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Rahimifar P, Hashemi H, Malek M, Ebrahimi S, Tabibian E, Alidoosti A, Mousavi A, Yarandi F. Diagnostic value of 3 T MR spectroscopy, diffusion-weighted MRI, and apparent diffusion coefficient value for distinguishing benign from malignant myometrial tumours. Clin Radiol 2019; 74:571.e9-571.e18. [DOI: 10.1016/j.crad.2019.03.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 03/13/2019] [Indexed: 10/27/2022]
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Role of diffusion weighted imaging and magnetic resonance spectroscopy in breast cancer patients with indeterminate dynamic contrast enhanced magnetic resonance imaging findings. Magn Reson Imaging 2019; 61:66-72. [PMID: 31128225 DOI: 10.1016/j.mri.2019.05.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 05/20/2019] [Accepted: 05/21/2019] [Indexed: 11/21/2022]
Abstract
PURPOSE Dynamic contrast enhanced MRI (DCEMRI), diffusion weighted imaging (DWI) and in vivo proton (1H) magnetic resonance spectroscopy (MRS) provides functional and molecular nature of breast cancer. This study evaluates the potential of the combination of three MR parameters [curve kinetics, apparent diffusion coefficient (ADC) and total choline (tCho) concentration] determined from these techniques in increasing the sensitivity of breast cancer detection. METHODS MR investigations were carried out at 1.5 T on 56 patients with cytologically/histologically confirmed breast carcinoma. Single-voxel MRS was used to determine the tCho concentration. 3D FLASH was used for DCEMRI while single shot EPI based DWI was used for ADC determination. RESULTS On DCEMRI, one patient showed type I curve, while 8 showed type II and 47 showed type III curve thus giving a sensitivity of 83.9% as detection rate of malignancy. tCho concentration was above cut-off value (2.54 mmol/kg) for 50/56 cases giving a sensitivity of 89.3%. Among 9 indeterminate DCEMRI cases, tCho showed malignancy in 6 cases with type II curve. DWI detected malignancy in 54/56 cases that included 9 cases that were false negative on DCEMRI, yielding a sensitivity of 96.4%. A total of 54 cases showed malignancy when any two of the three MR parameters was positive for malignancy yielding a sensitivity of 96.4% while it increased to 100% when any one parameters showed positive result. CONCLUSION DWI showed highest sensitivity of detection compared to DCEMRI and MRS. Multi-parametric approach yielded 96.4% and 100% sensitivity when any two or one of the three parameters was taken as positive for malignancy, respectively. Also the results demonstrated that addition of DWI and MRS play a significant role in establishing the final diagnosis of malignancy, especially in cases where DCEMRI is indeterminate.
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Lima ZS, Ebadi MR, Amjad G, Younesi L. Application of Imaging Technologies in Breast Cancer Detection: A Review Article. Open Access Maced J Med Sci 2019; 7:838-848. [PMID: 30962849 PMCID: PMC6447343 DOI: 10.3889/oamjms.2019.171] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 02/16/2019] [Accepted: 02/17/2019] [Indexed: 12/12/2022] Open
Abstract
One of the techniques utilised in the management of cancer in all stages is multiple biomedical imaging. Imaging as an important part of cancer clinical protocols can provide a variety of information about morphology, structure, metabolism and functions. Application of imaging technics together with other investigative apparatus including in fluids analysis and vitro tissue would help clinical decision-making. Mixed imaging techniques can provide supplementary information used to improve staging and therapy planning. Imaging aimed to find minimally invasive therapy to make better results and reduce side effects. Probably, the most important factor in reducing mortality of certain cancers is an early diagnosis of cancer via screening based on imaging. The most common cancer in women is breast cancer. It is considered as the second major cause of cancer deaths in females, and therefore it remained as an important medical and socio-economic issue. Medical imaging has always formed part of breast cancer care and has used in all phases of cancer management from detection and staging to therapy monitoring and post-therapeutic follow-up. An essential action to be performed in the preoperative staging of breast cancer based on breast imaging. The general term of breast imaging refers to breast sonography, mammography, and magnetic resonance tomography (MRT) of the breast (magnetic resonance mammography, MRM). Further development in technology will lead to increase imaging speed to meet physiological processes requirements. One of the issues in the diagnosis of breast cancer is sensitivity limitation. To overcome this limitation, complementary imaging examinations are utilised that traditionally includes screening ultrasound, and combined mammography and ultrasound. Development in targeted imaging and therapeutic agents calls for close cooperation among academic environment and industries such as biotechnological, IT and pharmaceutical industries.
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Affiliation(s)
- Zeinab Safarpour Lima
- Shahid Akbarabadi Clinical Research Development Unit (ShACRDU), Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Mohammad Reza Ebadi
- Shohadaye Haft-e-tir Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Ghazaleh Amjad
- Shahid Akbarabadi Clinical Research Development Unit (ShACRDU), Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Ladan Younesi
- Shahid Akbarabadi Clinical Research Development Unit (ShACRDU), Iran University of Medical Sciences (IUMS), Tehran, Iran
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Dejust S. L’exploration axillaire : un standard du bilan préthérapeutique. ONCOLOGIE 2019. [DOI: 10.3166/onco-2019-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
L’exploration préthérapeutique axillaire est une étape majeure du bilan initial du cancer du sein. L’échographie associée à un prélèvement est actuellement recommandée en première intention. L’IRM et la TEP/TDM au 18FDG sont utiles dans l’évaluation ganglionnaire axillaire. Les sensibilités et spécificités des examens d’imagerie sont globalement identiques, et leur combinaison permet d’obtenir les meilleures performances. Actuellement, la technique du ganglion sentinelle est indispensable en cas de tumeurs mammaires T1-T2 N0 et en cas d’adénopathie suspecte échographiquement avec cytoponction ou microbiopsie négative.
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Study of lipid metabolism by estimating the fat fraction in different breast tissues and in various breast tumor sub-types by in vivo 1H MR spectroscopy. Magn Reson Imaging 2018; 49:116-122. [PMID: 29454110 DOI: 10.1016/j.mri.2018.02.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 02/01/2018] [Accepted: 02/12/2018] [Indexed: 12/15/2022]
Abstract
PURPOSE To evaluate the utility of fat fraction (FF) for the differentiation of different breast tissues and in various breast tumor subtypes using in vivo proton (1H) magnetic resonance spectroscopy (MRS). METHODS 1H MRS was performed on 68 malignant, 35 benign, and 30 healthy volunteers at 1.5 T. Malignant breast tissues of patients were characterized into different subtypes based on the differences in the expression of hormone receptors and the FF was calculated. Further, the sensitivity and specificity of FF to differentiate malignant from benign and from normal breast tissues of healthy volunteers was determined using receiver operator curve (ROC) analysis. RESULTS A significantly lower FF of malignant (median 0.12; range 0.01-0.70) compared to benign lesions (median 0.28; range 0.02-0.71) and normal breast tissue of healthy volunteers (median 0.39; range 0.06-0.76) was observed. No significant difference in FF was seen between benign lesions and normal breast tissues of healthy volunteers. Sensitivity and specificity of 75% and 68.6%, respectively was obtained to differentiate malignant from benign lesions. For the differentiation of malignant from healthy breast tissues, 76% sensitivity and 74.5% specificity was achieved. Higher FF was seen in patients with ER-/PR- status as compared to ER+/PR+ patients. Similarly, FF of HER2neu+ tumors were significantly higher than in HER2neu- breast tumors. CONCLUSION The results showed the potential of in vivo 1H MRS in providing insight into the changes in the fat content of different types of breast tissues and in various breast tumor subtypes.
