How to optimize breast MRI protocol? The value of combined analysis of ultrafast and diffusion-weighted MRI sequences

•Ultrafast MRI sequences and diffusion-weighted sequences are useful to improve specificity and improve BI-RADS classification of breast lesions presenting with benign morphology.•Washout criteria issued from the analysis of time intensity curves can be equally replaced by early enhancement analysis (≤ 30 s after injection) on ultrafast MRI sequences.•Apparent diffusion coefficient ≥ 1.5 × 10−3 mm2/s allows excluding malignancy in mass or non-mass breast lesions (excluding focus) rated BI-RADS 3, 4A or 4B.•BI-RADS analysis based on a simple short protocol plus early enhancement on ultrafast sequences and apparent diffusion coefficient value has a greater diagnostic accuracy than a conventional protocol and may avoid unnecessary breast biopsy.