This review is focused on two relatively new developments in magnetic resonance imaging (MRI) and their application to breast lesion characterization: diffusion and perfusion MRI. Diffusion MRI measures the mobility of the water protons and thus provides a window to tissue microstructure. Perfusion MRI measures the rate at which blood is delivered to tissue and thus provides information about microvasculature. Because both tissue structure and vasculature are likely to change in disease states, measurement of diffusion and perfusion may have direct physiologic relevance. This review covers topics related to the imaging sequences, image analysis, and clinical studies for diffusion and perfusion breast MRI. Preliminary studies show that the apparent diffusion coefficient (ADC) is a marker of cell density and can distinguish malignant from benign lesions. Perfusion MR also shows promise for breast tumor characterization: malignant tumors have consistently higher relative tissue blood volumes (rTBV) than normal and benign tumors. Additional research is required with large patient cohorts to establish these two techniques on a clinical footing.
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