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1H MR spectroscopy with external reference solution at 1.5 T for differentiating malignant and benign breast lesions: comparison using qualitative and quantitative approaches

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Abstract

Objective

To compare the diagnostic capability of proton (1H) magnetic resonance spectroscopy (MRS) in differentiating benign from malignant breast lesions on the basis of qualitative and quantitative approaches.

Methods

We performed single-voxel 1H MRS for 208 breast lesions, identified a clear total composite choline compounds (tCho) peak of signal-to-noise of ≥2 to represent malignancy (qualitative approach), and regarded tCho concentration equal to or greater than the cut-off value to represent malignancy (quantitative approach). We compared the diagnostic ability of both approaches using the Akaike information criterion (AIC) and McFadden’s R 2.

Results

Histologically, 169 lesions were malignant; 39 were benign. The qualitative approach demonstrated 84.6 % sensitivity and 51.3 % specificity for differentiating malignant and benign lesions. The mean tCho concentration was 1.13 mmol/kg for malignancy, 0.43 mmol/kg for benignity. The optimal cut-off point was 0.61 mmol/kg, use of which achieved 68.1 % sensitivity and 79.4 % specificity. Calculated AIC and R 2 score suggested the superiority of the quantitative approach for differentiating malignancy.

Conclusions

Quantitative MRS provides higher specificity than qualitative MRS for differentiating malignant from benign lesions and could be more useful as an additional examination in routine breast MR imaging.

Key Points

• Magnetic resonance spectroscopy of the breast helps distinguish malignant from benign lesions.

• Magnetic resonance spectra demonstrate a choline signal even from benign lesions.

• Choline concentration is higher in breast carcinomas than in benign lesions.

• Quantitative magnetic resonance spectroscopy differentiates breast malignancies better than qualitative MRS.

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Acknowledgments

This study was supported in part by a research grant from Bayer Healthcare, Japan. We thank Mr Shin Takahashi for his help with the statistical analysis.

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Authors and Affiliations

  1. Department of Diagnostic Radiology, International Medical Center of Saitama Medical University, 1397-1 Yamane, Hidaka City, Saitama, Japan

    Waka Mizukoshi, Eito Kozawa, Naoko Saito, Naoko Nishi & Fumiko Kimura

  2. Department of Radiology, Saitama Medical University, 38 Morohongou, Moroyamachou, Irumagun, Saitama, Japan

    Kaiji Inoue

  3. Department of Breast Oncology, International Medical Center of Saitama Medical University, 1397-1 Yamane, Hidaka City, Saitama, Japan

    Toshiaki Saeki

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  1. Waka Mizukoshi
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  2. Eito Kozawa
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Correspondence to Waka Mizukoshi.

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Mizukoshi, W., Kozawa, E., Inoue, K. et al. 1H MR spectroscopy with external reference solution at 1.5 T for differentiating malignant and benign breast lesions: comparison using qualitative and quantitative approaches. Eur Radiol 23, 75–83 (2013). https://doi.org/10.1007/s00330-012-2555-6

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  • DOI: https://doi.org/10.1007/s00330-012-2555-6

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