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Cheung SM, Husain E, Masannat Y, Miller ID, Wahle K, Heys SD, He J. Lactate concentration in breast cancer using advanced magnetic resonance spectroscopy. Br J Cancer 2020; 123:261-267. [PMID: 32424149 PMCID: PMC7374160 DOI: 10.1038/s41416-020-0886-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/09/2020] [Accepted: 04/22/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Precision medicine in breast cancer demands markers sensitive to early treatment response. Aerobic glycolysis (AG) upregulates lactate dehydrogenase A (LDH-A) with elevated lactate production; however, existing approaches for lactate quantification are either invasive or impractical clinically. METHODS Thirty female patients (age 39-78 years, 15 grade II and 15 grade III) with invasive ductal carcinoma were enrolled. Lactate concentration was quantified from freshly excised whole tumours with double quantum filtered (DQF) magnetic resonance spectroscopy (MRS), and Nottingham Prognostic Index (NPI), LDH-A and proliferative marker Ki-67 were assessed histologically. RESULTS There was a significantly higher lactate concentration (t = 2.2224, p = 0.0349) in grade III (7.7 ± 2.9 mM) than in grade II (5.5 ± 2.4 mM). Lactate concentration was correlated with NPI (ρ = 0.3618, p = 0.0495), but not with Ki-67 (ρ = 0.3041, p = 0.1023) or tumour size (r = 0.1716, p = 0.3645). Lactate concentration was negatively correlated with LDH-A (ρ = -0.3734, p = 0.0421). CONCLUSION Our results showed that lactate concentration in whole breast tumour from DQF MRS is sensitive to tumour grades and patient prognosis.
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Affiliation(s)
- Sai Man Cheung
- Institute of Medical Sciences, School of Medicine, University of Aberdeen, Aberdeen, UK.
| | - Ehab Husain
- Pathology Department, Aberdeen Royal Infirmary, Aberdeen, UK
| | | | - Iain D Miller
- Pathology Department, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Klaus Wahle
- Strathclyde Institute of Pharmacy and Biological Sciences, University of Strathclyde, Glasgow, UK
| | | | - Jiabao He
- Institute of Medical Sciences, School of Medicine, University of Aberdeen, Aberdeen, UK
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2
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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.
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Affiliation(s)
- Uma Sharma
- Department of NMR & MRI Facility, All India Institute of Medical Sciences , New Delhi, India
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Lee BY, Zhu XH, Chen W. Quantitative analysis of spatial averaging effect on chemical shift imaging SNR and noise coherence with k-space sampling schemes. Magn Reson Imaging 2019; 60:85-92. [PMID: 30943436 DOI: 10.1016/j.mri.2019.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 03/25/2019] [Accepted: 03/27/2019] [Indexed: 01/19/2023]
Abstract
Spatial averaging of multiple voxels from high-resolution chemical shift imaging (hrCSI) is a common strategy for in vivo metabolic studies to achieve a better signal-to-noise ratio (SNR) for a region-of-interest. However, the mechanism about how the spatial averaging approach influences the respective spectral signal and noise and its relevance to the k-space sampling schemes remains unclear. Using three-dimension 17O CSI technique with the weighted k-space sampling method of Fourier series window, we performed quantitative SNR comparisons between a single low-resolution CSI (lrCSI) voxel (being 27 times larger than the hrCSI voxel size) and the spatially averaged hrCSI voxels with matched sampling volume and location. We demonstrated that the averaged hrCSI voxel spectrum had a large SNR loss (> 4 times) compared to the lrCSI voxel, which was resulted from unmatched increases in signal (~1.9 fold) and noise (~9.3 fold). The signal increase was caused by the spatial overlapping between the adjacent hrCSI voxels. The substantial noise increase was mainly attributed to the strong noise coherence among hrCSI voxels acquired with the weighted k-space sampling. This study presents a quantitative relation between the k-space sampling schemes to an apparent SNR penalty of the spatial averaging approach. The information could be useful for designing CSI acquisition method and determination of optimal spatial resolution for in vivo metabolic imaging studies.
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Affiliation(s)
- Byeong-Yeul Lee
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota Medical School, MN, USA.
| | - Xiao-Hong Zhu
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota Medical School, MN, USA
| | - Wei Chen
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota Medical School, MN, USA.
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Fardanesh R, Marino MA, Avendano D, Leithner D, Pinker K, Thakur SB. Proton MR spectroscopy in the breast: Technical innovations and clinical applications. J Magn Reson Imaging 2019; 50:1033-1046. [PMID: 30848037 DOI: 10.1002/jmri.26700] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 02/20/2019] [Indexed: 01/27/2023] Open
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.
