Application value of 3T 1H-magnetic resonance spectroscopy in diagnosing breast tumors

Background Assessment of breast lesions with magnetic resonance imaging (MRI) provides a means for lesion detection and diagnosis. Proton (hydrogen-1) magnetic resonance spectroscopy (1H-MRS) has been proposed as a useful diagnostic technique in providing metabolic information of suspicious breast lesions. Purpose To determine the clinical significance of in-vivo single voxel 1H-MRS at 3T in the assessment of benign and malignant breast lesions in combination with dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Material and Methods Twenty-four women with known breast abnormalities from conventional imaging (mammography, ultrasonography) underwent DCE-MRI at a 3T MR scanner and 26 breast lesions were detected. Breast lesions were assessed according BI-RADS classification. Single voxel 1H-MRS was performed after gadolinium administration and choline peak was qualitatively evaluated. All lesions were confirmed histologically from the surgically excised specimens. Sensitivity, specificity, and accuracy of the 1H-MRS, of the BI-RADS classification and of their combination (DCE-MRI + 1H-MRS) were calculated. Results Fifteen out of 26 lesions proved to be malignant and 11 proved to be benign. In our study 1H-MRS showed sensitivity 80%, specificity 81.8%, and accuracy 80.7%. DCE-MRI showed sensitivity 100%, specificity 63.6%, and accuracy 84.6%. The combination of DCE-MRI and 1H-MRS provided higher accuracy (96.4%), as well as higher specificity 81.8% compared to BI-RADS classification. Conclusion The combined use of 1H-MRS and DCE-MRI found to have improved diagnostic performance in the assessment of equivocal breast lesions. 1H-MRS can be used as a useful adjunct during lesion characterization in clinical routine in cases classified as BI-RADS 3 and 4.

[1]  Z. Bhujwalla,et al.  Malignant transformation alters membrane choline phospholipid metabolism of human mammary epithelial cells. , 1999, Cancer research.

[2]  H. Degani,et al.  Metabolic markers of breast cancer: enhanced choline metabolism and reduced choline-ether-phospholipid synthesis. , 2002, Cancer research.

[3]  Linda Moy,et al.  Is breast MRI helpful in the evaluation of inconclusive mammographic findings? , 2009, AJR. American journal of roentgenology.

[4]  W. Negendank,et al.  Studies of human tumors by MRS: A review , 1992, NMR in biomedicine.

[5]  Hon J. Yu,et al.  Detection of choline signal in human breast lesions with chemical‐shift imaging , 2008, Journal of magnetic resonance imaging : JMRI.

[6]  H. Degani,et al.  Variations in energy and phospholipid metabolism in normal and cancer human mammary epithelial cells. , 1996, Anticancer research.

[7]  D. Bluemke,et al.  Proton magnetic resonance spectroscopic imaging of human breast cancer: A preliminary study , 2004, Journal of magnetic resonance imaging : JMRI.

[8]  I. Gribbestad,et al.  Characterization of neoplastic and normal human breast tissues with in vivo 1H MR spectroscopy , 1999, Journal of magnetic resonance imaging : JMRI.

[9]  K. Brandt,et al.  Adding in vivo quantitative 1H MR spectroscopy to improve diagnostic accuracy of breast MR imaging: preliminary results of observer performance study at 4.0 T. , 2005, Radiology.

[10]  Winnie C W Chu,et al.  Characterization of lesions of the breast with proton MR spectroscopy: comparison of carcinomas, benign lesions, and phyllodes tumors. , 2003, AJR. American journal of roentgenology.

[11]  Wei Huang,et al.  A high spatial resolution 1H magnetic resonance spectroscopic imaging technique for breast cancer with a short echo time. , 2008, Magnetic resonance imaging.

[12]  D. Yeung,et al.  Human breast lesions: characterization with contrast-enhanced in vivo proton MR spectroscopy--initial results. , 2001, Radiology.

[13]  Michael Garwood,et al.  In vivo quantification of choline compounds in the breast with 1H MR spectroscopy , 2003, Magnetic resonance in medicine.

[14]  Saadallah Ramadan,et al.  Proton MRS of the breast in the clinical setting , 2009, NMR in biomedicine.

[15]  R. Lenkinski,et al.  Human breast lesions: characterization with proton MR spectroscopy. , 1998, Radiology.

[16]  Wei Huang,et al.  Proton MR spectroscopy with choline peak as malignancy marker improves positive predictive value for breast cancer diagnosis: preliminary study. , 2006, Radiology.

[17]  F. Podo,et al.  In vivo proton MR spectroscopy of the breast using the total choline peak integral as a marker of malignancy. , 2009, AJR. American journal of roentgenology.

[18]  R. Birdwell.  1H MR Spectroscopy and Diffusion-Weighted Imaging of the Breast: Are They Useful Tools for Characterizing Breast Lesions Before Biopsy? , 2010 .

