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Elevated tissue sodium concentration in malignant breast lesions detected with non-invasive 23Na MRI

  • Preclinical Study/Clinical Trial/Epidemiology/Invited Comentary
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Abstract

Background

The hypothesis that physiological and biochemical changes associated with proliferating malignant tumors may cause an increase in total tissue sodium concentration (TSC) was tested with non-invasive, quantitative sodium (23Na) magnetic resonance imaging (MRI) in patients with benign and malignant breast tumors.

Methods

23Na and 1H MRI of the breast was performed on 22 women with suspicious breast lesions (≥1 cm) at 1.5 Tesla. A commercial proton (1H) phased array breast coil and custom solenoidal 23Na coil were used to acquire 1H and 23Na images during the same MRI examination. Quantitative 3-dimensional 23Na projection imaging was implemented with negligible signal loss from MRI relaxation, or from radio-frequency field inhomogeneity, in less than 15 min. Co-registered 1H and 23Na images permitted quantification of TSC in normal and suspicious tissues on the basis of 1H MRI contrast enhancement and anatomy, with histology confirmed by biopsy.

Results

Sodium concentrations were consistently elevated in (N = 19) histologically proven malignant breast lesions by an average of 63% compared to glandular tissue. The increase in sodium concentration in malignant tissue was highly significant compared to unaffected glandular tissue (P < 0.0001, paired t-test), adipose tissue, and TSC in three patients with benign lesions.

Conclusion

Elevated TSC in breast lesions measured by non-invasive 23Na MRI appears to be a cellular-level indicator associated with malignancy. This method may have potential to improve the specificity of breast MRI with only a modest increase in scan time per patient.

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Notes

  1. ACR BI-RADS Breast Imaging Reporting and Data System, American College of Radiology.

  2. Assuming TSC = (1−EVF)·[Na]in + EVF·[Na]ex with EVF = 1−IVF.

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Acknowledgments

This work was supported by NIH grants R21CA095907, 1R01CA100184, P50CA103175 ACS Grant IRS-58-005-40. The authors would like to thank Cynthia Schultz and Cynthia Maranto and Donna Hardy for their vital support in interactions with patients and in running MR protocols.

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Authors and Affiliations

  1. Division of MR Research, Russel H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, School of Medicine, 601 N. Caroline Street, JHOC 4241, Baltimore, MD, 21287-0845, USA

    Ronald Ouwerkerk, Michael A. Jacobs, Katarzyna J. Macura, Sarah D. Mezban, Nagi F. Khouri, David A. Bluemke & Paul A. Bottomley

  2. Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, School of Medicine, Baltimore, MD, USA

    Michael A. Jacobs, Antonio C. Wolff & Vered Stearns

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  1. Ronald Ouwerkerk
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  2. Michael A. Jacobs
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  3. Katarzyna J. Macura
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  4. Antonio C. Wolff
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  5. Vered Stearns
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  6. Sarah D. Mezban
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  7. Nagi F. Khouri
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  8. David A. Bluemke
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  9. Paul A. Bottomley
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Correspondence to Ronald Ouwerkerk.

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Ouwerkerk, R., Jacobs, M.A., Macura, K.J. et al. Elevated tissue sodium concentration in malignant breast lesions detected with non-invasive 23Na MRI. Breast Cancer Res Treat 106, 151–160 (2007). https://doi.org/10.1007/s10549-006-9485-4

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  • DOI: https://doi.org/10.1007/s10549-006-9485-4

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