title: The added value of quantitative multi-voxel MR spectroscopy in breast magnetic resonance imaging.
abstract: OBJECTIVE
  To determine whether quantitative multivoxel MRS improves the accuracy of MRI in the assessment of breast lesions.
  
  
  METHODS
  Twenty-five consecutive patients with 26 breast lesions ≥ 1 cm assessed as BI-RADS 3 or 4 with mammography underwent quantitative multivoxel MRS and contrast-enhanced MRI. The choline (Cho) concentration was calculated using the unsuppressed water signal as a concentration reference. ROC analysis established the diagnostic accuracy of MRI and MRS in the assessment of breast lesions.
  
  
  RESULTS
  Respective Cho concentrations in 26 breast lesions re-classified by MRI as BI-RADS 2 (n = 5), 3 (n = 8), 4 (n = 5) and 5 (n = 8) were 1.16 ± 0.43 (mean ± SD), 1.43 ± 0.47, 2.98 ± 2.15 and 4.94 ± 3.10 mM. Two BI-RADS 3 lesions and all BI-RADS 4 and 5 lesions were malignant on histopathology and had Cho concentrations between 1.7 and 11.8 mM (4.03 ± 2.72 SD), which were significantly higher (P = 0.01) than that in the 11 benign lesions (0.4-1.5 mM; 1.19 ± 0.33 SD). Furthermore, Cho concentrations in the benign and malignant breast lesions in BI-RADS 3 category differed (P = 0.01). The accuracy of combined multivoxel MRS/breast MRI BI-RADS re-classification (AUC = 1.00) exceeded that of MRI alone (AUC = 0.96 ± 0.03).
  
  
  CONCLUSIONS
  These preliminary data indicate that multivoxel MRS improves the accuracy of MRI when using a Cho concentration cut-off ≤ 1.5 mM for benign lesions.
  
  
  CONCLUSIONS
  Quantitative multivoxel MR spectroscopy can improve the accuracy of contrast-enhanced breast MRI. Multivoxel-MRS can differentiate breast lesions by using the highest Cho-concentration. Multivoxel-MRS can exclude patients with benign breast lesions from further invasive diagnostic procedures.
authors.affiliation: Department of Radiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands. m.d.dorrius@umcg.nl
authors.forename: M D
authors.initials: MD
authors.lastname: Dorrius
authors.forename: R M
authors.initials: RM
authors.lastname: Pijnappel
authors.forename: M C
authors.initials: MC
authors.lastname: van der Weide Jansen
authors.forename: L
authors.initials: L
authors.lastname: Jansen
authors.forename: P
authors.initials: P
authors.lastname: Kappert
authors.forename: M
authors.initials: M
authors.lastname: Oudkerk
authors.forename: P E
authors.initials: PE
authors.lastname: Sijens
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis*; D001943:Breast Neoplasms / Q000175:diagnosis*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D014408:Biomarkers, Tumor
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