Aim: Assessing the diagnostic role of multiparametric MRI (mpMRI) in indeterminate mammographic breast lesions and postulated a diagnostic model for MRI interpretation integrating the morphological, and functional parameters.
Material and Methods: Two hundred forty patients included in a self-control retrospective study in a tertiary center. All patients examined with 1.5T MR unit using multiparametric studies including morphological analysis followed by functional evaluation via MR diffusion (MR-DWI), spectroscopy(MRS), and kinetic enhanced curves (DCE-MRI). Diagnostic performance of each parameter was evaluated alone and in combination. The histopathological results were the standard of reference. Results: Combined mpMRI parameters possess a moderate agreement (κ=0.435) with 23.5% false discovery rate (FDR) and an overall accuracy of 78%.On the other hand, combined mpMRI data after omitting MRS data show almost perfect agreement (κ=0.923)with histopathological data and recorded 100% specificity, 90% specificity, 5% FDR and zero% for both false omission rate (FOR) and false-negative rate (FNR). The Quantitative analysis of DWI with ADC map shows a significant statistical value for mean ADC (m-ADC) value and relative ADC (r-ADC) value. The former has cutoff value 1.1x10-3 mm2/sec with higher specificity 97.5% while r-ADC has cutoff value 0.42x10-3 mm2/sec with quite lower specificity 85%. Perfect agreement in the interpretation of DCE-MRI curves, MR-DWI, and MRS with κ =0.92,0.9 and 0.84 respectively.  Conclusion: Tailored combined multiparametric MRI is a potent diagnostic tool in the characterization of indeterminate mammographic breast lesions.