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Buré L, Boucher LM, Blumenkrantz M, Schob S, Lafaye de Micheaux P, Reinhold C, Gallix B. Can magnetic resonance spectroscopy differentiate malignant and benign causes of lymphadenopathy? An in-vitro approach. PLoS One 2017; 12:e0182169. [PMID: 28792506 PMCID: PMC5549694 DOI: 10.1371/journal.pone.0182169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 07/13/2017] [Indexed: 11/23/2022] Open
Abstract
Lymphadenopathy continues to be a common problem to radiologists and treating physicians because of the difficulty in confidently categorizing a node as being benign or malignant using standard diagnostic techniques. The goal of our research was to assess whether magnetic resonance (MR) spectroscopy contains the necessary information to allow differentiation of benign from malignant lymph nodes in an in-vitro approach using a modern pattern recognition method. Tissue samples from a tissue bank were analyzed on a nuclear magnetic resonance (NMR) spectrometer. A total of 69 samples were studied. The samples included a wide variety of malignant and benign etiologies. Using 45 samples, we initially created a model which was able to predict if a certain spectrum originates from benign or malignant lymph nodes using a pattern-recognition technique which takes into account the entire magnetic spectrum rather than single peaks alone. The remaining 24 samples were blindly loaded in the model to assess its performance. We obtained an excellent accuracy in differentiating benign and malignant lymphadenopathy using the model. It correctly differentiated as malignant or benign, in a blinded fashion, all of the malignant samples (13 of 13) and 10 out of the 11 benign samples. We thus showed that magnetic spectroscopy is able to differentiate benign from malignant causes of lymphadenopathy. Additional experiments were performed to verify that the differentiating abilities of our model were not due to differential tissue decay in between benign and malignant tissues. If future experiments demonstrate that a similar approach could be executed with standard MR imaging, this technique could be useful as a problem-solving tool when assessing lymphadenopathy in general. Alternatively, our in-vitro technique could also be useful to pathologists faced with indeterminate pathologies of the lymph nodes after validating our results with a larger sample size.
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Affiliation(s)
- Lionel Buré
- Department of Radiology, McGill University Health Center, Montreal General Hospital, Montreal, Qc, Canada
| | - Louis-Martin Boucher
- Department of Radiology, McGill University Health Center, Montreal General Hospital, Montreal, Qc, Canada
| | - Miriam Blumenkrantz
- Department of Adult and Pediatric Pathology, McGill University Health Center, Royal Victoria Hospital, Montreal, Qc, Canada
| | - Stefan Schob
- Department of Neuroradiology, Leipzig University Hospital, Leipzig, Germany
| | | | - Caroline Reinhold
- Department of Radiology, McGill University Health Center, Montreal General Hospital, Montreal, Qc, Canada
| | - Benoit Gallix
- Department of Radiology, McGill University Health Center, Montreal General Hospital, Montreal, Qc, Canada
- * E-mail:
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Zhang L, Zhuang L, Shi C, Miao Y, Zhang W, Song Q, Kang J, Lang Z, Xin X, Liu A, Hu J. A pilot evaluation of magnetic resonance imaging characteristics seen with solid papillary carcinomas of the breast in 4 patients. BMC Cancer 2017; 17:525. [PMID: 28784112 PMCID: PMC5547522 DOI: 10.1186/s12885-017-3518-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 08/01/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Solid papillary carcinoma (SPC) is a rare variant of breast papillary carcinoma with unique pathological morphology and biological behavior. There is only one case report on T1-MRI of SPC. In this study, we report our findings on this new category of papillary carcinoma to fill the gap in MRI characterization of SPC. METHODS This retrospective study included four pathology-confirmed in situ SPC patients. Conventional MRI, diffusion weighted imaging (DWI), and magnetic resonance spectroscopy (MRS) were performed with a 1.5 T whole-body MR scanner before surgical operation. The following characteristics of each lesion were recorded: signal intensity on T2WI/STIR and T1FSPGR, morphology, maximum lesion size, and time intensity curve (TIC) on dynamic contrast enhancement MRI (DCE-MRI), apparent diffusion coefficient (ADC) value from DWI, and Cho peak from MRS. RESULTS Signal intensities of all lesions were heterogenous on T2WI/STIR and T1FSPGR. Mass enhancements were observed for all lesions with either oval or irregular shapes on DCE-MRI. The maximum lesion size ranged from 0.8 cm to 3.2 cm. All lesion margins were circumscribed, and internal enhancements were homogeneous or heterogeneous from DCE-MRI. TIC appeared with a rapid increase in initial contrast phases of all lesions. All lesions on DWI (b = 1000s/mm2) were slightly hyperintense with an ADC value range of 1.3 × 10-3 mm2/s to 1.9 × 10-3 mm2/s. Cho peak was absent at 3.2 ppm for all lesions. CONCLUSIONS MRI characteristics of SPC include heterogeneous signal intensity within the lesion on T2WI/STIR and T1FSPGR, mass enhancement with circumscribed margins, either oval or irregular shapes, and a rapid initial enhancement of TIC on DCE-MRI. ADC values and the absence of Cho peak may provide valuable information to distinguish SPC from other invasive breast carcinomas.
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Affiliation(s)
- Lina Zhang
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China
| | - Ling Zhuang
- Department of Oncology, Wayne State University School of Medicine, Detroit, USA
| | - Chang Shi
- Department of Pathology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yanwei Miao
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China
| | - Weisheng Zhang
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China
| | - Qingwei Song
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China
| | - Jianyun Kang
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China
| | - Zhijin Lang
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China
| | - Xuegang Xin
- Department of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, China
| | - Ailian Liu
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China.
| | - Jiani Hu
- Department of Radiology, Wayne State University, Detroit, USA.
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Clauser P, Marcon M, Dietzel M, Baltzer PA. A new method to reduce false positive results in breast MRI by evaluation of multiple spectral regions in proton MR-spectroscopy. Eur J Radiol 2017. [DOI: 10.1016/j.ejrad.2017.04.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Bekhouche A, Tardivon A. Statut ganglionnaire axillaire chez les patientes prises en charge pour un cancer du sein : évaluation préopératoire et évolution de la prise en charge. IMAGERIE DE LA FEMME 2017. [DOI: 10.1016/j.femme.2017.01.005] [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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10
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García-Figueiras R, Baleato-González S, Padhani AR, Oleaga L, Vilanova JC, Luna A, Cobas Gómez JC. Proton magnetic resonance spectroscopy in oncology: the fingerprints of cancer? Diagn Interv Radiol 2017; 22:75-89. [PMID: 26712681 DOI: 10.5152/dir.2015.15009] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Abnormal metabolism is a key tumor hallmark. Proton magnetic resonance spectroscopy (1H-MRS) allows measurement of metabolite concentration that can be utilized to characterize tumor metabolic changes. 1H-MRS measurements of specific metabolites have been implemented in the clinic. This article performs a systematic review of image acquisition and interpretation of 1H-MRS for cancer evaluation, evaluates its strengths and limitations, and correlates metabolite peaks at 1H-MRS with diagnostic and prognostic parameters of cancer in different tumor types.