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Affiliation(s)
- Reza Fardanesh
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Maria Adele Marino
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico Universitario G. Martino, University of Messina, Italy
| | - Daly Avendano
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Doris Leithner
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Katja Pinker
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Sunitha B Thakur
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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5
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Bolan PJ, Kim E, Herman BA, Newstead GM, Rosen MA, Schnall MD, Pisano ED, Weatherall PT, Morris EA, Lehman CD, Garwood M, Nelson MT, Yee D, Polin SM, Esserman LJ, Gatsonis CA, Metzger GJ, Newitt DC, Partridge SC, Hylton NM. MR spectroscopy of breast cancer for assessing early treatment response: Results from the ACRIN 6657 MRS trial. J Magn Reson Imaging 2016; 46:290-302. [PMID: 27981651 DOI: 10.1002/jmri.25560] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 11/01/2016] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To estimate the accuracy of predicting response to neoadjuvant chemotherapy (NACT) in patients with locally advanced breast cancer using MR spectroscopy (MRS) measurements made very early in treatment. MATERIALS AND METHODS This prospective Health Insurance Portability and Accountability Act (HIPAA)-compliant protocol was approved by the American College of Radiology and local-site institutional review boards. One hundred nineteen women with invasive breast cancer of ≥3 cm undergoing NACT were enrolled between September 2007 and April 2010. MRS measurements of the concentration of choline-containing compounds ([tCho]) were performed before the first chemotherapy regimen (time point 1, TP1) and 20-96 h after the first cycle of treatment (TP2). The change in [tCho] was assessed for its ability to predict pathologic complete response (pCR) and radiologic response using the area under the receiver operating characteristic curve (AUC) and logistic regression models. RESULTS Of the 119 subjects enrolled, only 29 cases (24%) with eight pCRs provided usable data for the primary analysis. Technical challenges in acquiring quantitative MRS data in a multi-site trial setting limited the capture of usable data. In this limited data set, the decrease in tCho from TP1 to TP2 had poor ability to predict either pCR (AUC = 0.53, 95% confidence interval [CI]: 0.27-0.79) or radiologic response (AUC = 0.51, 95% CI: 0.27-0.75). CONCLUSION The technical difficulty of acquiring quantitative MRS data in a multi-site clinical trial setting led to a low yield of analyzable data, which was insufficient to accurately measure the ability of early MRS measurements to predict response to NACT. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;46:290-302.
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Affiliation(s)
- Patrick J Bolan
- Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Eunhee Kim
- National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Maryland, USA.,American College of Radiology Imaging Network (ACRIN), Philadelphia, Pennsylvania, USA
| | - Benjamin A Herman
- American College of Radiology Imaging Network (ACRIN), Philadelphia, Pennsylvania, USA.,Center for Statistical Sciences, Brown University, Providence, Rhode Island, USA
| | | | - Mark A Rosen
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mitchell D Schnall
- American College of Radiology Imaging Network (ACRIN), Philadelphia, Pennsylvania, USA.,Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Etta D Pisano
- Department of Radiology, Medical College of South Carolina, Charleston, South Carolina, USA
| | - Paul T Weatherall
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Elizabeth A Morris
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Constance D Lehman
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael Garwood
- Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Michael T Nelson
- Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Douglas Yee
- Masonic Cancer Center and Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sandra M Polin
- Washington Radiology Associates, P.C., Fairfax, Virginia, USA
| | - Laura J Esserman
- Department of Surgery, University of California, San Francisco, California, USA
| | - Constantine A Gatsonis
- American College of Radiology Imaging Network (ACRIN), Philadelphia, Pennsylvania, USA.,Center for Statistical Sciences, Brown University, Providence, Rhode Island, USA
| | - Gregory J Metzger
- Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - David C Newitt
- Department of Radiology, University of California, San Francisco, California, USA
| | | | - Nola M Hylton
- Department of Radiology, University of California, San Francisco, California, USA
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Porembka JH, Seiler SJ, Sharma PB. Advanced Breast MRI Techniques: Helpful for Screening Breast Cancer? CURRENT BREAST CANCER REPORTS 2016. [DOI: 10.1007/s12609-016-0226-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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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.
