Abstract
Magnetic Resonance Imaging has gained popularity in breast cancer diagnosis since the introduction of contrast media, and recent developments in MRI have demonstrated a new potential use in diagnosis. Indeed, the application of in vivo spectroscopy to mammary tissue has revealed that the spectral appearance of choline could be a marker of malignancy, but early diagnosis and unambiguous breast cancer characterization could benefit by a standardized protocol for the simultaneous use of Dynamic Contrast Enhancement MRI and Magnetic Resonance Spectroscopy and combined interpretation of associated markers. A total of 29 female patients took part in the study. The combined protocol was performed on a General Electric Signa HDtx 1.5 Tesla, and the DCE data analysis was performed through an evaluation of the ROI signal intensity over time. The MRS data analysis evaluated choline concentration and the signal to noise ratio of the choline peak. Sensitivity, specificity and accuracy were assessed by the Receiver Operating Characteristic methodology for Dynamic Contrast Enhancement, Magnetic Resonance Spectroscopy and their linear combination. We performed a linear combination of Dynamic Contrast Enhancement MRI and 1H-Magnetic Resonance Spectroscopy by distribution free approach to obtain a high level diagnostic index. Combining the results of the two diagnostic tests has resulted in a new, very effective, diagnostic index able to discriminate between patients with and without malignant disease.
Highlights
Accurate breast cancer diagnosis is essential to implement successful treatments and to improve the patient’s quality of life
The application of in vivo spectroscopy to mammary tissue has revealed that the spectral appearance of choline could be a marker of malignancy, but early diagnosis and unambiguous breast cancer characterization could benefit by a standardized protocol for the simultaneous use of Dynamic Contrast Enhancement Magnetic Resonance Imaging (MRI) and Magnetic Resonance Spectroscopy and combined interpretation of associated markers
Sensitivity, specificity and accuracy were assessed by the Receiver Operating Characteristic methodology for Dynamic Contrast Enhancement, Magnetic Resonance Spectroscopy and their linear combination
Summary
Accurate breast cancer diagnosis is essential to implement successful treatments and to improve the patient’s quality of life. Magnetic resonance imaging began to spread as a tool for breast cancer diagnosis after the introduction of contrast media. In terms of Bi-Rads lexicon, Magnetic Resonance Imaging (MRI) sensitivity varies over a very wide range (from 20% to 100%) [1,2], while the specificity is around 88% [3]. Recent developments in the MRI technique have demonstrated new potential diagnostic use in breast. Results of the last ten years of applying in vivo Magnetic Resonance Spectroscopy (MRS) to mammary tissues have shown that the spectral appearance of Choline compounds could be considered a marker of malignancy. Sensitivity varies from 70% to 90% and specificity is around 86% [4,5,6,7,8]
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