European Radiology

, Volume 29, Issue 3, pp 1425–1434 | Cite as

Added value of mean and entropy of apparent diffusion coefficient values for evaluating histologic phenotypes of invasive ductal breast cancer with MR imaging

  • Shiteng Suo
  • Dandan Zhang
  • Fang Cheng
  • Mengqiu Cao
  • Jia HuaEmail author
  • Jinsong Lu
  • Jianrong XuEmail author
Magnetic Resonance



To study the added value of mean and entropy of apparent diffusion coefficient (ADC) values at standard (800 s/mm2) and high (1500 s/mm2) b-values obtained with diffusion-weighted imaging in identifying histologic phenotypes of invasive ductal breast cancer (IDC) with MR imaging.


One hundred thirty-four IDC patients underwent diffusion-weighted imaging with b-values of 800 and 1500 s/mm2, and corresponding ADC800 and ADC1500 maps were generated. Mean and entropy of volumetric ADC values were compared with molecular markers (estrogen receptor [ER], progesterone receptor [PR], human epidermal growth factor receptor 2 [HER2], and Ki-67). Associations among morphologic features, ADC metrics, and phenotypes (luminal A, luminal B [HER2 negative], luminal B [HER2 positive], HER2 positive, and triple negative) were evaluated.


Mean ADC values were significantly decreased in ER-positive, PR-positive, and HER2-negative tumors (p < 0.01). Ki-67 ≥ 20% tumors demonstrated significantly higher ADC entropy values compared with Ki-67 < 20% tumors (p < 0.001). Luminal A subtype tended to display lower ADC entropy values compared with other subtypes, while HER2-positive subtype tended to display higher mean ADC values. ADC1500 entropy provided superior diagnostic performance over ADC800 entropy (p = 0.04). Independent risk factors were ADC1500 entropy (p = 0.002) associated with luminal A, irregular mass shape (p = 0.018) and ADC1500 entropy (p = 0.022) with luminal B (HER2 positive), mean ADC1500 (p = 0.018) with HER2 positive, and smooth mass margin (p = 0.012) and rim enhancement (p = 0.003) with triple negative.


Mean and entropy of ADC values provided complementary information and added value for evaluating IDC histologic phenotypes. High-b-value ADC1500 may facilitate better phenotype discrimination.

Key Points

• ADC metrics are associated with molecular marker status in IDC.

• ADC 1500 improves differentiation of histologic phenotypes compared with ADC 800 .

• ADC metrics add value to morphologic features in IDC phenotyping.


Diffusion magnetic resonance imaging Breast cancer Phenotype Immunohistochemistry Prognosis 



Apparent diffusion coefficient


Dynamic contrast enhanced


Diffusion-weighted imaging


Estrogen receptor


Human epidermal growth factor receptor 2


Invasive ductal carcinoma




Odds ratio


Progesterone receptor


Receiver-operating characteristic


Region of interest


Spectral adiabatic inversion recovery


T1-weighted high resolution isotropic volume examination



This study has received funding from the National Natural Science Foundation of China (nos. 81501458 and 81701642) and Medical Engineering Cross Research Foundation of Shanghai Jiao Tong University (nos. YG2015QN37 and YG2014ZD05).

Compliance with Ethical Standards


The scientific guarantor of this publication is Jianrong Xu.

Conflict of Interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and Biometry

No complex statistical methods were necessary for this paper.

Informed Consent

Written informed consent was waived by the Institutional Review Board.

Ethical Approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in:

Suo S, Cheng F, Cao M et al (2017) Multiparametric diffusion-weighted imaging in breast lesions: Association with pathologic diagnosis and prognostic factors. J Magn Reson Imaging. DOI: 10.1002/jmri.25612


• retrospective

• diagnostic or prognostic study

• performed at one institution

Supplementary material

330_2018_5667_MOESM1_ESM.docx (28 kb)
ESM 1 (DOCX 27 kb)


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of Radiology, Renji Hospital, School of MedicineShanghai Jiao Tong UniversityShanghaiChina
  2. 2.Department of Breast Surgery, Renji Hospital, School of MedicineShanghai Jiao Tong UniversityShanghaiChina

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