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Affiliation(s)
- Roberto García-Figueiras
- Department of Radiology, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain.
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Ramazan A, Demircioglu O, Ugurlu U, Kaya H, Aribal E. Efficacy of single voxel 1H MR spectroscopic imaging at 3T for the differentiation of benign and malign breast lesions. Clin Imaging 2016; 40:831-6. [PMID: 27179154 DOI: 10.1016/j.clinimag.2016.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 02/18/2016] [Accepted: 03/10/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of our study was to evaluate the effect of 1H Magnetic Resonance Spectroscopy (MRS) in differentiating breast lesions. MATERIALS AND METHODS Single voxel 1H Magnetic Resonance Spectroscopy (1H-MRS) was performed with 3T magnet in 45 women. The choline cut off point was set semi-quantitavely. Sensitivity, specificity and accuracy of MRS were calculated. RESULTS Twenty-four of 25 (96%) malignant and 9 of 26 (35%) benign lesions had choline peak. With the use cutoff value of 19,5 MRS provided a 96% sensitivity, 65% specificity and 80% accuracy. CONCLUSION MRS has a high diagnostic accuracy in differentiating breast lesions.
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Affiliation(s)
- Abdullah Ramazan
- Marmara University Pendik Education and Research Hospital, Department of Radiology, Istanbul.
| | - Ozlem Demircioglu
- Marmara University Pendik Education and Research Hospital, Department of Radiology, Istanbul.
| | - Umit Ugurlu
- Marmara University Pendik Education and Research Hospital, Department of General Surgery, Istanbul.
| | - Handan Kaya
- Marmara University Pendik Education and Research Hospital, Department of Pathology, Istanbul.
| | - Erkin Aribal
- Marmara University Pendik Education and Research Hospital, Department of Radiology, Istanbul.
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Wang J, Wang MY, Kuo WH, Chen KL, Shih TTF. Proton MR spectroscopy of normal breasts: Association of risk factors for breast cancer with water and lipid composition of the breast. Magn Reson Imaging 2016; 34:524-8. [DOI: 10.1016/j.mri.2015.12.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 12/15/2015] [Indexed: 10/22/2022]
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Teama AH, Hassanien OA, Hashish AAE, Shaarawy HA. The role of conventional and functional MRI in diagnosis of breast masses. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Murray PJ, Wivell G, Denton E. Breast cancer screening and diagnosis in the 21st century within the U.K. Post Reprod Health 2015. [PMID: 26209528 DOI: 10.1177/2053369115594954] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In the UK, breast cancer represents the most commonly diagnosed cancer in females and carries with it a significant morbidity and mortality. An established national screening programme is in place to identify those with the disease at an early stage in order to optimise treatment and prognosis. This article provides an overview for the non-breast specialist clinician whose practice regularly deals with women who may be the subject of the screening programme. It outlines the diagnostic methods employed in the screening programme, the controversies that have surrounded it and the evolving technologies that will improve detection and diagnostic accuracy.
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Affiliation(s)
- Philip J Murray
- Department of Radiology, Norfolk and Norwich University Hospital, Norfolk, Norwich, UK
| | - Glynis Wivell
- Department of Radiology, Norfolk and Norwich University Hospital, Norfolk, Norwich, UK
| | - Erika Denton
- Department of Radiology, Norfolk and Norwich University Hospital, Norfolk, Norwich, UK
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Rivera DS, Wijnen JP, van der Kemp WJM, Raaijmakers AJ, Luijten PR, Klomp DWJ. MRI and 31
P magnetic resonance spectroscopy hardware for axillary lymph node investigation at 7T. Magn Reson Med 2014; 73:2038-46. [DOI: 10.1002/mrm.25304] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 05/07/2014] [Accepted: 05/07/2014] [Indexed: 12/19/2022]
Affiliation(s)
- Debra S. Rivera
- Department of Neurophysics; Max Planck Institute for Human Cognitive and Brain Sciences; Leipzig Germany
| | - Jannie P. Wijnen
- Department of Radiology; University Medical Center Utrecht; Utrecht the Netherlands
| | | | | | - Peter R. Luijten
- Department of Radiology; University Medical Center Utrecht; Utrecht the Netherlands
| | - Dennis W. J. Klomp
- Department of Radiology; University Medical Center Utrecht; Utrecht the Netherlands
- Department of Radiology; University Medical Center Nijmegen; Nijmegen the Netherlands
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Lynch K, O'Brien R. ¹H magnetic resonance spectroscopy: a review of the current literature and its potential utility in veterinary oncology. Vet J 2014; 200:240-7. [PMID: 24662026 DOI: 10.1016/j.tvjl.2014.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Revised: 02/04/2014] [Accepted: 02/06/2014] [Indexed: 11/15/2022]
Abstract
Advanced imaging of veterinary cancer patients has evolved in recent years and modalities once limited to human medicine have now been described for diagnostic purposes in veterinary medicine (positron emission tomography/computed tomography, single-photon emission computed tomography, whole body magnetic resonance imaging). Magnetic resonance spectroscopy (MRS) is a non-invasive and non-ionizing technique that is well described in the human medical literature and is most frequently used to evaluate the metabolic activity of tissues with questionable malignant transformation. Differentiation of neoplastic tissue from surrounding normal tissue is dependent on variations in cellular metabolism. Positive identification of malignancy can be made when neoplastic alterations are occurring at the cellular level prior to gross anatomic changes. This improved, early detection of cancer occurrence (or recurrence) can improve patient survival and direct medical therapy. MRS techniques are largely underutilized in veterinary medicine, with current research predominantly limited to the brain (both evaluation of normal and diseased tissue). Given the clinical utility of MRS in humans, the technique may also be useful in the staging of cancer in veterinary medicine.
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Affiliation(s)
- Katherine Lynch
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, IL 61801, USA.
| | - Robert O'Brien
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, IL 61801, USA
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Tsougos I, Svolos P, Kousi E, Athanassiou E, Theodorou K, Arvanitis D, Fezoulidis I, Vassiou K. The contribution of diffusion tensor imaging and magnetic resonance spectroscopy for the differentiation of breast lesions at 3T. Acta Radiol 2014; 55:14-23. [PMID: 23864060 DOI: 10.1177/0284185113492152] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Conventional breast magnetic resonance imaging (MRI), including dynamic contrast-enhanced MR mammography (DCE-MRM), may lead to ambiguous diagnosis and unnecessary biopsies. PURPOSE To investigate the contribution of proton MR spectroscopy (1H-MRS) combined with diffusion tensor imaging (DTI) metrics in the discrimination between benign and malignant breast lesions. MATERIAL AND METHODS Fifty-one women with known breast abnormalities from conventional imaging were examined on a 3T MR scanner. DTI was performed during breast MRI, and fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were measured in the breast lesions and the contralateral normal breast. FA and ADC were compared between malignant lesions, benign lesions, and normal tissue. 1H-MRS was performed after gadolinium administration and choline peak was qualitatively evaluated. RESULTS In our study 1H-MRS showed a sensitivity of 93.5%, specificity 80%, and accuracy 88.2%. FA was significantly higher in breast carcinomas compared to benign lesions. However, no significant difference was observed in ADC between benign and malignant lesions. The combination of Cho presence and FA achieved higher levels of accuracy and specificity in discriminating malignant from benign lesions over Cho presence or FA alone. CONCLUSION In conclusion, applying DTI and 1H-MRS together, adds incremental diagnostic value in the characterization of breast lesions and may sufficiently improve the low specificity of conventional breast MRI.
