Advanced Diffusion MRI for Women's Cancer Imaging

Accurate, non-invasive tumor characterization remains a critical challenge in gynecologic and breast oncology. Conventional diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) mapping provide limited biological specificity, constraining their utility for diagnosis, staging, and treatment response assessment. Restriction Spectrum Imaging (RSI), an advanced multi-shell diffusion MRI framework, addresses these limitations by decomposing the diffusion signal into biologically distinct compartments — restricted, hindered, and free water fractions — enabling superior in vivo characterization of tissue microstructure.
This talk presents clinical and translational applications of RSI across three cancer sites. In breast cancer, RSI-derived signal fraction maps demonstrate improved lesion conspicuity over standard DWI, with data supporting reduced unnecessary biopsies through more accurate discrimination of malignant from benign lesions. In cervical cancer, voxel-wise probability maps generated from multi-shell RSI acquisitions enable quantitative assessment of tumor extent, with promising applications in pre-treatment staging and longitudinal monitoring of chemoradiotherapy response. In ovarian cancer, RSI preliminary findings suggest the hindered diffusion fraction may differentiate borderline from malignant tumors, a distinction with significant surgical implications.
Ongoing work correlates RSI biomarkers with molecular markers of tumor biology, including Myc expression as a surrogate for cellularity and FAK for vascularity, bridging quantitative imaging with tumor genomics. These advances position RSI as a biologically grounded tool for precision oncology, with potential to transform staging, treatment planning, and surveillance across women's cancers.