title: Detection of choline signal in human breast lesions with chemical-shift imaging.
abstract: OBJECTIVE
  To investigate the application of MR spectroscopy using chemical-shift imaging (CSI) for characterizing human breast lesions at 1.5T, and to evaluate the diagnostic performance using ROC (receiver operating characteristics) analysis.
  
  
  METHODS
  Thirty-six patients (35-73 years old, mean 52), with 27 malignant and 9 benign lesions, underwent anatomical imaging, dynamic contrast-enhanced MR imaging, and CSI. The ROC analysis was performed and the cutoff point yielding the highest accuracy was found to be a choline (Cho) signal-to-noise ratio (SNR) >3.2.
  
  
  RESULTS
  The mean Cho SNR was 2.8 +/- 0.8 (range, 1.8-4.3) for the benign group and 5.9 +/- 3.4 (2.1-17.5) for the malignant group (P = 0.01). Based on the criterion of Cho SNR >3.2 as malignant, CSI correctly diagnosed 22 of 27 malignant lesions and 7 of 9 benign lesions, resulting in a sensitivity of 81%, specificity of 78%, and overall accuracy of 81%. If the criterion was set higher at Cho SNR >4.0 the specificity improved to 89% but sensitivity was lowered to 67%.
  
  
  CONCLUSIONS
  The ROC analysis presented in this work could be used to set an objective diagnostic criterion depending on preferred emphasis on sensitivity or specificity.
authors.affiliation: Tu and Yuen Center for Functional Onco-Imaging, University of California, Irvine, California 92697-5020, USA. hbaek@uci.edu
authors.forename: Hyeon-Man
authors.initials: HM
authors.lastname: Baek
authors.forename: Jeon-Hor
authors.initials: JH
authors.lastname: Chen
authors.forename: Hon J
authors.initials: HJ
authors.lastname: Yu
authors.forename: Rita
authors.initials: R
authors.lastname: Mehta
authors.forename: Orhan
authors.initials: O
authors.lastname: Nalcioglu
authors.forename: Min-Ying
authors.initials: MY
authors.lastname: Su
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000378:metabolism* / Q000473:pathology; D002794:Choline / Q000378:metabolism*; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008875:Middle Aged; D012372:ROC Curve; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; C064925:gadodiamide; D019786:Gadolinium DTPA; D002794:Choline