title: Effect of contrast agent on the results of in vivo ¹H MRS of breast tumors - is it clinically significant?
abstract: Choline (Cho) signal identification and quantification in (1)H MRS are used in breast cancer diagnosis. However, an influence of the gadolinium-based contrast agent on the Cho amplitude has been reported experimentally. This study aims to identify the impact of gadolinium-based contrast agents on Cho detection and quantification in postcontrast breast MRS. Consecutive patients were recruited prospectively and randomly allocated to two groups. Group A received a neutral (gadolinium diethylenetriaminepentaacetic acid bis-methylamide) and group B an ionic (gadolinium diethylenetriaminepentaacetic acid) contrast agent, each at a dosage of 0.1 mmol/kg. First, the presence of Cho was identified visually. Then, the normalized Cho intensity in malignant lesions was quantified. Multivariate analysis was applied to identify independent influencing factors on Cho. Sixty-three lesions were investigated [A, n = 34; B, n = 29; 43 malignant (one bilaterally malignant), 20 benign]. Cho was identified visually in 14 of 20 malignant tumors in group A and 12 of 22 malignant tumors in group B (p = 0.477). Normalized Cho differed significantly (p = 0.001) between groups A (mean, 26.8 ± 6.0 AU) and B (mean, 18.2 ± 12.5 AU). No linewidth differences were identified (p > 0.05). Multivariate analysis revealed only group membership (A versus B) as an independent predictor of Cho (p = 0.017). The results suggest stronger negative effects of an ionic relative to a neutral gadolinium-based contrast agent on breast tumor MRS in vivo. These results should be considered when conducting and comparing quantitative Cho measurements in the breast.
authors.affiliation: Institute of Diagnostic and Interventional Radiology, Friedrich Schiller University Jena, Germany. pascal.baltzer@med.uni-jena.de
authors.forename: Pascal A T
authors.initials: PA
authors.lastname: Baltzer
authors.forename: Alexander
authors.initials: A
authors.lastname: Gussew
authors.forename: Matthias
authors.initials: M
authors.lastname: Dietzel
authors.forename: Reinhard
authors.initials: R
authors.lastname: Rzanny
authors.forename: Mieczyslaw
authors.initials: M
authors.lastname: Gajda
authors.forename: Oumar
authors.initials: O
authors.lastname: Camara
authors.forename: Jürgen R
authors.initials: JR
authors.lastname: Reichenbach
authors.forename: Werner A
authors.initials: WA
authors.lastname: Kaiser
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis / Q000473:pathology; D002794:Choline / Q000378:metabolism; D003287:Contrast Media; D005260:Female; D006801:Humans; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008875:Middle Aged; D011522:Protons; D012044:Regression Analysis; D055815:Young Adult
chemical_list: D003287:Contrast Media; D011522:Protons; D002794:Choline