Abstract
To make a comparison of single voxel magnetic resonance spectroscopy (SV-MRS) and dynamic contrast enhancement (DCE) MRI for differentiation of benign and malignant breast lesions in a sample of Iranian women. A total of 30 women with abnormal breast lesions detected in mammography, ultrasound, or clinical breast exam were examined with DCE and SV-MRS. tCho (total choline) resonance in MRS spectra was qualitatively evaluated and detection of a visible tCho peak at 3.2 ppm was defined as a positive finding for malignancy. Different types of DCE curves were persistent (type 1), plateau (type 2), and washout (type 3). At first, lesions were classified according to choline findings and types of DCE curve, finally being compared to pathological results as the standard reference. this study included 19 patients with malignant lesions and 11 patients with benign ones. While 63.6 % of benign lesions (7 of 11) showed type 1 DCE curves and 36.4% (4 of 11) showed type 2, 57.9% (11of 19) of malignant lesions were type 3 and 42.1% (8 of 19) type 2. Choline peaks were detected in 18 of 19 malignant lesions and in 3 of 11 benign counterparts. 1 malignant and 8 benign cases did not show any visible resonance at 3.2 ppm so SV-MRS featured 94.7% sensitivity, 72.7 % specificity and 86.7% accuracy. The present findings indicate that a combined approach using MRS and DCE MRI can improve the specificity of MRI for differentiation of benign and malignant breast lesions.
Highlights
Breast cancer is one of the leading causes of death in women all over the world and its prevalence is increasing in many countries
Materials and Methods: A total of 30 women with abnormal breast lesions detected in mammography, ultrasound, or clinical breast exam were examined with dynamic contrast enhancement (DCE) and single voxel magnetic resonance spectroscopy (SV-MRS). total choline (tCho) resonance in MRS spectra was qualitatively evaluated and detection of a visible tCho peak at 3.2 ppm was defined as a positive finding for malignancy
Choline peaks were detected in 18 of 19 malignant lesions and in 3 of 11 benign counterparts. 1 malignant and 8 benign cases did not show any visible resonance at 3.2 ppm so SV-MRS featured 94.7% sensitivity, 72.7 % specificity and 86.7% accuracy.Conclusions: The present findings indicate that a combined approach using MRS and DCE magnetic resonance imaging (MRI) can improve the specificity of MRI for differentiation of benign and malignant breast lesions
Summary
Breast cancer is one of the leading causes of death in women all over the world and its prevalence is increasing in many countries. It’s the most common cancer in Iranian women with a mortality rate of 2614 cases per year (Jafari et al, 2014; Sharifian et al, 2015). Detection of that would be helpful for its successful treatment. Nowadays some techniques such as X-ray mammography, ultrasound and magnetic resonance imaging (MRI) are used for the diagnosis of breast lesions (Kvistad et al, 1999; Katz-Brull et al, 2002). Mammography which is the most common screening method of this disease, has high sensitivity but low specificity especially in low-density breasts. False positive results of mammography is about 60-80%, resulting in many unnecessary biopsies of benign lesions and in some patients there is the likelihood of infections, bleeding and abscess because of biopsy, the risk of complications from general anesthesia in patients for whom local anesthesia is not possible (Huang et al, 2004)
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