1
|
Billy CA, Darmiati S, Prihartono J. Diagnostic accuracy of diffusion weighted imaging compared to magnetic resonance spectroscopy in differentiation of benign and malignant breast lesions: A systematic review and meta-analysis. Eur J Radiol 2023; 168:111124. [PMID: 37820523 DOI: 10.1016/j.ejrad.2023.111124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 07/12/2023] [Accepted: 09/28/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE To compare the sensitivity and specificity of diffusion weighted imaging (DWI) and magnetic resonance spectroscopy (MRS) in the differentiation of benign and malignant breast lesions. METHODS Scopus, PubMed, and other registries were searched up to April 2023. We included diagnostic studies with DWI and MRS as index tests and histopathologic examination as the reference standard for differentiating benign and malignant breast lesions in adult females. We excluded studies involving healthy women, only breast cancer patients, and non-comparative diagnostic accuracy studies on either index test. The sensitivity and specificity of DWI and MRS were investigated and pooled using random-effect bivariate meta-analysis. Risk of bias was assessed using QUADAS-2. Evidence quality was summarized using GRADE. RESULTS Eight eligible studies involving 632 females and 687 breast lesions were identified. The pooled sensitivity and specificity of DWI were 92% (CI 85-96%) and 88% (CI 75-94%), respectively. The pooled sensitivity and specificity of MRS were 85% (CI 66-94%) and 85% (CI 77-91%), respectively. No significant difference was noted in the sensitivity (7%, CI -8-22%) and specificity (3%, CI -9-14%) between DWI and MRS. CONCLUSIONS In low to moderate quality evidence, DWI and MRS show comparable sensitivity and specificity in differentiating benign and malignant breast lesions.
Collapse
Affiliation(s)
- Christy Amanda Billy
- Department of Radiology, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine, University of Indonesia, Jakarta 10430, Indonesia.
| | - Sawitri Darmiati
- Department of Radiology, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine, University of Indonesia, Jakarta 10430, Indonesia
| | - Joedo Prihartono
- Department of Community Medicine, Faculty of Medicine, University of Indonesia, Jakarta 10310, Indonesia
| |
Collapse
|
2
|
Sharma U, Jagannathan NR. In vivo MR spectroscopy for breast cancer diagnosis. BJR Open 2019; 1:20180040. [PMID: 33178927 PMCID: PMC7592438 DOI: 10.1259/bjro.20180040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 05/02/2019] [Accepted: 06/14/2019] [Indexed: 12/23/2022] Open
Abstract
Breast cancer is a significant health concern in females, worldwide. In vivo proton (1H) MR spectroscopy (MRS) has evolved as a non-invasive tool for diagnosis and for biochemical characterization of breast cancer. Water-to-fat ratio, fat and water fractions and choline containing compounds (tCho) have been identified as diagnostic biomarkers of malignancy. Detection of tCho in normal breast tissue of volunteers and in lactating females limits the use of tCho as a diagnostic marker. Technological developments like high-field scanners, multi channel coils, pulse sequences with water and fat suppression facilitated easy detection of tCho. Also, quantification of tCho and its cut-off for objective assessment of malignancy have been reported. Meta-analysis of in vivo 1H MRS studies have documented the pooled sensitivities and the specificities in the range of 71-74% and 78-88%, respectively. Inclusion of MRS has been shown to enhance the diagnostic specificity of MRI, however, detection of tCho in small sized lesions (≤1 cm) is challenging even at high magnetic fields. Potential of MRS in monitoring the effect of chemotherapy in breast cancer has also been reported. This review briefly presents the potential clinical role of in vivo 1H MRS in the diagnosis of breast cancer, its current status and future developments.
