Diffusion-weighted breast imaging: Beyond morphology

Abstract

Diffusion-weighted imaging (DWI) is a magnetic resonance imaging (MRI) technique that explores the molecular diffusivity of water in biological tissues to probe its microstructure. Its application to the study of breast lesions has been shown to improve their detection, characterization, and the diagnostic accuracy of breast lesions using MRI. In this chapter, the biophysical basis of diffusion is presented, including the model currently used for DWI in the clinical setting; the concept of apparent diffusion coefficient (ADC) is introduced. A theoretical framework of DWI in healthy conditions and in tissues affected by pathological processes is presented, followed by a literature review on the application of DWI to breast imaging. As the technique has only recently been used in breast imaging studies, controversial issues regarding its application have arisen, namely related to its technical challenges. Therefore, we detail the main technical issues associated with the implementation of DWI in the clinical setting and present potential approaches for obtaining good-quality images. Finally, we identify relevant future research needs involving hardware and software optimization as well as clinical issues which need to be addressed to improve breast lesion diagnosis.