Diagnostic Value of Diffusion-Weighted MRI in Breast Masses: A Comparative Study with Dual-Energy Contrast -Enhanced Digital Mammography and Dynamic Breast MRI with Contrast

Background: Breast cancer (BC) is the most common malignancy in women. Early detection and accurate characterization are essential for prognosis and treatment planning. Dual-energy contrast-enhanced digital mammography (CEDM) improves diagnostic performance compared to standard mammography, while diffusion-weighted MRI (DW-MRI) offers a fast, non-invasive, and contrast-free method reflecting tissue cellularity. Objectives: To evaluate the diagnostic performance of DW-MRI in differentiating benign from malignant breast lesions and to compare its accuracy with CEDM and dynamic contrast-enhanced MRI (DCE-MRI). Patients and Methods: This retrospective study included 30 women (mean age 41.1 years, range 25–71). All patients had suspicious findings on ultrasound or mammography and underwent DW-MRI, DCE-MRI, and CEDM. Final diagnoses were confirmed by biopsy or surgical excision. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated. Results: DW-MRI showed 73% sensitivity, 100% specificity, 78.9% PPV, 100% NPV, and 86.7% overall accuracy. Combined DW-MRI and DCE-MRI revealed no false negatives, 15 true positives, and 13 true negatives, indicating diagnostic accuracy superior to DCE-MRI alone and better than CEDM. Conclusion: We found that DW-MRI performs better than dual-energy CEDM in the diagnosis of breast lesions and is on par with contrast-enhanced MRI. As a viable substitute for contrast-enhanced imaging, DW MR imaging can be employed.