Intravoxel incoherent motion diffusion-weighted MRI of invasive breast cancer: Correlation with prognostic factors and kinetic features acquired with computer-aided diagnosis

Abstract

Background: As both intravoxel incoherent motion (IVIM) modeling and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) provide perfusion parameters, IVIM-derived perfusion parameters might be expected to correlate with the kinetic features from DCE-MRI. Purpose: To investigate the association between IVIM parameters and prognostic factors and to evaluate the correlation between IVIM parameters and kinetic features in invasive breast cancer patients using computer-aided diagnosis (CAD). Study Type: Retrospective. Population: Eighty-five patients (invasive cancers; mean size, 1.8 cm; range, 0.8–4.8 cm) who underwent diffusion-weighted imaging with 12 b-values (0–1000 s/mm2). Field Strength/Sequence: 3.0T MRI axial, IVIM-DWI epi-sequence, and DCE-MRI. Assessment: Two radiologists measured the apparent diffusion coefficient (ADC), diffusion coefficient, pseudodiffusion coefficient, and perfusion fraction (f) using IVIM modeling. Kinetic features such as peak enhancement and early and delayed enhancement profiles were acquired using CAD. Statistical Tests: The correlation between the IVIM parameters and kinetic features and the association between the IVIM parameters and prognostic factors were investigated using Mann–Whitney test and Spearman correlation test. Results: There were no significant associations between IVIM parameters and prognostic factors. When IVIM parameters were correlated with kinetic features by CAD, both the ADC and f values showed correlations with delayed enhancement profiles. The ADC values were lower in tumors with lower persistent components (P = 0.013) and higher washout components (P = 0.045) and showed a positive correlation with persistent proportion (Spearman's rho (r) = 0.222, P = 0.041). The f value was higher in tumors with higher persistent components (P = 0.021) and showed a positive correlation with persistent proportion (r = 0.227, P = 0.029). Data Conclusion: This analysis revealed that IVIM-derived ADC and f values showed correlations with kinetic features at the delayed phase as assessed by CAD. These results indicate the potential of IVIM imaging biomarkers to provide information on the biological and kinetic properties of breast cancers without a contrast agent. Level of Evidence: 4. Technical Efficacy: Stage 2. J. Magn. Reson. Imaging 2019;49:118–130.