Collapse
Affiliation(s)
- Uma Sharma
- Department of NMR & MRI Facility, All India Institute of Medical Sciences , New Delhi, India
| | | |
Collapse
|
3
|
Di Leo G, Ioan I, Luciani ML, Midulla C, Podo F, Sardanelli F, Pediconi F. Changes in total choline concentration in the breast of healthy fertile young women in relation to menstrual cycle or use of oral contraceptives: a 3-T 1H-MRS study. Eur Radiol Exp 2018; 2:43. [PMID: 30560497 PMCID: PMC6297122 DOI: 10.1186/s41747-018-0075-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/26/2018] [Indexed: 02/03/2023] Open
Abstract
Background To evaluate changes in total choline (tCho) absolute concentration ([tCho]) in the breast of healthy fertile women in relation to menstrual cycle (MC) or use of oral contraceptives (OC). Methods After institutional review board approval, we prospectively evaluated 40 healthy fertile volunteers: 20 with physiological MC, aged 28 ± 3 years (mean ± standard deviation; nOC group); 20 using OC, aged 26 ± 3 years (OC group). Hormonal assays and water-suppressed single-voxel 3-T proton magnetic resonance spectroscopy (1H-MRS) were performed on MC days 7, 14, and 21 in the nOC group and only on MC day 14 in the OC group. [tCho] was measured versus an external phantom. Mann-Whitney U test and Spearman coefficient were used; data are given as median and interquartile interval. Results All spectra had good quality. In the nOC group, [tCho] (mM) did not change significantly during MC: 0.8 (0.3–2.4) on day 7, 0.9 (0.4–1.2) on day 14, and 0.4 (0.2–0.8) on day 21 (p = 0.963). In the OC group, [tCho] was 0.7 (0.2–1.7) mM. The between-groups difference was not significant on all days (p ≥ 0.411). All hormones except prolactin changed during MC (p ≤ 0.024). In the OC group, [tCho] showed a borderline correlation with estradiol (r = 0.458, p = 0.056), but no correlation with other hormones (p ≥ 0.128). In the nOC group, [tCho] negatively correlated with prolactin (r = -0.587, p = 0.006) on day 7; positive correlation was found with estradiol on day 14 (r = 0.679, p = 0.001). Conclusions A tCho peak can be detected in the normal mammary gland using 3-T 1H-MRS. The [tCho] in healthy volunteers was 0.4–0.9 mM, constant over the MC and independent of OC use.
Collapse
Affiliation(s)
- Giovanni Di Leo
- Radiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
| | - Ileana Ioan
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Maria Laura Luciani
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Cecilia Midulla
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Franca Podo
- Department of Cell Biology and Neurosciences, Istituto Superiore di Sanità, Rome, Italy
| | - Francesco Sardanelli
- Radiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, San Donato Milanese, Italy
| | - Federica Pediconi
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
4
|
Abstract
Magnetic resonance spectroscopy (MRS) can be performed in vivo using commercial MRI systems to obtain biochemical information about tissues and cancers. Applications in brain, prostate and breast aid lesion detection and characterisation (differential diagnosis), treatment planning and response assessment. Multi-centre clinical trials have been performed in all these tissues. Single centre studies have been performed in many other tissues including cervix, uterus, musculoskeletal and liver. While generally MRS is used to study endogenous metabolites it has also been used in drug studies, for example those that include 19F as part of their structure. Recently the hyperpolarisation of compounds enriched with 13C such as [1-13C] pyruvate has been demonstrated in animal models and now in preliminary clinical studies, permitting the monitoring of biochemical processes with unprecedented sensitivity. This review briefly introduces the underlying methods and then discusses the current status of these applications.
Collapse
Affiliation(s)
- Geoffrey S Payne
- University Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, United Kingdom
| |
Collapse
|
5
|
Breast Tissue Metabolism by Magnetic Resonance Spectroscopy. Metabolites 2017; 7:metabo7020025. [PMID: 28590405 PMCID: PMC5487996 DOI: 10.3390/metabo7020025] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 05/31/2017] [Accepted: 05/31/2017] [Indexed: 02/06/2023] Open
Abstract
Metabolic alterations are known to occur with oncogenesis and tumor progression. During malignant transformation, the metabolism of cells and tissues is altered. Cancer metabolism can be studied using advanced technologies that detect both metabolites and metabolic activities. Identification, characterization, and quantification of metabolites (metabolomics) are important for metabolic analysis and are usually done by nuclear magnetic resonance (NMR) or by mass spectrometry. In contrast to the magnetic resonance imaging that is used to monitor the tumor morphology during progression of the disease and during therapy, in vivo NMR spectroscopy is used to study and monitor tumor metabolism of cells/tissues by detection of various biochemicals or metabolites involved in various metabolic pathways. Several in vivo, in vitro and ex vivo NMR studies using 1H and 31P magnetic resonance spectroscopy (MRS) nuclei have documented increased levels of total choline containing compounds, phosphomonoesters and phosphodiesters in human breast cancer tissues, which is indicative of altered choline and phospholipid metabolism. These levels get reversed with successful treatment. Another method that increases the sensitivity of substrate detection by using nuclear spin hyperpolarization of 13C-lableled substrates by dynamic nuclear polarization has revived a great interest in the study of cancer metabolism. This review discusses breast tissue metabolism studied by various NMR/MRS methods.
