title: MR-Guided Near-Infrared Spectral Tomography Increases Diagnostic Performance of Breast MRI.
abstract: OBJECTIVE
  The purpose of this study was to determine the diagnostically most important molecular biomarkers quantified by magnetic resonance-guided (MR) near-infrared spectral tomography (NIRST) that distinguish malignant breast lesions from benign abnormalities when combined with outcomes from clinical breast MRI.
  
  
  METHODS
  The study was HIPAA compliant and approved by the Dartmouth Institutional Review Board, the NIH, the United States State Department, and Xijing Hospital. MR-guided NIRST evaluated hemoglobin, water, and lipid content in regions of interest defined by concurrent dynamic contrast-enhanced MRI (DCE-MRI) in the breast. MRI plus NIRST was performed in 44 subjects (median age, 46, age range, 20-81 years), 28 of whom had subsequent malignant pathologic diagnoses, and 16 had benign conditions. A subset of 30 subject examinations yielded optical data that met minimum sensitivity requirements to the suspicious lesion and were included in the analyses of diagnostic performance.
  
  
  RESULTS
  In the subset of 30 subject examinations meeting minimum optical data sensitivity criterion, the MR-guided NIRST separated malignant from benign lesions using total hemoglobin (HbT; P < 0.01) and tissue optical index (TOI; P < 0.001). Combined MRI plus TOI data caused one false positive and 1 false negative, and produced the best diagnostic performance, yielding an AUC of 0.95, sensitivity of 95%, specificity of 89%, positive predictive value of 95%, and negative predictive value of 89%, respectively.
  
  
  CONCLUSIONS
  MRI plus NIRST results correlated well with histopathologic diagnoses and could provide additional information to reduce the number of MRI-directed biopsies.
authors.affiliation: Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Mastanduno
authors.affiliation: Department of Radiology, Xijing Hospital, Xi'an, China.
authors.forename: Junqing
authors.initials: J
authors.lastname: Xu
authors.affiliation: Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire.
authors.forename: Fadi
authors.initials: F
authors.lastname: El-Ghussein
authors.affiliation: Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire.
authors.forename: Shudong
authors.initials: S
authors.lastname: Jiang
authors.affiliation: Department of Radiology, Xijing Hospital, Xi'an, China. keith.paulsen@dartmouth.edu yinhong@fmmu.edu.cn.
authors.forename: Hong
authors.initials: H
authors.lastname: Yin
authors.affiliation: Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire.
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Department of Radiology, Xijing Hospital, Xi'an, China.
authors.forename: Ke
authors.initials: K
authors.lastname: Wang
authors.affiliation: Department of Radiology, Xijing Hospital, Xi'an, China.
authors.forename: Fang
authors.initials: F
authors.lastname: Ren
authors.affiliation: Department of Community and Family Medicine, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.
authors.forename: Jiang
authors.initials: J
authors.lastname: Gui
authors.affiliation: Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire.
authors.forename: Brian W
authors.initials: BW
authors.lastname: Pogue
authors.affiliation: Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire. Department of Diagnostic Radiology, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire. keith.paulsen@dartmouth.edu yinhong@fmmu.edu.cn.
authors.forename: Keith D
authors.initials: KD
authors.lastname: Paulsen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D012372:ROC Curve; D015203:Reproducibility of Results; D019265:Spectroscopy, Near-Infrared / Q000379:methods*; D041622:Tomography, Optical / Q000379:methods*; D047368:Tumor Burden; D055815:Young Adult