Amide proton transfer weighted imaging and diffusion kurtosis imaging in differentiating malignant from benign breast tumors compared with BI-RADS

Abstract Background: The present study aims to evaluate the diagnostic performance of amide proton transfer weighted imaging (APTWI) and diffusion kurtosis imaging (DKI) in terms of differentiating malignant from benign breast lesions and to compare them with the Breast Imaging Reporting and Data System (BI-RADS) independently or jointly. Methods: In this prospective study, participants with no previous treatment and lesions larger than 10 mm were enrolled from September 2022 to June 2023. All participants underwent APTWI and DKI preoperatively. The APTWI derived MTRasym and DKI parameters of mean kurtosis (MK) and mean diffusivity (MD) values were measured independently by two radiologists. The BI-RADS was scored by another two radiologists. Receiver operating characteristic (ROC) curves were separately generated to evaluate the diagnostic performance of each individual parameter and the combination of all parameters. Pathologic analysis results were used as the gold standard. Results:Totally, 67 participants (48 malignant lesions vs. 19 benign lesions) were evaluated. Malignant lesions showed higher MTRasym value, lower MD value and higher MK value than benign lesions. The resultant areas under the ROC curves (AUC) were 0.836 for MTRasym, 0.970 for MD, 0.905 for MK, and 0.690 for BI-RADS in differentiating malignant from benign breast lesions. Moreover, with the combination of quantitative parameters of the two quantitative MRI techniques, the diagnostic performance and specificity of BI-RADS were improved. Conclusion: APTWI and DKI have been demonstrated as potentially promising quantitative techniques for distinguishing the characteristics of breast lesions and may augment the diagnostic performance of BI-RADS.