title: Detection of breast malignancy: diagnostic MR protocol for improved specificity.
abstract: OBJECTIVE
  To prospectively determine if a combined magnetic resonance (MR) protocol that includes T1-weighted dynamic contrast agent-enhanced (DCE) MR imaging, hydrogen 1 (1H) MR spectroscopy, and T2*-weighted perfusion MR imaging improves specificity in the diagnosis of breast cancer.
  
  
  METHODS
  The combined MR imaging-MR spectroscopy protocol was performed in 50 patients after positive findings at mammography but prior to biopsy. Single-voxel proton MR spectroscopy and perfusion MR imaging were conducted only if DCE MR images showed rapid contrast enhancement in the lesion. Biopsy results were used as the reference for comparison with MR results and for calculation of sensitivity and specificity in the detection of breast malignancy.
  
  
  RESULTS
  DCE MR imaging alone showed 100% sensitivity and 62.5% specificity. The specificity improved to 87.5% with the addition of 1H MR spectroscopy and to 100% with the further addition of perfusion MR imaging. Twenty-eight patients underwent both MR spectroscopy and perfusion MR imaging. Two patients underwent MR spectroscopy but declined to undergo perfusion MR imaging. The remaining 20 patients had negative results at DCE MR imaging and therefore did not undergo the additional examinations.
  
  
  CONCLUSIONS
  The combined MR protocol of DCE MR imaging, 1H MR spectroscopy, and perfusion MR imaging has high sensitivity and specificity in the diagnosis of breast cancer.
authors.affiliation: Department of Radiology, State University of New York, Stony Brook, USA. huangw2@mskcc.org
authors.forename: Wei
authors.initials: W
authors.lastname: Huang
authors.forename: Paul R
authors.initials: PR
authors.lastname: Fisher
authors.forename: Khaldoon
authors.initials: K
authors.lastname: Dulaimy
authors.forename: Luminita A
authors.initials: LA
authors.lastname: Tudorica
authors.forename: Brian
authors.initials: B
authors.lastname: O'Hea
authors.forename: Terry M
authors.initials: TM
authors.lastname: Button
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D001940:Breast / Q000098:blood supply / Q000473:pathology; D001943:Breast Neoplasms / Q000098:blood supply / Q000175:diagnosis* / Q000473:pathology; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007089:Image Enhancement; D007091:Image Processing, Computer-Assisted; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D008327:Mammography; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000175:diagnosis / Q000473:pathology; D012680:Sensitivity and Specificity; D013382:Subtraction Technique
chemical_list: D003287:Contrast Media; C064925:gadodiamide; D019786:Gadolinium DTPA