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Affiliation(s)
- Ioannis Tsougos
- Department of Medical Physics, University of Thessaly Medical School, Larissa, Greece
| | - Patricia Svolos
- Department of Medical Physics, University of Thessaly Medical School, Larissa, Greece
| | - Evanthia Kousi
- Department of Medical Physics, University of Thessaly Medical School, Larissa, Greece
| | | | - Kiriaki Theodorou
- Department of Medical Physics, University of Thessaly Medical School, Larissa, Greece
| | - Dimitrios Arvanitis
- Department of Anatomy-Histology-Embryology, University of Thessaly Medical School, Larissa, Greece
| | - Ioannis Fezoulidis
- Department of Diagnostic Radiology, University of Thessaly Medical School, Larissa, Greece
| | - Katerina Vassiou
- Department of Diagnostic Radiology, University of Thessaly Medical School, Larissa, Greece
- Department of Anatomy-Histology-Embryology, University of Thessaly Medical School, Larissa, Greece
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Carbonaro LA. Can we use MR-mammography to predict nodal status? Eur J Radiol 2013; 81 Suppl 1:S17-8. [PMID: 23083577 DOI: 10.1016/s0720-048x(12)70007-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Luca Alessandro Carbonaro
- Department/Institution: Radiology Unit, IRCCS Policlinico San Donato, Piazza E. Malan 2, San Donato Milanese, Italy.
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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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SUARIS TD, FROUD I, VINNICOMBE SJ. Breast MRI: getting started. IMAGING 2013. [DOI: 10.1259/imaging.20100022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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22
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Vassiou K, Tsougos I, Kousi E, Vlychou M, Athanasiou E, Theodorou K, Arvanitis DL, Fezoulidis IV. Application value of 3T ¹H-magnetic resonance spectroscopy in diagnosing breast tumors. Acta Radiol 2013; 54:380-8. [PMID: 23436823 DOI: 10.1177/0284185113475921] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Assessment of breast lesions with magnetic resonance imaging (MRI) provides a means for lesion detection and diagnosis. Proton (hydrogen-1) magnetic resonance spectroscopy ((1)H-MRS) has been proposed as a useful diagnostic technique in providing metabolic information of suspicious breast lesions. PURPOSE To determine the clinical significance of in-vivo single voxel (1)H-MRS at 3T in the assessment of benign and malignant breast lesions in combination with dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). MATERIAL AND METHODS Twenty-four women with known breast abnormalities from conventional imaging (mammography, ultrasonography) underwent DCE-MRI at a 3T MR scanner and 26 breast lesions were detected. Breast lesions were assessed according BI-RADS classification. Single voxel (1)H-MRS was performed after gadolinium administration and choline peak was qualitatively evaluated. All lesions were confirmed histologically from the surgically excised specimens. Sensitivity, specificity, and accuracy of the (1)H-MRS, of the BI-RADS classification and of their combination (DCE-MRI + (1)H-MRS) were calculated. RESULTS Fifteen out of 26 lesions proved to be malignant and 11 proved to be benign. In our study (1)H-MRS showed sensitivity 80%, specificity 81.8%, and accuracy 80.7%. DCE-MRI showed sensitivity 100%, specificity 63.6%, and accuracy 84.6%. The combination of DCE-MRI and (1)H-MRS provided higher accuracy (96.4%), as well as higher specificity 81.8% compared to BI-RADS classification. CONCLUSION The combined use of (1)H-MRS and DCE-MRI found to have improved diagnostic performance in the assessment of equivocal breast lesions. (1)H-MRS can be used as a useful adjunct during lesion characterization in clinical routine in cases classified as BI-RADS 3 and 4.
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Evaluation of breast cancer using proton MR spectroscopy: total choline peak integral and signal-to-noise ratio as prognostic indicators. AJR Am J Roentgenol 2012; 198:W488-97. [PMID: 22528931 DOI: 10.2214/ajr.11.7292] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The purpose of this article is to determine whether the peak integral and signal-to-noise ratio (SNR) of total choline-containing compounds obtained by MR spectroscopy (MRS) correlate with histologic biomarkers currently used for predicting prognosis in patients with breast cancer. MATERIALS AND METHODS Single-voxel proton MRS using a 1.5-T scanner was performed in 184 patients (mean age, 48 years; range, 28-72 years) with breast cancer. We obtained absolute total choline-containing compound peak integral, total choline-containing compound peak integral normalized for the volume of interest, and SNR after MRI. On surgical pathology, pathologic subtype and prognostic factors such as nuclear grade, histologic grade, estrogen receptor (ER), HER-2≠neu, extensive intraductal component (EIC), lymphovascular invasion, and lymph node metastasis were also evaluated. Statistical analysis was performed using Mann-Whitney U test and Spearman rank correlation. RESULTS The total choline-containing compound SNR, absolute total choline-containing compound peak integral, and normalized total choline-containing compound integral were significantly higher for invasive ductal carcinoma, cancer of high nuclear or histologic grade, and EIC-negative cancer (p < 0.001) than for in situ or other invasive carcinomas (p = 0.005), cancer of low nuclear or histologic grade (p = 0.009), and EIC-positive cancer (p = 0.017). There was a significant difference in the total choline-containing compound SNR between ER-positive and -negative groups (p = 0.007) and between triple-negative and non-triple-negative groups (p = 0.002). A positive correlation was found between the volume of interest (p < 0.001), tumor size (p = 0.011), and three MRS parameters (p = 0.003). CONCLUSION Our study suggests that proton MRS can play a role in predicting prognostic indicators of tumor aggressiveness in patients with newly diagnosed breast cancer.
