Comparison of Advanced ZOOMit DWI, SMS Readout-segmented EPI DWI and Single-shot EPI DWI for evaluation of primary breast lesions at 3T MRI

Motivation: Optimal diffusion-weighted imaging (DWI) sequence selection for breast lesion characterization remains challenging, with various techniques offering different advantages. Goal(s): To comprehensively compare three DWI techniques (A-ZOOMit DWI, SMS rs-EPI DWI, and ss-EPI DWI) for breast lesion evaluation at 3T MRI. Approach: In this prospective study of 68 patients with suspicious breast lesions, three experienced observers evaluated quantitative metrics and qualitative parameters using standardized assessment criteria. Results: A-ZOOMit DWI demonstrated superior measurement precision (AUC=0.92) and image quality, while SMS rs-EPI DWI excelled in periareolar regions. Each sequence showed distinct advantages for specific clinical scenarios, providing evidence-based guidance for protocol optimization. Impact: This evidence-based comparison enables optimized protocol selection for breast DWI based on specific clinical needs and lesion locations, potentially improving diagnostic accuracy and standardizing breast MRI protocols in clinical practice.