title: 1H-MR spectroscopy of suspicious breast mass lesions at 3T: a clinical experience.
abstract: OBJECTIVE
  To test 3T proton magnetic resonance spectroscopy (1H-MRS) for breast mass lesions.
  
  
  METHODS
  Patients with BI-RADS 4-5 lesions at mammography/ultrasound were prospectively enrolled. After contrast-enhanced breast MRI, single-voxel MRS (point-resolved volume selection, PRESS); pencil-beam shimming; volume of interest 1 cm3; TR/TE = 3000/135 ms) was performed. Spectra were considered reliable if the full width at half maximum (FWHM) of the water peak was ≤45 Hz. A signal-to-noise ratio of the total choline (tCho) peak at 3.21 ppm ≥2 was used as cutoff for malignancy. All lesions underwent needle sampling. Final pathology was available for all malignant lesions; for benign lesions the reference standard was final pathology or at least 1-year negative follow-up.
  
  
  RESULTS
  Reliable spectra were obtained in 115/127 lesions (91%), with a mean FWHM of 32.4 Hz (range 8-45 Hz). A tCho peak SNR ≥2 was detected in 66 malignant lesions (62 invasive cancers; 4 ductal carcinoma in situ) and in 3 benign lesions. Excluding lesions located ≤1 cm from the skin (n = 3) or pectoral muscle (n = 11), sensitivity was 65/73 [89%, 95% confidence interval (CI): 80-95%], and specificity 25/28 (89%) (95% CI: 72-98%). Considering only invasive cancers, sensitivity reached 61/68 (90%, 95% CI: 81-96%). MRS additional time was 8 min.
  
  
  CONCLUSIONS
  When lesions close to the skin or pectoral muscle are excluded, 3T1H-MRS of mass lesions ≥1 cm showed a high diagnostic performance, however, insufficient to avoid needle biopsy.
authors.affiliation: Radiology Unit, Department of Pathology and Diagnostics, Azienda Ospedaliera Universitaria Integrata - Verona, P.le Stefani 1, 37126, Verona, Italy. stefania.montemezzi@ospedaleuniverona.it.
authors.forename: Stefania
authors.initials: S
authors.lastname: Montemezzi
authors.affiliation: Medical Physics Unit, Department of Pathology and Diagnostics, Azienda Ospedaliera Universitaria Integrata - Verona, P.le Stefani 1, 37126, Verona, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Cavedon
authors.affiliation: Radiology Unit, Department of Pathology and Diagnostics, Azienda Ospedaliera Universitaria Integrata - Verona, P.le Stefani 1, 37126, Verona, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Camera
authors.affiliation: Medical Physics Unit, Department of Pathology and Diagnostics, Azienda Ospedaliera Universitaria Integrata - Verona, P.le Stefani 1, 37126, Verona, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Meliadò
authors.affiliation: Radiology Unit, Department of Pathology and Diagnostics, Azienda Ospedaliera Universitaria Integrata - Verona, P.le Stefani 1, 37126, Verona, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Caumo
authors.affiliation: Radiology Unit, Department of Pathology and Diagnostics, Azienda Ospedaliera Universitaria Integrata - Verona, P.le Stefani 1, 37126, Verona, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Baglio
authors.affiliation: Department of Biomedical Sciences for Health, Radiology Unit, Università degli Studi di Milano, Research Hospital Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Sardanelli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D001834:Body Water; D001940:Breast / Q000737:chemistry / Q000473:pathology; D001943:Breast Neoplasms / Q000737:chemistry / Q000175:diagnosis* / Q000473:pathology; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000737:chemistry / Q000175:diagnosis / Q000473:pathology; D002794:Choline; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010369:Pectoralis Muscles / Q000000981:diagnostic imaging; D011446:Prospective Studies; D066244:Proton Magnetic Resonance Spectroscopy; D012680:Sensitivity and Specificity; D059629:Signal-To-Noise Ratio; D016217:Ultrasonography, Mammary
chemical_list: D002794:Choline
keywords: Breast; Breast cancer; Magnetic resonance imaging; Proton magnetic resonance spectroscopy (1H-MRS)