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Baek HM. Diagnostic value of breast proton magnetic resonance spectroscopy at 1.5T in different histopathological types. ScientificWorldJournal 2012; 2012:508295. [PMID: 22654620 PMCID: PMC3361280 DOI: 10.1100/2012/508295] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 11/29/2011] [Indexed: 11/19/2022] Open
Abstract
The purpose of this study was to investigate the usefulness of quantitative proton magnetic resonance spectroscopy (1H-MRS) for characterizing breast lesions at 1.5T, and to evaluate the diagnostic performance of in vivo breast 1H-MRS using receiver operating characteristics (ROC) analysis. 112 patients (99 malignant and 13 benign tumors) who were scanned with the MRI/MRS protocol were included in this study. Choline-containing compounds (tCho) levels were measured and compared with histological findings. The measured tCho levels in this work had range of 0.08–9.99 mmol/kg from 65 (66%) of 99 patients with malignant tumors. Of the 13 benign lesions, 1H-MRS detected one as false positive, with tCho level of 0.66 mmol/kg. The optimal tCho level cutoff point that yielded the highest accuracy was found to be >0.0 mmol/kg. The resulting sensitivity was 66% and
specificity 92% for distinguishing benign from malignant lesions. The tCho levels were found to be higher in invasive cancer compared to ductal carcinoma in situ or benign lesions, possibly associated with more aggressive behavior or faster cell replication in invasive cancer. Quantitative in vivo
1H-MRS may provide useful information for characterizing histopatholoigical types in breast cancer.
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Affiliation(s)
- Hyeon-Man Baek
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, 5325 Harry Hines Boulevard, Dallas, TX 75390-8830, USA
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Khattab EM, Abdulmonaem G, Al-Attar AZEA. Magnetic resonance spectroscopy in recurrent breast masses following conservative surgery and radiation therapy. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2012. [DOI: 10.1016/j.ejrnm.2011.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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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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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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Feasibility of 7 Tesla breast magnetic resonance imaging determination of intrinsic sensitivity and high-resolution magnetic resonance imaging, diffusion-weighted imaging, and (1)H-magnetic resonance spectroscopy of breast cancer patients receiving neoadjuvant therapy. Invest Radiol 2011; 46:370-6. [PMID: 21317792 DOI: 10.1097/rli.0b013e31820df706] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To evaluate the feasibility of 7T breast magnetic resonance imaging (MRI) by determining the intrinsic sensitivity gain compared with 3T in healthy volunteers and to explore clinical application of 7T MRI in breast cancer patients receiving neoadjuvant chemotherapy (NAC). MATERIALS AND METHODS In 5 volunteers, the signal-to-noise ratio (SNR) was determined on proton density MRI at 3T using a conventional 4-channel bilateral breast coil and at 7T using a dedicated 2-channel unilateral breast coil, both obtained at identical scan parameters. Subsequently, consecutive breast cancer patients on NAC were included. The 7T breast MRI protocol consisted of diffusion-weighted imaging, 3D high-resolution (450 μm isotropic) T1-weighted fat-suppressed gradient-echo sequences and quantified single voxel (1)H-magnetic resonance spectroscopy. Morphology was scored according to the MRI Breast Imaging-Reporting and Data System (BI-RADS)-lexicon, and the images were compared with 3T and histopathologic findings. Image quality was evaluated using a 5-point scale. RESULTS A 5.7-fold higher SNR was measured at 7T than at 3T, which reflects the advantages of a higher field strength and the use of optimized radiofrequency coils. Three breast cancer patients were included and received a total of 13 7T MRI examinations. The image quality of the high-resolution examinations was at least satisfactory, and good to excellent in 9 of the 13 examinations performed. More anatomic detail was depicted at 7T than at 3T. In 1 case, a fat plane between the muscle and tumor was visible at 7T, but not at the clinically performed 3T examination, suggesting that there was no muscle invasion, which was confirmed by pathology. Changes in tumor apparent diffusion coefficient values could be monitored in 2 patients and were found to increase during NAC, consistent with published results from studies at lower field strengths. Apparent diffusion coefficient values increased respectively from 0.33 × 10(-3) mm(2)/s to 1.78 × 10(-3) mm(2)/s after NAC and from 1.20 × 10(-3) mm(2)/s to 1.44 × 10(-3) mm(2)/s during NAC. Choline concentrations as low as 0.77 mMol/kg(water) could be detected. In 1 patient, choline levels showed an overall decrease from 4.2 mMol/kw(water) to 2.6 mMol/kg(water) after NAC and the tumor size decreased correspondingly from 3.9 × 4.1 × 5.6 cm(3) to 2.0 × 2.7 × 2.4 cm(3). All 7T MRI findings were consistent with pathology analysis. CONCLUSION Dedicated 7T breast MRI is technically feasible, can provide more SNR than at 3T, and has diagnostic potential.
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Magnetic resonance for assessment of axillary lymph node status in early breast cancer: a systematic review and meta-analysis. Eur J Surg Oncol 2011; 37:928-36. [PMID: 21855267 DOI: 10.1016/j.ejso.2011.07.007] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Revised: 07/12/2011] [Accepted: 07/25/2011] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Current methods of identifying axillary node metastases in breast cancer patients are highly accurate, but are associated with several adverse events. This review evaluates the diagnostic accuracy of magnetic resonance imaging (MRI) techniques for identification of axillary metastases in early stage newly diagnosed breast cancer patients. METHODS Comprehensive searches were conducted in April 2009. Study quality was assessed. Sensitivity and specificity were meta-analysed using a bivariate random effects approach, utilising pathological diagnosis via node biopsy as the comparative gold standard. RESULTS Based on the highest sensitivity and specificity reported in each of the nine studies evaluating MRI (n = 307 patients), mean sensitivity was 90% (95% CI: 78-96%; range 65-100%) and mean specificity 90% (95% CI: 75-96%; range 54-100%). Across five studies evaluating ultrasmall super-paramagnetic iron oxide (USPIO)-enhanced MRI (n = 93), mean sensitivity was 98% (95% CI: 61-100%) and mean specificity 96% (95% CI: 72-100%). Across three studies of gadolinium-enhanced MRI (n = 187), mean sensitivity was 88% (95% CI: 78-94%) and mean specificity 73% (95% CI: 63-81%). In the single study of in-vivo proton MR spectroscopy (n = 27), sensitivity was 65% (95% CI: 38-86%) and specificity 100% (95% CI: 69-100%). CONCLUSIONS USPIO-enhanced MRI showed a trend towards higher sensitivity and specificity and may make a useful addition to the current diagnostic pathway. Additional larger studies with standardised methods and standardised criteria for classifying a node as positive are needed. Current estimates of sensitivity and specificity do not support replacement of SLNB with any current MRI technology in this patient group.
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Thakur SB, Brennan SB, Ishill NM, Morris EA, Liberman L, Dershaw DD, Bartella L, Koutcher JA, Huang W. Diagnostic usefulness of water-to-fat ratio and choline concentration in malignant and benign breast lesions and normal breast parenchyma: an in vivo (1) H MRS study. J Magn Reson Imaging 2011; 33:855-63. [PMID: 21448950 DOI: 10.1002/jmri.22493] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To compare total choline concentrations ([Cho]) and water-to-fat (W/F) ratios of subtypes of malignant lesions, benign lesions, and normal breast parenchyma and determine their usefulness in breast cancer diagnosis. Reference standard was histology. MATERIALS AND METHODS In this HIPPA compliant study, proton MRS was performed on 93 patients with suspicious lesions (>1 cm) who underwent MRI-guided interventional procedures, and on 27 prospectively accrued women enrolled for screening MRI. (W/F) and [Cho] values were calculated using MRS data. RESULTS Among 88 MRS-evaluable histologically-confirmed lesions, 40 invasive ductal carcinoma (IDC); 10 invasive lobular carcinoma (ILC); 4 ductal carcinoma in situ (DCIS); 3 invasive mammary carcinoma (IMC); 31 benign. No significant difference observed in (W/F) between benign lesions and normal breast tissue. The area under curve (AUC) of receiver operating characteristic (ROC) curves for discriminating the malignant group from the benign group were 0.97, 0.72, and 0.99 using [Cho], (W/F) and their combination as biomarkers, respectively. (W/F) performs significantly (P < 0.0001;AUC = 0.96) better than [Cho] (AUC = 0.52) in differentiating IDC and ILC lesions. CONCLUSION Although [Cho] and (W/F) are good biomarkers for differentiating malignancy, [Cho] is a better marker. Combining both can further improve diagnostic accuracy. IDC and ILC lesions have similar [Cho] levels but are discriminated using (W/F) values.