[19]  C. Kappas,et al.  Magnetic Resonance Spectroscopy of the Breast at 3T: Pre- and Post-Contrast Evaluation for Breast Lesion Characterization , 2012, TheScientificWorldJournal.

[20]  G. Glover,et al.  Breast disease: dynamic spiral MR imaging. , 1998, Radiology.

[21]  I. Gribbestad,et al.  In vivo 1H MRS of normal breast and breast tumors using a dedicated double breast coil , 1998, Journal of magnetic resonance imaging : JMRI.

[22]  E. Yeh.  Characterization of breast lesions with proton MR spectroscopy. , 2003, AJR. American journal of roentgenology.

[23]  Michael Garwood,et al.  Metabolite quantification and high‐field MRS in breast cancer , 2009, NMR in biomedicine.

[24]  H. D. de Koning,et al.  Efficacy of MRI and mammography for breast-cancer screening in women with a familial or genetic predisposition. , 2004, The New England journal of medicine.

[25]  Peter Stanwell,et al.  In vivo proton MR spectroscopy of the breast. , 2007, Radiographics : a review publication of the Radiological Society of North America, Inc.

[26]  C. Kuhl,et al.  Dynamic breast MR imaging: are signal intensity time course data useful for differential diagnosis of enhancing lesions? , 1999, Radiology.

[27]  Hiromu Nishitani,et al.  Comparison of 3.0-and 1.5-tesla diffusion-weighted imaging in the visibility of breast cancer , 2008, Radiation Medicine.

[28]  M. Yaffe,et al.  American Cancer Society Guidelines for Breast Screening with MRI as an Adjunct to Mammography , 2007 .

[29]  Juan Alvarez-Linera,et al.  3T MRI: advances in brain imaging. , 2008, European journal of radiology.

[30]  W. Thilly,et al.  Pyruvate utilization, phosphocholine and adenosine triphosphate (ATP) are markers of human breast tumor progression: a 31P- and 13C-nuclear magnetic resonance (NMR) spectroscopy study. , 1995, Cancer research.

[31]  M. Oudkerk,et al.  The negative predictive value of breast Magnetic Resonance Imaging in noncalcified BIRADS 3 lesions. , 2012, European journal of radiology.

[32]  T. Helbich,et al.  Three-dimensional proton MR spectroscopic imaging at 3 T for the differentiation of benign and malignant breast lesions. , 2011, Radiology.

[33]  M D Schnall,et al.  MR imaging of the breast for the detection, diagnosis, and staging of breast cancer. , 2001, Radiology.

[34]  M. Moerland,et al.  Human breast cancer in vivo: H-1 and P-31 MR spectroscopy at 1.5 T. , 1988, Radiology.

[35]  L. Liberman,et al.  Breast cancer screening with MRI--what are the data for patients at high risk? , 2004, The New England journal of medicine.

[36]  Dimitrios L. Arvanitis,et al.  Characterization of breast lesions with CE-MR multimodal morphological and kinetic analysis: comparison with conventional mammography and high-resolution ultrasound. , 2009, European journal of radiology.

[37]  M. Leach,et al.  The effect of Gd-DTPA on T(1)-weighted choline signal in human brain tumours. , 2002, Magnetic resonance imaging.

[38]  R. Lenkinski,et al.  Clinical utility of proton magnetic resonance spectroscopy in characterizing breast lesions. , 2002, Journal of the National Cancer Institute.

[39]  D Krebs,et al.  Breast MR imaging screening in 192 women proved or suspected to be carriers of a breast cancer susceptibility gene: preliminary results. , 2000, Radiology.

[40]  B. Grube,et al.  MRI of occult breast carcinoma in a high-risk population , 2004 .

[41]  L. Liberman,et al.  Breast lesions detected on MR imaging: features and positive predictive value. , 2002, AJR. American journal of roentgenology.

[42]  Peter B Barker,et al.  Combined dynamic contrast enhanced breast MR and proton spectroscopic imaging: A feasibility study , 2005, Journal of magnetic resonance imaging : JMRI.

[43]  R. Lenkinski,et al.  Interaction of gadolinium‐based MR contrast agents with choline: Implications for MR spectroscopy (MRS) of the breast , 2009, Magnetic resonance in medicine.

[44]  Wei-Tse Yang,et al.  Breast cancer: in vivo proton MR spectroscopy in the characterization of histopathologic subtypes and preliminary observations in axillary node metastases. , 2002, Radiology.

[45]  K. Offit,et al.  Breast MRI for women with hereditary cancer risk. , 2004, JAMA.

[46]  Robert E. Lenkinski,et al.  The evaluation of human breast lesions with magnetic resonance imaging and proton magnetic resonance spectroscopy , 2001, Breast Cancer Research and Treatment.