Breast magnetic resonance imaging (MRI) is an excellent technique for breast screening with estimated 99% sensitivity and 89% specificity of [1]. The number of breast MRI examinations performed each year is on the increase, partly linked to the increase in screening indications [2]. In this setting, abbreviated protocols could simplify breast MRI examinations by decreasing the acquisition and reading times of breast MRI, for a similar sensitivity [3], [4], [5]. The main limitation of abbreviated protocol is the loss of the washout criteria which improves lesion characterization and thus increases specificity of breast MRI [6,7]. In this setting, some authors demonstrated the equal diagnostic value of early enhancement evaluated on ultrafast MRI analysis. Diffusion weighted imaging (DWI) is another key sequence to improve lesion characterization and is routinely recommended for breast lesion classification [8,9]. Apparent diffusion coefficient (ADC) values measured from DWI sequences have been widely studied [10], [11], [12], [13], [14] and thought to be of limited use in routine clinical practice due to variability, the presence of artifacts, a lack of standardization [15,16] and a lack of validation in an external dataset [14,17]. Nevertheless, recent meta-analyses have suggested a great potential for the clinical implementation of ADC [15,18] with one reporting a pooled sensitivity of 84% and specificity of 79% for lesion ADC values to predict malignancy [13]. A consensus and mission statement from the European Society of Breast Radiology (EUSOBI) International Breast Diffusion-Weighted Imaging working group encourages the inclusion of a DWI in all MRI protocols regardless of the indication [8]. A previous study fulfilled the prospective trial conditions, providing a rigorously determined ADC cutoff of 1.5 × 10−3 mm2/s and was validated by an external dataset [19,20].

Our objectives were to validate the added value of both criteria (i.e., early enhancement (≤ 30 s) on ultrafast and an ADC cut-off of 1.5 × 10−3 mm2/s) to improve diagnostic value of an abbreviated breast MRI protocol in a large cohort and to compare this value with the diagnostic value of conventional breast MRI protocol.