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Affiliation(s)
- Sunitha B Thakur
- Departments of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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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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Siegmann KC, Krämer B, Claussen C. Current Status and New Developments in Breast MRI. Breast Care (Basel) 2011; 6:87-92. [PMID: 21673817 PMCID: PMC3104897 DOI: 10.1159/000328273] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
SUMMARY: Breast magnetic resonance imaging (MRI) is the most sensitive imaging modality for the detection of breast cancer. Its specificity is equivalent to that of mammography. Nowadays, breast MRI is an absolutely essential breast imaging method. Technical innovations allow dynamic contrast-enhanced (DCE) MRI of both breasts with high image quality. Thereby, DCE breast MRI should always be performed with regard to current standards. New quantitative techniques such as diffusion-weighted MRI are promising. However, they still have potential pitfalls, in particular with regard to the diagnosis of non-mass lesions and small breast lesions. Ongoing technical innovations can possibly help to further optimize breast MRI.
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Affiliation(s)
- Katja C. Siegmann
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Germany
| | - Bernhard Krämer
- Department of Obstetrics and Gynaecology, University Hospital Tuebingen, Germany
| | - Claus Claussen
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Germany
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Wasser K, Schnitzer A, Brade J, Schoenberg SO. [Non-invasive imaging modalities for preoperative axillary lymph node staging in patients with breast cancer]. Radiologe 2011; 50:1022-9. [PMID: 20953577 DOI: 10.1007/s00117-010-2072-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
In the last decade sentinel lymph node biopsy has become a well-established method for axillary lymph node staging in patients with breast cancer. Using preoperative imaging modalities it can be tested whether patients are suitable for sentinel node biopsy or if they should directly undergo an axillary dissection. The imaging modalities used must be mainly characterized by a high positive predictive value (PPV). For this question B-mode ultrasound is the best evaluated method and provides clear morphological signs for a high PPV (>90%) but the sensitivity barely exceeds 50%. It has not yet been proven whether other modalities such as duplex sonography, magnetic resonance imaging, computed tomography (CT) or scintigraphy might achieve a higher sensitivity while still maintaining a high PPV. There is only some evidence that positron emission tomography (PET) might achieve a higher sensitivity. This should be confirmed by further studies because PET or PET/CT will play an increasing role for an initial whole body staging in patients with breast cancer in the near future.
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Affiliation(s)
- K Wasser
- Institut für Klinische Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Deutschland.
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Chen JH, Mehta RS, Baek HM, Nie K, Liu H, Lin MQ, Yu HJ, Nalcioglu O, Su MY. Clinical characteristics and biomarkers of breast cancer associated with choline concentration measured by 1H MRS. NMR IN BIOMEDICINE 2011; 24:316-24. [PMID: 20862660 PMCID: PMC3075960 DOI: 10.1002/nbm.1595] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Revised: 06/30/2010] [Accepted: 07/02/2010] [Indexed: 05/21/2023]
Abstract
This study investigated the association between the total choline (tCho) concentration and the clinical characteristics and biomarker status of breast cancer. Sixty-two patients with breast cancer, 1.5 cm or larger in size on MR images, were studied. The tCho concentration was correlated with the MRI features, contrast enhancement kinetics, clinical variables and biomarkers. Pairwise two-tailed Spearman's nonparametric test was used for statistical analysis. The tCho concentration was higher in high-grade than moderate-/low-grade tumors (p = 0.04) and in tumors with higher K(trans) and k(ep) (p < 0.001 for both). The association of tCho concentration with age (p = 0.05) and triple negative biomarker (p = 0.09) approached significance. tCho was not detected in 17 patients, including 15 with invasive ductal cancer and two with infiltrating lobular cancer. Fifteen of the 17 patients had moderate- to low-grade cancers, and 11 had human epidermal growth factor-2-negative cancer, suggesting that these two factors might lead to false-negative choline. Higher tCho concentration in high-grade tumors and tumors with higher K(trans) and k(ep) indicates that choline is associated with cell proliferation and tumor angiogenesis. The higher choline level in younger women may be caused by their more aggressive tumor type. The results presented here may aid in the better interpretation of (1)H MRS for the diagnosis of breast lesions.
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Affiliation(s)
- J-H Chen
- Tu & Yuen Center for Functional Onco-Imaging, University of California, Irvine, CA 92697, USA.
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Lee CW, Lee JH, Kim DH, Min HS, Park BK, Cho HS, Kang HG, Suh JS, Ehara S. Proton magnetic resonance spectroscopy of musculoskeletal lesions at 3 T with metabolite quantification. Clin Imaging 2010; 34:47-52. [DOI: 10.1016/j.clinimag.2009.03.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2009] [Accepted: 03/10/2009] [Indexed: 11/26/2022]
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In vivo proton MR spectroscopy of the breast using the total choline peak integral as a marker of malignancy. AJR Am J Roentgenol 2009; 192:1608-17. [PMID: 19457825 DOI: 10.2214/ajr.07.3521] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The purpose of our study was to use the total choline-containing compound (tCho) peak integral as a marker of malignancy in breast MR spectroscopy (MRS). SUBJECTS AND METHODS Forty-eight single-voxel water- and fat-suppressed 1.5-T MRS measurements were performed in 42 patients, obtaining both absolute tCho peak integral and tCho peak integral normalized for the volume of interest (VOI). Our reference standard was histology for lesions with BI-RADS category 4 and 5 and histology or at least a 2-year follow-up for findings with BI-RADS 2 and 3 and normal glands. Receiver operating characteristic (ROC) analysis, Mann-Whitney U test, and Spearman's rank correlation were used. RESULTS Three of 48 measurements (6%) failed. Of the remaining 45 spectra, 18 nonmalignant tissues showed no tCho peak, eight nonmalignant tissues showed a tCho peak integral from 0.99 to 9.03 arbitrary units (AU), and 19 malignant lesions showed a tCho peak integral from 1.26 to 19.80 AU. The diameter of nonmalignant tissues was 16.9 +/- 7.4 mm; that of malignant lesions was 15.3 +/- 6.9 mm (p = 0.308). At ROC analysis, the optimal threshold was 1.90 AU for absolute tCho peak, with 0.895 (17/19) sensitivity, 0.923 (24/26) specificity, and an AUC (area under the curve) of 0.917 (95% CI, 0.822-1.000); the optimal threshold was 0.85 AU/mL for the normalized tCho peak integral with 0.842 (16/19) sensitivity, 0.885 (23/26) specificity, and an AUC of 0.941 (0.879-1.000) (p = 0.470). A negative correlation (p = 0.011) was found between the VOI and the normalized tCho peak integral of malignant tissues. CONCLUSION Breast MRS using tCho peak integral reaches a high level of diagnostic performance.
