title: Combined dynamic contrast enhanced breast MR and proton spectroscopic imaging: a feasibility study.
abstract: OBJECTIVE
  To investigate the feasibility of combined dynamic contrast enhanced (DCE) and magnetic resonance spectroscopy (MRS) in evaluating breast lesions.
  
  
  METHODS
  Nine patients with positive mammograms scheduled for either biopsy or mastectomy were examined on a 1.5-T MR scanner. DCE was performed with administration of gadolinium-DTPA contrast using a two-dimensional spoiled gradient recall echo (SPGR) sequence. Proton spectroscopy (TR/TE = 2000/272 msec) was performed using PRESS single slice (10 mm). Lesion time intensity curves were classified as persistent (type 1), plateau (type 2), or washout (type 3) pattern enhancement. Choline (Cho) signal-to-noise ratios (SNRs) and enhancement patterns were compared between benign and malignant lesions as determined by histopathology.
  
  
  RESULTS
  Five patients had breast carcinoma and four had benign lesions. Type 1 enhancement was found in two benign cases, type 2 enhancement in two of four benign and four of five malignant lesions, and one malignant case exhibited a type 3 pattern. Choline SNR was significantly different (P < 0.003) between benign and malignant lesions (2.0 +/- 0.3 vs. 5.7 +/- 1.4; P < 0.003). Choline SNR was less than 4.0 in all of the benign lesions, including the two lesions with type 2 enhancement.
  
  
  CONCLUSIONS
  Proton MRS appears to be a promising technique for classification of breast lesions when DCE results are equivocal. A combination of DCE and MRS is feasible, and may have improved specificity compared to either modality alone.
authors.affiliation: The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA. mikej@mri.jhu.edu
authors.forename: Michael A
authors.initials: MA
authors.lastname: Jacobs
authors.forename: Peter B
authors.initials: PB
authors.lastname: Barker
authors.forename: Pedram
authors.initials: P
authors.lastname: Argani
authors.forename: Ronald
authors.initials: R
authors.lastname: Ouwerkerk
authors.forename: Zaver M
authors.initials: ZM
authors.lastname: Bhujwalla
authors.forename: David A
authors.initials: DA
authors.lastname: Bluemke
mesh_terms: D001940:Breast / Q000098:blood supply / Q000473:pathology; D001943:Breast Neoplasms / Q000473:pathology*; D002794:Choline / Q000378:metabolism; D003287:Contrast Media; D005240:Feasibility Studies; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods*; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000175:diagnosis; D011522:Protons
chemical_list: D003287:Contrast Media; D011522:Protons; D019786:Gadolinium DTPA; D002794:Choline