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In phase one, 16 ANTs library-based co-registration methods were evaluated on a subset of\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009138 cases from our in-house cohort. The quantitative assessment included mean ADC values of manually segmented lesions (diagnostic metrics using individual and A6702-defined thresholds) and coefficient of Variation. In the second phase, the best-performing methods were tested for generalizability on an unseen set of 40 cases (20 from in-house and 20 from external dataset). Three blinded readers segmented lesions on co-registered and non-co-registered ADC maps. Agreement and consistency were evaluated via Bland\u2013Altman, segmentation distance, and intraclass correlation coefficient.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Rigid co-registration using DWI at\n                      <jats:italic>b<\/jats:italic>\n                      \u2009=\u2009750\u00a0s\/mm\n                      <jats:sup>2<\/jats:sup>\n                      as reference (b750-Rigid) improved accuracy of both optimal\/conservative A6702 trial thresholds with sensitivity\/specificity increasing from 93%\/10% to 97%\/30% and 100%\/30% respectively. Mean ADC values were not significantly different after co-registration (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Co-registration of DWI images before ADC map generation, particularly using b750-Rigid registration, seems promising for improving lesion classification in breast MRI. Further validation is warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10334-026-01324-z","type":"journal-article","created":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T07:50:38Z","timestamp":1769845838000},"page":"645-662","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Influence of co-registration on lesion characterization in diffusion-weighted breast MRI"],"prefix":"10.1007","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4591-4354","authenticated-orcid":false,"given":"Luise","family":"Brock","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrzej","family":"Liebert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannes","family":"Schreiter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominika","family":"Skwierawska","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Ehring","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Eberle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shirin","family":"Heidarikahkesh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederik Bernd","family":"Laun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Uder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenz","family":"Kapsner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"Lach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evelyn","family":"Wenkel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabine","family":"Ohlmeyer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominique","family":"Hadler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Knoll","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Bickelhaupt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,31]]},"reference":[{"issue":"12","key":"1324_CR1","doi-asserted-by":"publisher","first-page":"3669","DOI":"10.1007\/s00330-015-3807-z","volume":"25","author":"RM Mann","year":"2015","unstructured":"Mann RM, Balleyguier C, Baltzer PA, Bick U, Colin C, Cornford E, Evans A, Fallenberg E, Forrai G, Fuchsjager MH, Gilbert FJ, Helbich TH, Heywang-Kobrunner SH, Camps-Herrero J, Kuhl CK, Martincich L, Pediconi F, Panizza P, Pina LJ, Pijnappel RM, Pinker-Domenig K, Skaane P, Sardanelli F, wlrbED-TEBCC European Society of Breast Imaging (2015) Breast MRI: EUSOBI recommendations for women\u2019s information. 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