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Abstract
Breast MRI is an area of intense research and is fast becoming an important tool for the diagnosis of breast cancer. This review covers recent advances in breast MRI, MRS, and image post-processing and analysis. Several studies have explored a multi-parametric approach to breast imaging that combines analysis of traditional contrast enhancement patterns and lesion architecture with novel methods such as diffusion, perfusion, and spectroscopy to increase the specificity of breast MRI studies. Diffusion-weighted MRI shows some potential for increasing the specificity of breast lesion diagnosis and is even more promise for monitoring early response to therapy. MRS also has great potential for increasing specificity and for therapeutic monitoring. A limited number of studies have evaluated perfusion imaging based on first-pass contrast bolus tracking, and these clearly identify that vascular indices have great potential to increase specificity. The review also covers the relatively new acquisition technique of MR elastography for breast lesion characterization. A brief survey of image processing algorithms tailored for breast MR, including registration of serial dynamic images, segmentation and extraction of morphological features of breast lesions, and contrast uptake modeling, is also included. Recent advances in MRI, MRS, and automated image analysis have increased the utility of breast MR in diagnosis, screening, management, and therapy monitoring of breast cancer.
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Affiliation(s)
- S Sinha
- Department of Radiology, University of California-San Diego, San Diego, CA 92121-0852, USA.
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Geraghty PR, van den Bosch MAAJ, Spielman DM, Hunjan S, Birdwell RL, Fong KJ, Stables LA, Zakhour M, Herfkens RJ, Ikeda DM. MRI and (1)H MRS of the breast: presence of a choline peak as malignancy marker is related to K21 value of the tumor in patients with invasive ductal carcinoma. Breast J 2008; 14:574-80. [PMID: 19000051 DOI: 10.1111/j.1524-4741.2008.00650.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
To assess which specific morphologic features, enhancement patterns, or pharmacokinetic parameters on breast Magnetic Resonance Imaging (MRI) could predict a false-negative outcome of Proton MR Spectroscopy ((1)H MRS) exam in patients with invasive breast cancer. Sixteen patients with invasive ductal carcinoma of the breast were prospectively included and underwent both, contrast-enhanced breast MRI and (1)H MRS examination of the breast. The MR images were reviewed and the lesions morphologic features, enhancement patterns and pharmacokinetic parameters (k21-value) were scored according to the ACR BI-RADS-MRI lexicon criteria. For the in vivo MRS studies, each spectrum was evaluated for the presence of choline based on consensus reading. Breast MRI and (1)H MRS data were compared to histopathologic findings. In vivo (1)H MRS detected a choline peak in 14/16 (88%) cancers. A false-negative (1)H MRS study occurred in 2/16 (14%) cancer patients. K21 values differed between both groups: the 14 choline positive cancers had k21 values ranging from 0.01 to 0.20/second (mean 0.083/second), whereas the two choline-negative cancers showed k21 values of 0.03 and 0.05/second, respectively (mean 0.040/second). Also enhancement kinetics did differ between both groups; typically both cancers that were choline-negative showed a late phase plateau (100%), whereas this was only shown in 5/14 (36%) of the choline positive cases. There was no difference between both groups with regard to morphologic features on MRI. This study showed that false-negative (1)H MRS examinations do occur in breast cancer patients, and that the presence of a choline peak on (1)H MRS as malignancy marker is related to the k21 value of the invasive tumor being imaged.
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Affiliation(s)
- Patricia R Geraghty
- Department of Radiology, Stanford University School of Medicine, Stanford, CA 94305-5488, USA
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Abstract
Multiple biomedical imaging techniques are used in all phases of cancer management. Imaging forms an essential part of cancer clinical protocols and is able to furnish morphological, structural, metabolic and functional information. Integration with other diagnostic tools such as in vitro tissue and fluids analysis assists in clinical decision-making. Hybrid imaging techniques are able to supply complementary information for improved staging and therapy planning. Image guided and targeted minimally invasive therapy has the promise to improve outcome and reduce collateral effects. Early detection of cancer through screening based on imaging is probably the major contributor to a reduction in mortality for certain cancers. Targeted imaging of receptors, gene therapy expression and cancer stem cells are research activities that will translate into clinical use in the next decade. Technological developments will increase imaging speed to match that of physiological processes. Targeted imaging and therapeutic agents will be developed in tandem through close collaboration between academia and biotechnology, information technology and pharmaceutical industries.
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Affiliation(s)
- Leonard Fass
- GE Healthcare, 352 Buckingham Avenue, Slough, SL1 4ER, UK.
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Bartella L, Huang W. Proton (1H) MR spectroscopy of the breast. Radiographics 2008; 27 Suppl 1:S241-52. [PMID: 18180230 DOI: 10.1148/rg.27si075504] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Proton (hydrogen 1) [1H]) magnetic resonance (MR) spectroscopy provides biochemical information about the tissue under investigation. Its diagnostic value in cancer is typically based on the detection of elevated levels of choline compounds, choline being a marker of active tumor. The two main potential clinical applications of 1H MR spectroscopy are (a) as an adjunct to breast MR imaging to improve specificity in differentiating benign from malignant lesions, and (b) for monitoring or even predicting response to treatment in patients undergoing neoadjuvant chemotherapy. Preliminary data are promising, with study results suggesting that 1H MR spectroscopy may decrease the number of benign biopsies recommended on the basis of MR imaging findings and may help predict response as early as 24 hours after the first dose of neoadjuvant chemotherapy. Although several limitations currently exist that make the technique premature for clinical use, further evaluation with larger, preferably multicenter trials is certainly warranted.
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Affiliation(s)
- Lia Bartella
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA.
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41
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Sardanelli F, Fausto A, Podo F. MR spectroscopy of the breast. Radiol Med 2008; 113:56-64. [PMID: 18338127 DOI: 10.1007/s11547-008-0228-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2006] [Accepted: 07/27/2006] [Indexed: 12/16/2022]
Abstract
This literature review assesses the clinical potential of proton ((1)H) magnetic resonance spectroscopy (MRS) of breast lesions. We here illustrate the basic principles of spectrum acquisition for volumes of interest, determined on the basis of dynamic magnetic resonance imaging (MRI) and of MRS postprocessing. We discuss the criteria for interpreting the spectrum with particular reference to the metabolic significance of the peak of total choline containing compounds at 3.2 ppm, a marker that is correlated with malignancy. We then summarise the findings obtained in lesion characterisation (with a possible gain in specificity with respect to dynamic MRI), the assessment of the effects of neoadjuvant chemotherapy and the correlation reported at high-field between the tumour tissue concentration of choline-containing compounds and the presence of lymph node metastases. Lastly, we outline the clinical use of this technique as the final phase of a complete breast MR examination after intravenous administration of paramagnetic contrast material for the dynamic study, with reference to its use by radiologists dedicated to breast imaging.
