) for ADC, MK, DIVIM , D*IVIM , fIVIM , Ds , Dc , Dp , Fs , Fc , and Fp were 0.77, 0.72, 0.77, 0.51, 0.67, 0.54, 0.78, 0.51, 0.57, 0.54, and 0.57, respectively. The AUCs for the model combining very-slow and cellular compartments and the model combining the three compartments were 0.81 each, slightly and significantly higher than for ADC, DIVIM , and Dc (P = 0.09-0.14); and MK (P < 0.05), respectively.

CONCLUSION: Three-compartment model analysis using the diffusion spectrum accurately differentiated IDC from DCIS; however, it was not superior to ADC and DIVIM . The diagnostic performance of MK was lower than that of the three-compartment model.