Qualitative Assessment of Signal Intensity Evolution Across Three b-Values in DWIBS for Breast Lesion Differentiation.

Authors

Enas Moustafa Ibrahim, Shiamaa Samir Elwelily, Mohamad Gamal Nada, Yasmin Ibrahim Libda, Basma Kamal Soliman, Amr Essam Abdel Mageed Abdallah, Noha Yahia Ebaid

Published in

Academic radiology. Sep 23, 2026. Epub Sep 23, 2026.

Abstract

To evaluate the diagnostic accuracy and inter-observer reliability of qualitative signal intensity (SI) changes across three b-values in diffusion-weighted imaging with background suppression (DWIBS) for differentiating benign from malignant breast lesions.
This prospective diagnostic accuracy study enrolled 113 consecutive female patients (mean age 44.7 ± 12.1 years) with sono-mammographically suspicious lesions who underwent breast MRI including T2-weighted imaging and DWIBS at b-values of 800, 1000, and 1500 s/mm². Three expert breast-imaging radiologists independently assessed T2WI, SI behavior across b-values, and assigned a final ACR BI-RADS MRI category. Diagnostic performance was computed using the histopathological examination as the reference standard. Chi-square/Fisher exact tests evaluated the association between SI pattern on DWIBS and malignant outcome. Inter-observer agreement was assessed with Fleiss' kappa (SI classification).
Of 113 lesions, 64 (56.6%) were malignant and 49 (43.4%) were benign. SI changes from b = 800 to 1500s/mm² yielded sensitivity of 85.7-90.5%, specificity of 100%, and accuracy of 92.0-94.7% between reader 1 and 2 considering the increased SI as the optimal cutoff for predicting malignancy. While reader 3 recorded a stable/isointense SI as the best cutoff for predicting malignancy with sensitivity of 100%, specificity of 87.5% and accuracy of 94.7%. Inter-observer agreement was almost perfect for SI changes (κ = 0.856, p < 0.001).
DWIBS across three b-values provides an alternative, contrast-free method for breast lesion characterization with high reproducibility. DWIBS merits prospective validation within full DCE-MRI protocols in larger multicenter studies before clinical adoption.

PMID:
42778473
Bibliographic data and abstract were imported from PubMed on 24 Sep 2026.

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