(1)H MR spectroscopy with external reference solution at 1.5 T for differentiating malignant and benign breast lesions: comparison using qualitative and quantitative approaches.
OBJECTIVE
To compare the diagnostic capability of proton ((1)H) magnetic resonance spectroscopy (MRS) in differentiating benign from malignant breast lesions on the basis of qualitative and quantitative approaches.


METHODS
We performed single-voxel (1)H MRS for 208 breast lesions, identified a clear total composite choline compounds (tCho) peak of signal-to-noise of ≥2 to represent malignancy (qualitative approach), and regarded tCho concentration equal to or greater than the cut-off value to represent malignancy (quantitative approach). We compared the diagnostic ability of both approaches using the Akaike information criterion (AIC) and McFadden's R (2).


RESULTS
Histologically, 169 lesions were malignant; 39 were benign. The qualitative approach demonstrated 84.6 % sensitivity and 51.3 % specificity for differentiating malignant and benign lesions. The mean tCho concentration was 1.13 mmol/kg for malignancy, 0.43 mmol/kg for benignity. The optimal cut-off point was 0.61 mmol/kg, use of which achieved 68.1 % sensitivity and 79.4 % specificity. Calculated AIC and R (2) score suggested the superiority of the quantitative approach for differentiating malignancy.


CONCLUSIONS
Quantitative MRS provides higher specificity than qualitative MRS for differentiating malignant from benign lesions and could be more useful as an additional examination in routine breast MR imaging.
Department of Diagnostic Radiology, International Medical Center of Saitama Medical University, 1397-1 Yamane, Hidaka City, Saitama, Japan. wsaito@saitama-med.ac.jp
Waka
W
Mizukoshi
Eito
E
Kozawa
Kaiji
K
Inoue
Naoko
N
Saito
Naoko
N
Nishi
Toshiaki
T
Saeki
Fumiko
F
Kimura
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000378:metabolism; D002794:Choline / Q000378:metabolism; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008327:Mammography; D008875:Middle Aged; D012372:ROC Curve; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D016217:Ultrasonography, Mammary
D003287:Contrast Media; D019786:Gadolinium DTPA; D002794:Choline