Advanced breast diffusion-weighted imaging: what are the next steps? A proposal from the EUSOBI International Breast Diffusion-weighted Imaging working group

Abstract Objectives This study by the EUSOBI International Breast Diffusion-weighted Imaging (DWI) working group aimed to evaluate the current and future applications of advanced DWI in breast imaging. Methods A literature search and a comprehensive survey of EUSOBI members to explore the clinical use and potential of advanced DWI techniques and a literature search were involved. Advanced DWI approaches such as intravoxel incoherent motion (IVIM), diffusion kurtosis imaging (DKI), and diffusion tensor imaging (DTI) were assessed for their current status and challenges in clinical implementation. Results Although a literature search revealed an increasing number of publications and growing academic interest in advanced DWI, the survey revealed limited adoption of advanced DWI techniques among EUSOBI members, with 32% using IVIM models, 17% using non-Gaussian diffusion techniques for kurtosis analysis, and only 8% using DTI. A variety of DWI techniques are used, with IVIM being the most popular, but less than half use it, suggesting that the study identified a gap between the potential benefits of advanced DWI and its actual use in clinical practice. Conclusion The findings highlight the need for further research, standardization and simplification to transition advanced DWI from a research tool to regular practice in breast imaging. The study concludes with guidelines and recommendations for future research directions and clinical implementation, emphasizing the importance of interdisciplinary collaboration in this field to improve breast cancer diagnosis and treatment. Clinical relevance statement Advanced DWI in breast imaging, while currently in limited clinical use, offers promising improvements in diagnosis, staging, and treatment monitoring, highlighting the need for standardized protocols, accessible software, and collaborative approaches to promote its broader integration into routine clinical practice. Key Points Increasing number of publications on advanced DWI over the last decade indicates growing research interest . EUSOBI survey shows that advanced DWI is used primarily in research, not extensively in clinical practice . More research and standardization are needed to integrate advanced DWI into routine breast imaging practice .