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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
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8
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Koush Y, Elliott MA, Scharnowski F, Mathiak K. Comparison of real-time water proton spectroscopy and echo-planar imaging sensitivity to the BOLD effect at 3 T and at 7 T. PLoS One 2014; 9:e91620. [PMID: 24614912 PMCID: PMC3948886 DOI: 10.1371/journal.pone.0091620] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 02/10/2014] [Indexed: 12/02/2022] Open
Abstract
Gradient-echo echo-planar imaging (GE EPI) is the most commonly used approach to assess localized blood oxygen level dependent (BOLD) signal changes in real-time. Alternatively, real-time spin-echo single-voxel spectroscopy (SE SVS) has recently been introduced for spatially specific BOLD neurofeedback at 3 T and at 7 T. However, currently it is not known how neurofeedback based on real-time SE SVS compares to real-time GE EPI-based. We therefore compared both methods at high (3 T) and at ultra-high (7 T) magnetic field strengths. We evaluated standard quality measures of both methods for signals originating from the motor cortex, the visual cortex, and for a neurofeedback condition. At 3 T, the data quality of the real-time SE SVS and GE EPI R2* estimates were comparable. At 7 T, the data quality of the real-time GE EPI acquisitions was superior compared to those of the real-time SE SVS. Despite the somehow lower data quality of real-time SE SVS compared to GE EPI at 7 T, SE SVS acquisitions might still be an interesting alternative. Real-time SE SVS allows for a direct and subject-specific T2* estimation and thus for a physiologically more plausible neurofeedback signal.
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Affiliation(s)
- Yury Koush
- Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland
- Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
| | - Mark A. Elliott
- Center for Magnetic Resonance and Optical Imaging (CMROI), Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Frank Scharnowski
- Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland
- Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Klaus Mathiak
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
- JARA Translational Brain Medicine, Jülich - Aachen, Germany
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Abstract
In vivo magnetic resonance spectroscopy (MRS) of the breast can be used to measure the level of choline-containing compounds, which is a biomarker of malignancy. In the diagnostic setting, MRS can provide high specificity for distinguishing benign from malignant lesions. MRS also can be used as an early response indicator in patients undergoing neoadjuvant chemotherapy. This article describes the acquisition and analysis methods used for measuring total choline levels in the breast using MRS, reviews the findings from clinical studies of diagnosis and treatment response, and discusses problems, limitations, and future developments for this promising clinical technology.
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Affiliation(s)
- Patrick J Bolan
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN 55419, USA.
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Abramson RG, Arlinghaus LR, Weis JA, Li X, Dula AN, Chekmenev EY, Smith SA, Miga MI, Abramson VG, Yankeelov TE. Current and emerging quantitative magnetic resonance imaging methods for assessing and predicting the response of breast cancer to neoadjuvant therapy. BREAST CANCER-TARGETS AND THERAPY 2012; 2012:139-154. [PMID: 23154619 DOI: 10.2147/bctt.s35882] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Reliable early assessment of breast cancer response to neoadjuvant therapy (NAT) would provide considerable benefit to patient care and ongoing research efforts, and demand for accurate and noninvasive early-response biomarkers is likely to increase. Response assessment techniques derived from quantitative magnetic resonance imaging (MRI) hold great potential for integration into treatment algorithms and clinical trials. Quantitative MRI techniques already available for assessing breast cancer response to neoadjuvant therapy include lesion size measurement, dynamic contrast-enhanced MRI, diffusion-weighted MRI, and proton magnetic resonance spectroscopy. Emerging yet promising techniques include magnetization transfer MRI, chemical exchange saturation transfer MRI, magnetic resonance elastography, and hyperpolarized MR. Translating and incorporating these techniques into the clinical setting will require close attention to statistical validation methods, standardization and reproducibility of technique, and scanning protocol design.
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Affiliation(s)
- Richard G Abramson
- Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA ; Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN, USA ; Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, TN, USA
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Zhao C, Bolan PJ, Royce M, Lakkadi N, Eberhardt S, Sillerud L, Lee SJ, Posse S. Quantitative mapping of total choline in healthy human breast using proton echo planar spectroscopic imaging (PEPSI) at 3 Tesla. J Magn Reson Imaging 2012; 36:1113-23. [PMID: 22782667 DOI: 10.1002/jmri.23748] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Accepted: 06/01/2012] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To quantitatively measure tCho levels in healthy breasts using Proton-Echo-Planar-Spectroscopic-Imaging (PEPSI). MATERIALS AND METHODS The two-dimensional mapping of tCho at 3 Tesla across an entire breast slice using PEPSI and a hybrid spectral quantification method based on LCModel fitting and integration of tCho using the fitted spectrum were developed. This method was validated in 19 healthy females and compared with single voxel spectroscopy (SVS) and with PRESS prelocalized conventional Magnetic Resonance Spectroscopic Imaging (MRSI) using identical voxel size (8 cc) and similar scan times (∼7 min). RESULTS A tCho peak with a signal to noise ratio larger than 2 was detected in 10 subjects using both PEPSI and SVS. The average tCho concentration in these subjects was 0.45 ± 0.2 mmol/kg using PEPSI and 0.48 ± 0.3 mmol/kg using SVS. Comparable results were obtained in two subjects using conventional MRSI. High lipid content in the spectra of nine tCho negative subjects was associated with spectral line broadening of more than 26 Hz, which made tCho detection impossible. Conventional MRSI with PRESS prelocalization in glandular tissue in two of these subjects yielded tCho concentrations comparable to PEPSI. CONCLUSION The detection sensitivity of PEPSI is comparable to SVS and conventional PRESS-MRSI. PEPSI can be potentially used in the evaluation of tCho in breast cancer. A tCho threshold concentration value of ∼0.7 mmol/kg might be used to differentiate between cancerous and healthy (or benign) breast tissues based on this work and previous studies.
