Proton MR spectroscopy in the breast: Technical innovations and clinical applications

Abstract

Proton magnetic resonance spectroscopy (MRS) is a promising noninvasive diagnostic technique for investigation of breast cancer metabolism. Spectroscopic imaging data may be obtained following contrast‐enhanced MRI by applying the point‐resolved spectroscopy sequence (PRESS) or the stimulated echo acquisition mode (STEAM) sequence from the MR voxel encompassing the breast lesion. Total choline signal (tCho) measured in vivo using either a qualitative or quantitative approach has been used as a diagnostic test in the workup of malignant breast lesions. In addition to tCho metabolites, other relevant metabolites, including multiple lipids, can be detected and monitored. MRS has been heavily investigated as an adjunct to morphologic and dynamic MRI to improve diagnostic accuracy in breast cancer, obviating unnecessary benign biopsies. Besides its use in the staging of breast cancer, other promising applications have been recently investigated, including the assessment of treatment response and therapy monitoring. This review provides guidance on spectroscopic acquisition and quantification methods and highlights current and evolving clinical applications of proton MRS. Level of Evidence 5 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2019.

Renal carcinoma CD105−/CD44− cells display stem-like properties in vitro and form aggressive tumors in vivo

“…High choline signal is regarded as a biomarker of elevated lipid membranes turnover and proliferation 53 . Moreover, choline is an established biomarker of malignancy, especially in breast cancer 54 and proposed as a biomarker of malignancy in RCC 55 . Choline compounds are present in healthy renal tissue 56 .…”

Role of MRI to Assess Response to Neoadjuvant Therapy for Breast Cancer

“…Proton ( 1 H) MRS measures metabolites such as total choline (tCho), which is elevated in breast cancers due to increased cellular membrane turnover. 95 Small studies found that decreases in tCho signal during chemotherapy were associated with treatment response [96][97][98] (Fig. 13).…”

The role of magnetic resonance imaging on evaluating response of neoadjuvant therapy for breast cancer

“…MRS can noninvasively assess tumor microenvironment metabolism by measuring signal form metabolites such as the levels of total choline-containing metabolites (tCho) from Proton ( 1 H) MRS in breast [77]. High tCho level indicated cell membrane proliferation, therefore, it could be a marker for evaluating the early tumor response to NAT.…”

“…Before and during NAT, lymph node pCR can be predicted by negative hormone receptor and positive HER2 receptor status [103][104][105], lower clinical T and N stage [103], higher histological/nuclear grade [103], and treatment response to NAT of breast primary lesions [106,107]. According to the study by Osorio-Silla [77], 59.7% of patients with primary lesions complete response on MRI also achieved complete response on axillary lymph node, and 75.9% of patients with non-complete response of breast primary tumors on MRI had residual lymph node disease after surgery. Many studies [104,106,107] have similar results, indicating the importance of MRI complete response in primary lesion rate is an important independent for predicting of axillary pCR.…”