New lens on breast health - harnessing high-b-value synthetic diffusion-weighted imaging for breast lesion characterization

Q: What was the purpose of evaluating sDWI in this study?

To assess how synthetic DWI at various high b-values distinguishes malignant from benign breast lesions and to compare its performance with conventional DWI.

Q: How were lesions classified and which patient cohort was included?

After excluding 22 lesions, the study retrospectively included 63 women with 68 suspicious breast lesions on ultrasound; lesions were classified malignant or benign based on pathological results.

Q: How did the optimal b-value differ between mass and non-mass lesions?

Optimal high-b-value selection differed by lesion type: mass lesions showed comparable performance between synthetic and conventional b1500, while non-mass lesions benefited more from high-b-value DWI maps (b ≥ 2000 s/mm²).

Q: What was the main clinical takeaway regarding high-b-value sDWI?

A tailored DWI protocol is needed, because high-b-value sDWI offers limited added value for mass lesions but significantly improves malignancy detection in non-mass lesions compared with cDWI and ADC mapping.

Sep 29, 2026

Uploaded by Aditya

Study evaluates diagnostic efficacy of synthetic diffusion-weighted imaging (sDWI) across high b-values for distinguishing malignant from benign breast lesions, and compares it with conventional DWI (cDWI). A retrospective cohort included women with ultrasound-suspicious lesions undergoing multiparametric breast MRI before biopsy. Using pathology, lesions were grouped as malignant or benign and quantitative signal and ADC-derived parameters were tested via ROC analysis and DeLong statistics for both mass and non-mass lesions, identifying differing optimal b-values by lesion type.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

AccessFree to download

Purpose

Methods

Results

Conclusion

Clinical Significance

Keywords

Copyright @ 2026 Author(s) -[Available online at dirjournal.org.](Available online at dirjournal.org. ORIGINAL)[ ORIGINAL](Available online at dirjournal.org. ORIGINAL) ARTICLE Content of this journal is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. New lens on breast health: harnessing high-b-value synthetic diffusionweighted imaging for breast lesion characterization Serap Karabiyik1 Saime Ramadan2 Emil Settarzade3 Ali Ilker Filiz4 Hatice Ozturkmen Akay5 1 İstanbul Training and Research Hospital, Clinic of Radiology, İstanbul, Türkiye 2Baskent University Istanbul Hospital, Department of Pathology, İstanbul, Türkiye 3Zollernalb Klinikum, Radiologie Abteilung, Balingen, Germany 4Baskent University Istanbul Hospital, Department of General Surgery, İstanbul, Türkiye 5Baskent University Istanbul Hospital, Department of Radiology, İstanbul, Türkiye Corresponding author: Serap Karabiyik E-mail: [serapyucl@gmail.com](serapyucl@gmail.com) Received 21 December 2024; revision requested 27 January 2025; last revision received 26 March 2025; accepted 08 April 2025 Epub: 20.05.2025 Publication date: 02.01.2026 DOI: 10.4274/dir.2025.253190 PURPOSE This study aims to evaluate the diagnostic efficacy of synthetic diffusion-weighted imaging (sDWI) at various high b-values in distinguishing malignant from benign breast lesions and to compare its performance with that of conventional DWI (cDWI) . METHODS After the exclusion of 22 lesions, 63 women (age range, 24–99 years; mean age, 53.7 ± 15.1 years) with 68 suspicious breast lesions on ultrasound who underwent multiparametric breast magnetic resonance imaging before biopsy between January 2021 and April 2023 were included in this retrospective study. According to the pathological results, lesions were classified as malignant or benign. Volumetric mask images were defined. The lesion signal/normal breast signal ratio [relative signal intensity (rSI)] was measured on different diffusion-weighted images (cDWI at b = 800 and 1500 s/ mm2; sDWI at b = 1500-5000 s/mm2), and lesion SI on apparent diffusion coefficient (ADC) 0–800 and ADC0–1500 maps (mADC) was calculated. The diagnostic performances of these parameters were evaluated using a receiver operating characteristic curve analysis and the DeLong test in both the mass and non-mass lesion groups. RESULTS A total of 32 (47.06%) benign and 36 (52.94%) malignant lesions were identified. Malignant lesions exhibited significantly higher rSI values on cDWI800, cDWI1500, sDWI1500, sDWI2000, and sDWI3000 (P values: <0 .001, <0 .001, <0 .001, <0 .001, <0 .001, 0.03) and lower mADC800 and mADC1500 values (P values: 0.01 and 0.03) . In mass lesions, synthetic b1500 and conventional b1500 demonstrated diagnostic accuracy comparable with that of routine mADC800 and mADC1500 . However, in non-mass lesions, high-b-value DWI maps (b ≥ 2000 s/mm2) significantly outperformed mADC and cDWI in differentiating malignant from benign lesions. The highest diagnostic accuracy in non-mass lesions was observed with rSIC4000 [area under the curve (AUC) = 0.87], whereas in mass lesions, rSIC1500 exhibited the highest diagnostic performance (AUC = 0.79) . CONCLUSION The optimal b-value for DWI differs between mass and non-mass breast lesions, emphasizing the need for separate evaluation protocols. Although high-b-value sDWI provides limited added diagnostic value in mass lesions, it significantly improves malignancy detection in non-mass lesions, outperforming cDWI and ADC mapping. CLINICAL SIGNIFICANCE This study underscores the need for a tailored DWI protocol for optimal breast lesion characterization, particularly for non-mass lesions, where high-b-value synthetic imaging enhances diagnostic accuracy. KEYWORDS Breast, synthetic diffusion-weighted imaging, high-b-value, breast cancer, magnetic resonance imaging You may cite this article as: Karabiyik S, Ramadan S, S

FAQs

What was the purpose of evaluating sDWI in this study?

To assess how synthetic DWI at various high b-values distinguishes malignant from benign breast lesions and to compare its performance with conventional DWI.

How were lesions classified and which patient cohort was included?

After excluding 22 lesions, the study retrospectively included 63 women with 68 suspicious breast lesions on ultrasound; lesions were classified malignant or benign based on pathological results.

How did the optimal b-value differ between mass and non-mass lesions?

Optimal high-b-value selection differed by lesion type: mass lesions showed comparable performance between synthetic and conventional b1500, while non-mass lesions benefited more from high-b-value DWI maps (b ≥ 2000 s/mm²).

What was the main clinical takeaway regarding high-b-value sDWI?

A tailored DWI protocol is needed, because high-b-value sDWI offers limited added value for mass lesions but significantly improves malignancy detection in non-mass lesions compared with cDWI and ADC mapping.

Sep 29, 2026

Uploaded by Aditya