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Affiliation(s)
- Chenguang Zhao
- Department of Neurology and UNM Cancer Center, University of New Mexico School of Medicine, Albuquerque, New Mexico 87131, USA.
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12
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In vivo proton magnetic resonance spectroscopy of breast cancer: a review of the literature. Breast Cancer Res 2012; 14:207. [PMID: 22515594 PMCID: PMC3446370 DOI: 10.1186/bcr3132] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
An emerging clinical modality called proton magnetic resonance spectroscopy ((1)H-MRS) enables the non-invasive in vivo assessment of tissue metabolism and is demonstrating applications in improving the specificity of MR breast lesion diagnosis and monitoring tumour responsiveness to neoadjuvant chemotherapies. Variations in the concentration of choline-based cellular metabolites, detectable with (1)H-MRS, have shown an association with malignant transformation of tissue in in vivo and in vitro studies. (1)H-MRS exists as an adjunct to the current routine clinical breast MR examination. This review serves as an introduction to the field of breast (1)H-MRS, discusses modern high-field strength and quantitative approaches and technical considerations, and reviews the literature with respect to the application of (1)H-MRS for breast cancer.
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13
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Gruber S, Debski BK, Pinker K, Chmelik M, Grabner G, Helbich T, Trattnig S, Bogner W. Three-dimensional Proton MR Spectroscopic Imaging at 3 T for the Differentiation of Benign and Malignant Breast Lesions. Radiology 2011; 261:752-761. [DOI: 10.1148/radiol.11102096] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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14
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The added value of quantitative multi-voxel MR spectroscopy in breast magnetic resonance imaging. Eur Radiol 2011; 22:915-22. [PMID: 22076317 PMCID: PMC3297755 DOI: 10.1007/s00330-011-2322-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 10/04/2011] [Accepted: 10/06/2011] [Indexed: 12/25/2022]
Abstract
Objective To determine whether quantitative multivoxel MRS improves the accuracy of MRI in the assessment of breast lesions. Methods Twenty-five consecutive patients with 26 breast lesions ≥1 cm assessed as BI-RADS 3 or 4 with mammography underwent quantitative multivoxel MRS and contrast-enhanced MRI. The choline (Cho) concentration was calculated using the unsuppressed water signal as a concentration reference. ROC analysis established the diagnostic accuracy of MRI and MRS in the assessment of breast lesions. Results Respective Cho concentrations in 26 breast lesions re-classified by MRI as BI-RADS 2 (n = 5), 3 (n = 8), 4 (n = 5) and 5 (n = 8) were 1.16 ± 0.43 (mean ± SD), 1.43 ± 0.47, 2.98 ± 2.15 and 4.94 ± 3.10 mM. Two BI-RADS 3 lesions and all BI-RADS 4 and 5 lesions were malignant on histopathology and had Cho concentrations between 1.7 and 11.8 mM (4.03 ± 2.72 SD), which were significantly higher (P = 0.01) than that in the 11 benign lesions (0.4–1.5 mM; 1.19 ± 0.33 SD). Furthermore, Cho concentrations in the benign and malignant breast lesions in BI-RADS 3 category differed (P = 0.01). The accuracy of combined multivoxel MRS/breast MRI BI-RADS re-classification (AUC = 1.00) exceeded that of MRI alone (AUC = 0.96 ± 0.03). Conclusions These preliminary data indicate that multivoxel MRS improves the accuracy of MRI when using a Cho concentration cut-off ≤1.5 mM for benign lesions. Key Points • Quantitative multivoxel MR spectroscopy can improve the accuracy of contrast-enhanced breast MRI. • Multivoxel-MRS can differentiate breast lesions by using the highest Cho-concentration. • Multivoxel-MRS can exclude patients with benign breast lesions from further invasive diagnostic procedures.
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Dorrius MD, Pijnappel RM, Jansen-van der Weide MC, Jansen L, Kappert P, Oudkerk M, Sijens PE. Determination of Choline Concentration in Breast Lesions: Quantitative Multivoxel Proton MR Spectroscopy as a Promising Noninvasive Assessment Tool to Exclude Benign Lesions. Radiology 2011; 259:695-703. [DOI: 10.1148/radiol.11101855] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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