Magnetic Resonance Spectroscopy of the Breast at 3T: Pre- and Post-Contrast Evaluation for Breast Lesion Characterization

Abstract

Purpose. To determine whether in vivo proton magnetic resonance spectroscopy at 3T can provide accurate breast lesion characterization, and to determine the effect of gadolinium on the resonance of tCho. Methods. Twenty-four positive-mammogram patients were examined on a 3T MR scanner. 1H-MRS was performed before and after gadolinium administration. tCho peak was qualitatively evaluated before and after contrast injection. Results. Fourteen out of 27 lesions proved to be malignant after histopathological diagnosis. Using 1H-MRS, before contrast injection, 6/14 confirmed malignancies and 11/13 benign lesions were correctly classified; while, after contrast injection, 11/14 confirmed malignancies and 12/13 benign processes were correctly classified. Post gadolinium 1H-MRS proved useful in picking up tCho signal, improving the overall accuracy, sensitivity, and specificity by 35%, 83%, and 9%, respectively. Conclusion. 1H-MRS overall accuracy, sensitivity, and specificity in detecting breast lesion's malignancy were increased after gadolinium administration. It is prudent to perform 1H-MRS before contrast injection in large breast lesions to avoid choline underestimation. In cases of small or non-mass lesions, it is recommended to perform 1H-MRS after contrast injection for better voxel prescription to enable a reliable preoperative diagnosis.

Proton Magnetic Resonance Spectroscopy of the Central Nervous System

“…A recent study by Kousi et al revealed a distinct chemical compound, observed in all meningiomas recruited for that study, which may establish a rather specific marker in their differential diagnosis from high grade gliomas and metastases [6]. This chemical substance, resonated at 3.8ppm using short TE 1 H-MRS ( Figure 8) and according to the in vitro study of Tugnoli et al it might receive contribution from phosphoethanolamine (PE) and other amino acids such as Leukine, ALanine, Glutamate, Glutamine, Glutathione, Lysine, Arginine and Serine [110].…”

“…Although recent studies have shown promise for the use of 1 H-MRS to investigate malignant processes to prostate [5], breast [6], skeletal muscles [7], cervical and ovarian cancer [8], the overwhelming number of applications have been demonstrated in the brain, due to the absence of free lipid signals in normal cerebrum, relative ease of shimming, and lack of inherent motion artifacts.…”

Comparative Investigation of Single Voxel Magnetic Resonance Spectroscopy and Dynamic Contrast Enhancement MR Imaging in Differentiation of Benign and Malignant Breast Lesions in a Sample of Iranian Women

“…Breast cancer studies by MRS show that choline level in malignant lesions is higher than that in benign ones or normal breast tissue (Kousi et al, 2012). choline peak ,centered at 3.2 parts per million, includes choline, phosphocholine, and glycerophosphocholine, referred together as total choline (tCho) which is a marker of increased membrane synthesis so it can be a sign of cancer (Baltzer and Dietzel, 2013;Melsaether and Gudi, 2014).…”

Proton magnetic resonance spectroscopy in oncology: the fingerprints of cancer?

“…Adding 1 H-MRS to breast MRI may improve the specificity of breast cancer detection from 70% up to 92% (23)(24)(25). Dynamic contrast-enhanced acquisition may help identify enhancing areas in the tumor (usually associated to an increased metabolism) suitable for spectroscopic examination (26). However, several technical constraints must be considered in breast MRS.…”

“…Although any value of TE can be used in breast 1 H-MRS, the scientific published literature recommends the use of long TEs (>135 ms). Despite these challenges, several studies have demonstrated that MRS may differentiate benign and malignant lesions in the breast (22)(23)(24)(25)(26)(27)(28). Lesions with detectable choline peaks are suspicious for malignancy, with sensitivity and specificity rates reported as 83% and 85%, respectively (29).…”