![]() The combined model (D + D* + MD + MK) showed an AUC of 0.830 in diagnosing the Luminal and non-Luminal subtypes, which is significantly higher than that of a single parameter (Z = 3.273~4.440, p < 0.01). ![]() Luminal A/B showed significantly lower D, D*, MD, and MK than the non-Luminal subtypes (p < 0.05). The HER-2-positive subtype demonstrated increased ADC values compared with the Luminal B subtype (p < 0.05). Luminal B showed decreased D value compared with other subtypes (p < 0.05). D* and f values in the Luminal A subtype were significantly lower than in other subtypes (p < 0.05). The AUC of the combined model (D + D* + f + MK) was 0.755, being significantly higher than that of single parameters (Z = 2.770~3.244, p = 0.001~0.006) in distinguishing high from low Ki-67 expression. Additionally, higher D*, f, and MK and lower ADC and D values were observed in the high Ki-67 than low Ki-67 expression groups (p < 0.05). The combination of D* and MK demonstrated the highest AUC of 0.734 in grading NPI with sensitivity and accuracy of 71.7% and 77.1%, respectively. When D* ≥ 30.95 × 10 −3 mm 2/s and MK ≥ 0.69, the NPI tended to be high grade (with areas under the curve (AUCs) of 0.712 and 0.647, respectively). Results: D* and MK values were significantly higher in the high-grade Nottingham group (NPI ≥ 3.4) than the low-grade Nottingham group (NPI < 3.4) (p < 0.01). The nomogram of the combined genotype-prediction model was established based on the multivariate logistic regression model results. Multivariate logistic regression analysis and receiver operating characteristic (ROC) curve were used to analyze the diagnostic efficacy in predicting the Nottingham prognostic index (NPI), the expression of antigen Ki-67, and the molecular subtypes of breast cancer. The corresponding ADC, true diffusion coefficient (D), perfusion-related diffusion coefficient (D*), perfusion fraction (f), mean diffusion rate (MD), and mean kurtosis value (MK) were measured. Diffusion-weighted imaging (DWI), IVIM, and DKI were performed in all patients. Materials and Methods: A total of 227 patients with breast cancer confirmed by pathology were reviewed retrospectively. Purpose: To explore the clinical value of apparent diffusion coefficient (ADC), intravoxel incoherent motion (IVIM), and diffusion kurtosis imaging (DKI) based on diffusion-weighted MRI (DW-MRI) for predicting genotypes and prognostic factors of breast cancer. 2MR Research, GE Healthcare, Beijing, China.1Department of Medical Imaging, Affiliated Hospital of Jining Medical University, Jining, China.Weiwei Wang 1 Xindong Zhang 1 Laimin Zhu 1 Yueqin Chen 1 Weiqiang Dou 2 Fan Zhao 1 Zhe Zhou 1 Zhanguo Sun 1*
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