title: Adding in vivo quantitative 1H MR spectroscopy to improve diagnostic accuracy of breast MR imaging: preliminary results of observer performance study at 4.0 T.
abstract: OBJECTIVE
  To determine whether the addition of in vivo quantitative hydrogen 1 (1H) magnetic resonance (MR) spectroscopy can improve the radiologist's diagnostic accuracy in interpreting breast MR images to distinguish benign from malignant lesions.
  
  
  METHODS
  The study was approved by the institutional review board and, where appropriate, was compliant with the Health Insurance Portability and Accountability Act. All patients provided written informed consent. Fifty-five breast MR imaging cases-one lesion each in 55 patients aged 24-66 years with biopsy-confirmed findings-were retrospectively evaluated by four radiologists. Patients were examined with contrast material-enhanced fat-suppressed T1-weighted 4.0-T MR imaging. The concentration of total choline-containing compounds (tCho) was quantified by using single-voxel 1H MR spectroscopy. For each case, the radiologists were asked to give the percentage probability of malignancy, the Breast Imaging and Reporting Data System category, and a recommendation for patient treatment. Two interpretations were performed for each case: The initial interpretation was based on the lesion's morphologic features and time-signal intensity curve, and the second interpretation was based on the lesion's morphologic features, time-signal intensity curve, and tCho concentration. Receiver operating characteristic (ROC), Wilcoxon signed rank, kappa statistic, and accuracy (based on the area under the ROC curve) analyses were performed.
  
  
  RESULTS
  Of the 55 lesions evaluated, 35 were invasive carcinomas and 20 were benign. The addition of 1H MR spectroscopy resulted in higher sensitivity, specificity, accuracy, and interobserver agreement for all four radiologists. More specifically, two of the four radiologists achieved a significant improvement in sensitivity (P=.03, P=.03), and all four radiologists achieved a significant improvement in accuracy (P = .01, P = .05, P = .009, P < .001).
  
  
  CONCLUSIONS
  Current study results suggest that the addition of quantitative 1H MR spectroscopy to the breast MR imaging examination may help to improve the radiologist's ability to distinguish benign from malignant breast lesions.
authors.affiliation: Department of Radiology, Center for Magnetic Resonance Research Medical School, 2021 Sixth St SE, Minneapolis, MN 55455, USA.
authors.forename: Sina
authors.initials: S
authors.lastname: Meisamy
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Bolan
authors.forename: Eva H
authors.initials: EH
authors.lastname: Baker
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Pollema
authors.forename: Chap T
authors.initials: CT
authors.lastname: Le
authors.forename: Frederick
authors.initials: F
authors.lastname: Kelcz
authors.forename: Mary C
authors.initials: MC
authors.lastname: Lechner
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Luikens
authors.forename: Richard A
authors.initials: RA
authors.lastname: Carlson
authors.forename: Kathy R
authors.initials: KR
authors.lastname: Brandt
authors.forename: Kimberly K
authors.initials: KK
authors.lastname: Amrami
authors.forename: Michael T
authors.initials: MT
authors.lastname: Nelson
authors.forename: Lenore I
authors.initials: LI
authors.lastname: Everson
authors.forename: Tim H
authors.initials: TH
authors.lastname: Emory
authors.forename: Todd M
authors.initials: TM
authors.lastname: Tuttle
authors.forename: Douglas
authors.initials: D
authors.lastname: Yee
authors.forename: Michael
authors.initials: M
authors.lastname: Garwood
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000592:standards / Q000706:statistics & numerical data; D009682:Magnetic Resonance Spectroscopy / Q000592:standards* / Q000706:statistics & numerical data; D008875:Middle Aged; D015588:Observer Variation; D011877:Radionuclide Imaging; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity