title: Multiparametric MRI With Dynamic Contrast Enhancement, Diffusion-Weighted Imaging, and 31-Phosphorus Spectroscopy at 7 T for Characterization of Breast Cancer.
abstract: OBJECTIVE
  To describe and to correlate tumor characteristics on multiparametric 7 tesla (T) breast magnetic resonance imaging (MRI) with prognostic characteristics from postoperative histopathology in patients with breast cancer.
  
  
  METHODS
  Institutional review board approval and written informed consent of 15 women (46-70 years) with 17 malignant lesions were obtained. In this prospective study (March 2013 to March 2014), women were preoperatively scanned using dynamic contrast-enhanced MRI, diffusion-weighted imaging, and 31-phosphorus spectroscopy (¹³P-MRS). The value of the protocol was assessed to quantify tumor differentiation and proliferation. Dynamic contrast-enhanced MRI was assessed according to the American College of Radiology Breast Imaging Reporting and Data System-MRI lexicon. Apparent diffusion coefficients (ADCs) were calculated from diffusion-weighted imaging. On ¹³P-MRS, at the location of the tumor, the amount of phosphorus components was obtained in a localized spectrum. In this spectrum, the height of phosphodiester (PDE) and phosphomonoester (PME) peaks was assessed to serve as a measure for metabolic activity, stratifying tumors into a PDE > PME, PDE = PME, or PDE < PME group. Tumor grade and mitotic count from resection specimen were compared with the MRI characteristics using explorative analyses.
  
  
  RESULTS
  On dynamic contrast-enhanced MRI, the mean tumor size was 24 mm (range, 6-55 mm). An inverse trend was seen between ADC and tumor grade (P = 0.083), with mean ADC of 867 × 10⁻⁶ mm²/s for grade 1 (N = 4), 751 × 10⁻⁶ mm²/s for grade 2 (N = 6), and 659 × 10⁻⁶ mm²/s for grade 3 (N = 2) tumors. Between P-MR spectra and mitotic count, a relative increase of PME over PDE showed significant association with increasing mitotic counts (P = 0.02); a mean mitotic count of 6 was found in the PDE greater than PME group (N = 7), 8 in the PDE = PME group (N = 1), and 17 in the PDE < PME group (N = 3).
  
  
  CONCLUSIONS
  Multiparametric 7 T breast MRI is feasible in clinical setting and shows association between ADC and tumor grade, and between ¹³P-MRS and mitotic count.
authors.affiliation: From the *Department of Radiology/Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands; Departments of †Surgery, ‡Radiology, and §Pathology, Albert Schweitzer Hospital, Dordrecht, the Netherlands.
authors.forename: Alexander M Th
authors.initials: AM
authors.lastname: Schmitz
authors.forename: Wouter B
authors.initials: WB
authors.lastname: Veldhuis
authors.forename: Marian B E
authors.initials: MB
authors.lastname: Menke-Pluijmers
authors.forename: Wybe J M
authors.initials: WJ
authors.lastname: van der Kemp
authors.forename: Tijl A
authors.initials: TA
authors.lastname: van der Velden
authors.forename: Marc C J M
authors.initials: MC
authors.lastname: Kock
authors.forename: Pieter J
authors.initials: PJ
authors.lastname: Westenend
authors.forename: Dennis W J
authors.initials: DW
authors.lastname: Klomp
authors.forename: Kenneth G A
authors.initials: KG
authors.lastname: Gilhuijs
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000378:metabolism; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000378:metabolism*; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D017553:Phosphorus Compounds / Q000378:metabolism*; D010759:Phosphorus Isotopes / Q000493:pharmacokinetics; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D014408:Biomarkers, Tumor; D003287:Contrast Media; D017553:Phosphorus Compounds; D010759:Phosphorus Isotopes; D019275:Radiopharmaceuticals