title: Multiparametric breast MRI with 3T: Effectivity of combination of contrast enhanced MRI, DWI and 1H single voxel spectroscopy in differentiation of Breast tumors.
abstract: OBJECTIVE
  To evaluate the diagnostic accuracy of dynamic contrast enhanced breast MRI (DCE-MRI) combined with diffusion weighted imaging (DWI) and 1H single-voxel magnetic resonance spectroscopy (1HMRS) in differentiating malignant from benign breast lesions.
  
  
  METHODS
  One hundred twenty-nine patients with 138 lesions were included in the study. Multiparametric MRI of the breast was performed with a 3T unit. A DWI is followed by DCE-MRI and 1HMRS. All lesions were biopsied within one week after MRI. Histopathologic findings were accepted as the standard of reference. Probability of malignancy was assessed according to BI-RADS for DCE-MRI. ADC values were measured for DWI and choline peaks were assessed using a semi-quantitative method in 1HMRS. Two blinded radiologists evaluated findings in consensus. Diagnostic performance of DCE-MRI, DWI and 1HMRS alone or in combination for multiparametric imaging were statistically evaluated.
  
  
  RESULTS
  Histopathology revealed malignancy in 54.4% of lesions (75/138). DCE-MRI showed the highest AUC (0.978), sensitivity (97.33%) and specificity (88.89%) compared to DWI and 1HMRS. Sensitivity was 100% when a positive result from any one of three techniques was accepted as malignancy, albeit with a trade-off for 65.1% specificity. Highest specificity (98.4%) was attained when all three techniques were required to be positive, though with a lower sensitivity (82.7%) as trade-off. Logistic regression analysis confirmed significant association with DCE-MRI (p<0.001) and 1H MRS (p=0.009) but not with DWI (p=0.127). There was one case of fat necrosis which was false positive in all three techniques.
  
  
  CONCLUSIONS
  Multiparametric imaging with combination of DCE-MRI, DWI and 1HMRS does not improve, and may even reduce the diagnostic accuracy of breast MRI. Although, the specificity may be improved with a trade-off for lower sensitivity, we have not set a convenient algorithm for the combined use of these techniques.
authors.affiliation: Marmara University, Faculty of Medicine, Department of Radiology, Mimar Sinan cad 41, Pendik, 34890 Istanbul, Turkey. Electronic address: earibal@marmara.edu.tr.
authors.forename: Erkin
authors.initials: E
authors.lastname: Aribal
authors.affiliation: Marmara University, Faculty of Medicine, Department of Radiology, Mimar Sinan cad 41, Pendik, 34890 Istanbul, Turkey. Electronic address: dr.esedov@gmail.com.
authors.forename: Ruslan
authors.initials: R
authors.lastname: Asadov
authors.affiliation: TC SB Marmara University Pendik Training and Research Hospital, Radiology Department, Mimar Sinan cad 41, Pendik, 34890 Istanbul, Turkey. Electronic address: abdramazan@gmail.com.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Ramazan
authors.affiliation: Marmara University, Faculty of Medicine, Department of General Surgery, Mimar Sinan cad 41, Pendik, 34890 Istanbul, Turkey. Electronic address: umitugurlu@gmail.com.
authors.forename: Mustafa Ümit
authors.initials: MÜ
authors.lastname: Ugurlu
authors.affiliation: Marmara University, Faculty of Medicine, Department of Pathology, Mimar Sinan cad 41, Pendik, 34890 Istanbul, Turkey. Electronic address: hkaya@marmara.edu.tr.
authors.forename: Handan
authors.initials: H
authors.lastname: Kaya
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000473:pathology*; D002794:Choline / Q000378:metabolism; D003287:Contrast Media; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D009682:Magnetic Resonance Spectroscopy / Q000379:methods; D008875:Middle Aged; D064847:Multimodal Imaging; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D003287:Contrast Media; D002794:Choline
keywords: 1H single voxel MR spectroscopy; Breast cancer; Diffusion weighted imaging; Dynamic contrast enhanced magnetic resonance imaging; Fat necrosis; Mucinous cancer; Multiparametric MRI