Diagnostic accuracy and limitations of intravoxel incoherent motion diffusion-weighted imaging for differentiating breast tumors: A systematic review and meta-analysis.

[PURPOSE] Breast cancer diagnosis relies on early detection and accurate subtype identification. This meta-analysis evaluated Diffusion-weighted imaging (DWI) and Intravoxel incoherent motion (IVIM)-DWI techniques for differentiating breast lesions, focusing on sensitivity, specificity, and limitations, to address inconsistencies and enhance diagnostic reliability.

[METHODS] Data from PubMed, Scopus, Embase, and Google Scholar (January 2013-September 2024) were systematically searched to assess the diagnostic accuracy of IVIM for breast lesions. Studies meeting the inclusion criteria underwent QUADAS-2 evaluation. Statistical analyses included SROC curves, heterogeneity assessment, leave-one-out meta-analysis, and publication bias evaluation via R packages and MetaBayesDTA.

[RESULTS] A total of 442 articles were identified; 26 were included in the review, and 23 were included in the meta-analysis. The diffusion coefficient (D), perfusion fraction (f), and apparent diffusion coefficient (ADC) values were significantly different between benign and malignant lesions. Among the parameters, the ADC and D exhibited the highest pooled sensitivity at 0.84 (95% CI: [0.77, 0.89]) across 15 studies, and 0.84 (95% CI: [0.79, 0.88]) across 19 studies, respectively. Also, D parameter demonstrated the highest pooled specificity at 0.80 (95% CI: [0.73, 0.85]).

[CONCLUSION] Our meta-analysis identified D and ADC as the most current effective parameters for distinguishing benign from malignant breast lesions, warranting further research for comprehensive validation. Also, we outlined key methodological considerations in IVIM-DWI breast imaging, including sample size determination, b-value selection, ROI delineation, and menstrual status. However, careful planning, including b-value optimization and precise ROI placement, improves reliability in heterogeneous lesions, but the effect of hormonal fluctuations remains unclear.