title: The evaluation of human breast lesions with magnetic resonance imaging and proton magnetic resonance spectroscopy.
abstract: OBJECTIVE
  MR spectroscopy (MRS) assists in lesion characterization and diagnosis when combined with magnetic resonance imaging (MRI). Cancerous lesions demonstrate elevated composite choline levels arising from increased cellular proliferation. Our study investigated if MR spectroscopy of the breast would be useful for characterizing benign and malignant lesions.
  
  
  METHODS
  Single voxel proton MR spectroscopy (MRS) was acquired as part of an MR imaging protocol in 38 patients referred upon surgical consultation. The MR spectra were read independently in a blinded fashion without the MR images by three spectroscopists. The MRI exam was interpreted in two settings: (a) as a clinical exam with detailed histories and results from previous imaging studies such as mammography or ultrasound included and (b) as a blinded study without prior histories or imaging results.
  
  
  RESULTS
  Elevated choline levels were demonstrated by MRS in 19 of the 23 confirmed cancer patients. The sensitivity and specificity for determining malignancy from benign breast disease with MRS alone were 83 and 87%, respectively, while a blinded MRI review reported 95 and 86%, respectively.
  
  
  CONCLUSIONS
  Proton MR spectroscopy provides a noninvasive, biochemical measure of metabolism. The technique can be performed in less than 10 min as part of an MRI examination. MRI in combination with MRS may improve the specificity of breast MR and thereby, influence patient treatment options. This may be particularly true with less experienced breast MRI readers. In exams where MRI and MRS agree, the additional confidence measure provided by MRS may influence the course of treatment.
authors.affiliation: Department of Radiology, University of Pennsylvania Medical Center, Philadelphia, USA. cecil@athena.chmcc.org
authors.forename: K M
authors.initials: KM
authors.lastname: Cecil
authors.forename: M D
authors.initials: MD
authors.lastname: Schnall
authors.forename: E S
authors.initials: ES
authors.lastname: Siegelman
authors.forename: R E
authors.initials: RE
authors.lastname: Lenkinski
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D002794:Choline / Q000032:analysis / Q000378:metabolism; D015331:Cohort Studies; D003937:Diagnosis, Differential; D005260:Female; D005348:Fibrocystic Breast Disease / Q000175:diagnosis; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000592:standards*; D009682:Magnetic Resonance Spectroscopy / Q000592:standards*; D008875:Middle Aged; D011237:Predictive Value of Tests; D011877:Radionuclide Imaging; D012680:Sensitivity and Specificity; D016037:Single-Blind Method
chemical_list: D002794:Choline