title: Improved diagnostic accuracy in differentiating malignant and benign lesions using single-voxel proton MRS of the breast at 3 T MRI.
abstract: OBJECTIVE
  To investigate the diagnostic accuracy of single-voxel proton magnetic resonance spectroscopy (SV (1)H MRS) by quantifying total choline-containing compounds (tCho) in differentiating malignant from benign lesions, and subsequently, to analyse the relationship of tCho levels in malignant breast lesions with their histopathological subtypes.
  
  
  METHODS
  A prospective study of SV 1H MRS was performed following dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in 61 women using a 3 T MR system. All lesions (n = 57) were analysed for characteristics of morphology, contrast-enhancement kinetics, and tCho peak heights at SV (1)H MRS that were two-times above baseline. Subsequently, the tCho in selected lesions (n = 32) was quantified by calculating the area under the curve, and a tCho concentration equal to or greater than the cut-off value was considered to represent malignancy. The relationship between tCho in invasive ductal carcinomas (IDCs) and their Bloom & Richardson grading of malignancy was assessed.
  
  
  RESULTS
  Fifty-two patients (57 lesions; 42 malignant and 15 benign) were analysed. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), of predicting malignancy were 100, 73.3, 91.3, and 100%, respectively, using DCE-MRI and 95.2, 93.3, 97.6, and 87.5%, respectively, using SV (1)H MRS. The tCho cut-off for receiver operating characteristic (ROC) curve was 0.33 mmol/l. The relationship between tCho levels in malignant breast lesions with their histopathological subtypes was not statistically significant (p = 0.3).
  
  
  CONCLUSIONS
  Good correlation between tCho peaks and malignancy, enables SV (1)H MRS to be used as a clinically applicable, simple, yet non-invasive tool for improved specificity and diagnostic accuracy in detecting breast cancer.
authors.affiliation: Department of Biomedical Imaging, University Malaya Research Imaging Centre (UMRIC), Kuala Lumpur, Malaysia.
authors.forename: S
authors.initials: S
authors.lastname: Suppiah
authors.forename: K
authors.initials: K
authors.lastname: Rahmat
authors.forename: M N
authors.initials: MN
authors.lastname: Mohd-Shah
authors.forename: C A
authors.initials: CA
authors.lastname: Azlan
authors.forename: L K
authors.initials: LK
authors.lastname: Tan
authors.forename: Y F A
authors.initials: YF
authors.lastname: Aziz
authors.forename: A
authors.initials: A
authors.lastname: Vijayananthan
authors.forename: A L
authors.initials: AL
authors.lastname: Wui
authors.forename: C H
authors.initials: CH
authors.lastname: Yip
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001940:Breast / Q000737:chemistry; D001943:Breast Neoplasms / Q000175:diagnosis*; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis*; D002794:Choline / Q000032:analysis; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D009682:Magnetic Resonance Spectroscopy / Q000379:methods; D008875:Middle Aged; D011446:Prospective Studies; D011522:Protons; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D011522:Protons; D002794:Choline