Collapse
|
6
|
Sardanelli F, Carbonaro LA, Montemezzi S, Cavedon C, Trimboli RM. Clinical Breast MR Using MRS or DWI: Who Is the Winner? Front Oncol 2016; 6:217. [PMID: 27840809 PMCID: PMC5083850 DOI: 10.3389/fonc.2016.00217] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 09/30/2016] [Indexed: 12/14/2022] Open
Abstract
Magnetic resonance imaging (MRI) of the breast gained a role in clinical practice thanks to the optimal sensitivity of contrast-enhanced (CE) protocols. This approach, first proposed 30 years ago and further developed as bilateral highly spatially resolved dynamic study, is currently considered superior for cancer detection to any other technique. However, other directions than CE imaging have been explored. Apart from morphologic features on unenhanced T2-weighted images, two different non-contrast molecular approaches were mainly run in vivo: proton MR spectroscopy (1H-MRS) and diffusion-weighted imaging (DWI). Both approaches have shown aspects of breast cancer (BC) hidden to CE-MRI: 1H-MRS allowed for evaluating the total choline peak (tCho) as a biomarker of malignancy; DWI showed that restricted diffusivity is correlated with high cellularity and tumor aggressiveness. Secondary evidence on the two approaches is now available from systematic reviews and meta-analyses, mainly considered in this article: pooled sensitivity ranged 71–74% for 1H-MRS and 84–91% for DWI; specificity 78–88% and 75–84%, respectively. Interesting research perspectives are opened for both techniques, including multivoxel MRS and statistical strategies for classification of MR spectra as well as diffusion tensor imaging and intravoxel incoherent motion for DWI. However, when looking at a clinical perspective, while MRS remained a research tool with important limitations, such as relatively long acquisition times, frequent low quality spectra, difficult standardization, and quantification of tCho tissue concentration, DWI has been integrated in the standard clinical protocols of breast MRI and several studies showed its potential value as a stand-alone approach for BC detection.
Collapse
Affiliation(s)
- Francesco Sardanelli
- Utà di Radiologia, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy; Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | | | - Stefania Montemezzi
- Dipartimento di Radiologia, Azienda Ospedaliera Universitaria Integrata , Verona , Italy
| | - Carlo Cavedon
- Dipartimento di Fisica Sanitaria, Azienda Ospedaliera Universitaria Integrata , Verona , Italy
| | | |
Collapse
|
7
|
Faeghi F, Baniasadipour B, Jalalshokouhi J. 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. Asian Pac J Cancer Prev 2016; 16:8335-8. [PMID: 26745081 DOI: 10.7314/apjcp.2015.16.18.8335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To make a comparison of single voxel magnetic resonance spectroscopy (SV-MRS) and dynamic contrast enhancement (DCE) MRI for differentiation of benign and malignant breast lesions in a sample of Iranian women. MATERIALS AND METHODS A total of 30 women with abnormal breast lesions detected in mammography, ultrasound, or clinical breast exam were examined with DCE and SV-MRS. tCho (total choline) resonance in MRS spectra was qualitatively evaluated and detection of a visible tCho peak at 3.2 ppm was defined as a positive finding for malignancy. Different types of DCE curves were persistent (type 1), plateau (type 2), and washout (type 3). At first, lesions were classified according to choline findings and types of DCE curve, finally being compared to pathological results as the standard reference. RESULTS this study included 19 patients with malignant lesions and 11 patients with benign ones. While 63.6 % of benign lesions (7 of 11) showed type 1 DCE curves and 36.4% (4 of 11) showed type 2, 57.9% (11of 19) of malignant lesions were type 3 and 42.1% (8 of 19) type 2. Choline peaks were detected in 18 of 19 malignant lesions and in 3 of 11 benign counterparts. 1 malignant and 8 benign cases did not show any visible resonance at 3.2 ppm so SV-MRS featured 94.7% sensitivity, 72.7 % specificity and 86.7% accuracy. CONCLUSIONS The present findings indicate that a combined approach using MRS and DCE MRI can improve the specificity of MRI for differentiation of benign and malignant breast lesions.
