Diagnostic Value of Breast Proton Magnetic Resonance Spectroscopy at 1.5T in Different Histopathological Types

Hyeon-Man Baek

doi:10.1100/2012/508295

Abstract

The purpose of this study was to investigate the usefulness of quantitative proton magnetic resonance spectroscopy (1H-MRS) for characterizing breast lesions at 1.5T, and to evaluate the diagnostic performance of in vivo breast 1H-MRS using receiver operating characteristics (ROC) analysis. 112 patients (99 malignant and 13 benign tumors) who were scanned with the MRI/MRS protocol were included in this study. Choline-containing compounds (tCho) levels were measured and compared with histological findings. The measured tCho levels in this work had range of 0.08–9.99 mmol/kg from 65 (66%) of 99 patients with malignant tumors. Of the 13 benign lesions, 1H-MRS detected one as false positive, with tCho level of 0.66 mmol/kg. The optimal tCho level cutoff point that yielded the highest accuracy was found to be >0.0 mmol/kg. The resulting sensitivity was 66% and specificity 92% for distinguishing benign from malignant lesions. The tCho levels were found to be higher in invasive cancer compared to ductal carcinoma in situ or benign lesions, possibly associated with more aggressive behavior or faster cell replication in invasive cancer. Quantitative in vivo 1H-MRS may provide useful information for characterizing histopatholoigical types in breast cancer.

Highlights

High-resolution anatomic magnetic resonance imaging (MRI) and dynamic contrast-enhanced MRI have evolved into a standard clinical tool for detection and diagnosis of breast lesions [1, 2]
The diagnostic performance of this study. Choline-containing compounds (tCho) concentration level measured by 1H-MRS was evaluated using the receiver operating characteristics (ROC) analysis (Figure 1)
The diagnostic value of in vivo breast MR spectroscopy is typically based on the detection of elevated level of tCho, which is a marker of active tumor

Summary

Introduction

High-resolution anatomic magnetic resonance imaging (MRI) and dynamic contrast-enhanced MRI have evolved into a standard clinical tool for detection and diagnosis of breast lesions [1, 2]. Several studies conducted at 1.5T have shown that in vivo 1H-MRS can be used to distinguish between benign and malignant tissues based on the hypothesis that tCho is only detectable in malignancies [8,9,10, 12, 13]. A pooled analysis of these studies showed that this tCho detectability criterion could identify malignancies with 89% sensitivity and 87% specificity. A similar study has been performed at higher field (e.g., 4T) showing that the increased sensitivity allows detection of tCho in benign lesions and normal subjects [14]. A more general approach is to quantify the tCho peak with the assumption that tCho levels are higher in malignancies than in benign lesions or normal tissues [14,15,16,17]

Objectives

Methods

Results

Conclusion