Diagnostic and Interventional Radiology
Breast Imaging - Original Article

Region of interest demarcation for quantification of the apparent diffusion coefficient in breast lesions and its interobserver variability


Department of Radiology, Hospital São João, Porto University School of Medicine, Porto, Portugal; School of Allied Health Sciences, Oporto Polytechnic Institute, Porto, Portugal


MRI Unit, Department of Radiology, Hospital São João, Porto, Portugal


Department of Health Community, Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal


Institute of Biophysics and Biomedical Engineering, School of Sciences, University of Lisbon, Lisbon, Portugal


Department of Radiology, Hospital São João, Porto University School of Medicine, Porto, Portugal

Diagn Interv Radiol 2015; 21: 123-127
DOI: 10.5152/dir.2014.14217
Read: 1116 Downloads: 364 Published: 03 September 2019



We aimed to compare two different methods of region of interest (ROI) demarcation and determine interobserver variability on apparent diffusion coefficient (ADC) in breast lesions.



Thirty-two patients with 39 lesions were evaluated with a 3.0 Tesla scanner using a diffusion-weighted sequence with several b-values. Two observers independently performed the ADC measurements using: 1) a small fixed area of 10 mm2 ROI within the area with highest restriction; 2) a large ROI so as to include the whole lesion. Differences were assessed using the Wilcoxon-rank test. Bland-Altman method and Spearman coefficient were applied for interobserver variability and correlation analysis.



ADC values measured using the two ROI demarcation methods were significantly different for both observers (P = 0.026; P = 0.033). There was no interobserver variability in ADC values using either method (large ROI, P = 0.21; small ROI,  P = 0.64). ADC values of malignant lesions were significantly different between the two methods (P < 0.001). Variability in ADC was  ≤0.008×10-3 mm2/s for both methods. When using the same method, ADC values were significantly correlated between the observers (small ROI: r=0.990, P < 0.001; large ROI: r=0.985, P < 0.001).




The choice of ROI demarcation method influences ADC measurements. Small ROIs show less overlap in ADC values and higher ADC reproducibility, suggesting that this method may improve lesion discrimination. Interobserver variability was low for both methods. 

EISSN 1305-3612