Collapse
Affiliation(s)
- Fariborz Faeghi
- Radiology Technology Department, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran E-mail :
| | | | | |
Collapse
|
8
|
Xing H, Song CL, Li WJ. Meta analysis of lymph node metastasis of breast cancer patients: Clinical value of DWI and ADC value. Eur J Radiol 2016; 85:1132-7. [PMID: 27161063 DOI: 10.1016/j.ejrad.2016.03.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 03/05/2016] [Accepted: 03/20/2016] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To evaluate the diagnostic utility of DWI in the assessment of node metastases and investigate whether the ADC value could be used to discriminate between metastatic and non-metastatic lymph nodes in breast cancer patients. MATERIALS AND METHODS 13 studies with a total of 676 metastatic and 811 non-metastatic lymph nodes were included. RESULTS (1) The pooled sensitivity, specificity, PPV and NPV of DWI were 0.83, 0.82, 0.83 and 0.85, respectively. The PLR and NLR were 4.95 and 0.23, respectively. The AUC and Q* index were 0.91 and 0.85, respectively. (2) The ADC value of metastatic lymph nodes was lower than non-metastatic lymph nodes (WMD=-0.213, 95% CI -0.349 to -0.076, Z=3.05, P<0.05). (3) Subgroup meta-analysis of the group of b(0800): The pooled sensitivity, specificity, PPV and NPV of DWI were 0.86, 0.86, 0.82 and 0.90, respectively. The PLR and NLR were 6.76 and 0.18, respectively. The AUC and Q* index were 0.93 and 0.87. The ADC value of metastatic lymph nodes was lower than non-metastatic lymph nodes(WMD=-0.267, 95% CI -0.348 to -0.185, Z=6.40, P<0.05). CONCLUSIONS DWI and ADC value appear to be a reliable method to differentiate metastatic and non-metastatic lymph nodes. The combination of b=0 and 800s/mm(2) resulted in higher diagnostic accuracy and more pronounced ADC value difference. If only a couple of b values are used, those of b=0 and 800s/mm(2) are recommended.
Collapse
Affiliation(s)
- Hua Xing
- Breast Surgery Department, China-Japan Union Hospital Of Jilin University, Xian Tai street number 126, Changchun, Jilin Province 130033, PR China
| | - Chang-Long Song
- Breast Surgery Department, China-Japan Union Hospital Of Jilin University, Xian Tai street number 126, Changchun, Jilin Province 130033, PR China.
| | - Wen-Jia Li
- Breast Surgery Department, China-Japan Union Hospital Of Jilin University, Xian Tai street number 126, Changchun, Jilin Province 130033, PR China
| |
Collapse
|
9
|
Reply to: "in vivo post-contrast 1H-MRS evaluation of malignant and benign breast lesions: a meta-analysis". Tumour Biol 2015; 36:6669-70. [PMID: 26264620 DOI: 10.1007/s13277-015-3895-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 08/05/2015] [Indexed: 10/23/2022] Open
|
10
|
Liu Z, Zhang J. Comments on "In vivo post-contrast 1H-MRS evaluation of malignant and benign breast lesions: a meta-analysis". Tumour Biol 2015; 36:5757-8. [PMID: 25999207 DOI: 10.1007/s13277-015-3569-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 05/13/2015] [Indexed: 01/24/2023] Open
Affiliation(s)
- Zhenyin Liu
- Department of Medical Imaging, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou City, 510623, People's Republic of China
| | | |
Collapse
|
11
|
Wang X, Wang XJ, Song HS, Chen LH. 1H-MRS evaluation of breast lesions by using total choline signal-to-noise ratio as an indicator of malignancy: a meta-analysis. Med Oncol 2015; 32:160. [PMID: 25895597 DOI: 10.1007/s12032-015-0603-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 03/26/2015] [Indexed: 11/30/2022]
Abstract
The aim of this study was to evaluate the diagnostic performance of the use of total choline signal-to-noise ratio (tCho SNR) criteria in MRS studies for benign/malignant discrimination of focal breast lesions. We conducted (1) a meta-analysis based on 10 studies including 480 malignant breast lesions and 312 benign breast lesions and (2) a subgroup meta-analysis of tCho SNR ≥ 2 as cutoff for malignancy based on 7 studies including 371 malignant breast lesions and 239 benign breast lesions. (1) The pooled sensitivity and specificity of proton MRS with tCho SNR were 0.74 (95 % CI 0.69-0.77) and 0.76 (95 % CI 0.71-0.81), respectively. The PLR and NLR were 3.67 (95 % CI 2.30-5.83) and 0.25 (95 % CI 0.14-0.42), respectively. From the fitted SROC, the AUC and Q* index were 0.89 and 0.82. Publication bias was present (t = 2.46, P = 0.039). (2) Meta-regression analysis suggested that neither threshold effect nor evaluated covariates including strength of field, pulse sequence, TR and TE were sources of heterogeneity (all P value >0.05). (3) Subgroup meta-analysis: The pooled sensitivity and specificity were 0.79 and 0.72, respectively. The PLR and NLR were 3.49 and 0.20, respectively. The AUC and Q* index were 0.92 and 0.85. The use of tCho SNR criteria in MRS studies was helpful for differentiation between malignant and benign breast lesions. However, pooled diagnostic measures might be overestimated due to publication bias. A tCho SNR ≥ 2 as cutoff for malignancy resulted in higher diagnostic accuracy.
Collapse
Affiliation(s)
- Xin Wang
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | | | | | | |
Collapse
|