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Affiliation(s)
- F Sardanelli
- Università degli Studi di Milano, Dipartimento di Scienze Medico-chirurgiche, IRCCS Policlinico San Donato, Servizio di Radiologia, San Donato Milanese, Milano, Italy.
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Proton MR Spectroscopy in Normal Breasts Between Pre- and Postmenopausal Women: A Preliminary Study. AJR Am J Roentgenol 2008; 190:505-10. [DOI: 10.2214/ajr.07.2437] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Pfisterer WK, Hendricks WP, Scheck AC, Nieman RA, Birkner TH, Krampla WW, Preul MC. FLUORESCENT IN SITU HYBRIDIZATION AND EX VIVO 1H MAGNETIC RESONANCE SPECTROSCOPIC EXAMINATIONS OF MENINGIOMA TUMOR TISSUE. Neurosurgery 2007; 61:1048-59; discussion 1060-1. [DOI: 10.1227/01.neu.0000303201.62123.5c] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Wolfgang K. Pfisterer
- Neurosurgery and Neuro-Oncology Research, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, and Neurosurgical Department, Sozialmedizinisches Zentrum-Ost, Donauspital, Vienna, Austria
| | - William P. Hendricks
- Neurosurgery and Neuro-Oncology Research, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Adrienne C. Scheck
- Neuro-Oncology and Neurosurgery Research, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Ronald A. Nieman
- Nuclear Magnetic Resonance Core Facility, Department of Chemistry and Biochemistry, Arizona State University, Tempe, Arizona
| | - Thomas H. Birkner
- Pathology Department, Sozialmedizinisches Zentrum-Ost, Donauspital, Vienna, Austria
| | - Wolfgang W. Krampla
- Radiology Department, Sozialmedizinisches Zentrum-Ost, Donauspital, Vienna, Austria
| | - Mark C. Preul
- Neurosurgery Research Laboratory, Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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Bartella L, Thakur SB, Morris EA, Dershaw DD, Huang W, Chough E, Cruz MC, Liberman L. Enhancing Nonmass Lesions in the Breast: Evaluation with Proton (H) MR Spectroscopy. Radiology 2007; 245:80-7. [PMID: 17885182 DOI: 10.1148/radiol.2451061639] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE To prospectively evaluate the sensitivity and specificity of proton (hydrogen 1 [1H]) magnetic resonance (MR) spectroscopy for diagnosing malignant enhancing nonmass lesions identified at breast MR imaging, with histologic examination as the reference standard. MATERIALS AND METHODS In this HIPAA-compliant, institutional review board-approved study, in which all participants gave written informed consent, proton (1H) MR spectroscopy of the breast was performed in suspicious or biopsy-proved malignant lesions that were 1 cm or larger at MR imaging. Single-voxel proton (1H) MR spectroscopic data were collected. MR spectroscopic findings were defined as positive if the signal-to-noise ratio of the choline resonance peak was 2 or greater and as negative in all other cases. MR spectroscopic results were then compared with histologic findings, and statistical analysis was performed. RESULTS In 32 women (median age, 48.5 years [range, 20-63 years]) with enhancing nonmass lesions, the median lesion size at MR imaging was 2.8 cm (range, 1.2-9.0 cm). At histologic analysis, 12 (37%) of 32 lesions were malignant and 20 (63%) were benign. Positive choline findings were present in 15 of 32 lesions, including all 12 (100%) cancers and three (15%) of 20 benign lesions, giving proton (1H) MR spectroscopy a sensitivity of 100% (95% confidence interval [CI]: 74%, 100%) and a specificity of 85% (95% CI: 62%, 97%) for detection of enhancing nonmass lesions. For 25 lesions with unknown histologic features, proton (1H) MR spectroscopy would have significantly (P<.01) increased the positive predictive value of biopsy from 20% to 63%. If biopsy had been performed for only those lesions with positive choline findings at proton (1H) MR spectroscopy, biopsy might have been avoided for 17 (68%) of 25 lesions, and no cancers would have been missed. CONCLUSION Proton (1H) MR spectroscopy had 100% sensitivity and 85% specificity for the detection of malignancy in enhancing nonmass lesions.
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Affiliation(s)
- Lia Bartella
- Department of Radiology, Breast Imaging Section H-118, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA.
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Heijmink SWTPJ, Scheenen TWJ, Fütterer JJ, Klomp DWJ, Heesakkers RAM, Hulsbergen-van de Kaa CA, van Lin ENJT, Heerschap A, Barentsz JO. Prostate and lymph node proton magnetic resonance (MR) spectroscopic imaging with external array coils at 3 T to detect recurrent prostate cancer after radiation therapy. Invest Radiol 2007; 42:420-7. [PMID: 17507814 DOI: 10.1097/01.rli.0000262759.46364.50] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In a patient suspected of having recurrent prostate cancer after radiation therapy, we demonstrate the feasibility of noninvasive proton magnetic resonance spectroscopic (1H-MRS) imaging of the prostate and a lymph node at 3 T using a matrix of external surface coils. Written informed consent was obtained from the patient. With 1H-MRS imaging, high choline with low citrate signal was observed in the prostate, and in the lymph node a signal of choline-containing compounds was identified. The tissue level of the compounds in the enlarged lymph node was estimated to be 8.1 mmol/kg water. Subsequent histopathological analysis of systematic transrectal ultrasound-guided prostate biopsy and computed tomography-guided biopsy of the lymph node confirmed the presence of prostate cancer in both.
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Affiliation(s)
- Stijn W T P J Heijmink
- Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
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Genson CC, Blane CE, Helvie MA, Waits SA, Chenevert TL. Effects on breast MRI of artifacts caused by metallic tissue marker clips. AJR Am J Roentgenol 2007; 188:372-6. [PMID: 17242244 DOI: 10.2214/ajr.05.1254] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of our study was to investigate MR artifacts related to tissue marker clips used in breast imaging procedures. MATERIALS AND METHODS Breast phantoms were created using gelatin doped with gadolinium. Four commercially available tissue marker clips were evaluated. Clinical MR evaluation of all phantoms with 1.5-T gradient-recalled echo sequences was performed. Images were evaluated for size and character of the visible artifacts and graphically appreciable fat saturation inhomogeneities. Quantitative measurement of the local inhomogeneity in 3D parts per million maps was obtained as a function of distance from each tissue marker. RESULTS All tissue marker clips caused signal void artifacts on non-fat-suppressed images that measured 2-6 times the clip diameter. The degree of fat suppression inhomogeneity was minor but clinically appreciable. The local clip-induced field inhomogeneity varied from 0.25 to greater than 4.0 PPM for the four clips. At 0.25 PPM, the zonal diameter of frequency shift varied from 6 mm to 44 mm. CONCLUSION Artifacts caused by tissue marker clips could limit the sensitivity of MRI for detection and follow-up of breast cancer. The local effects on field inhomogeneity will affect local fat suppression and make spectroscopy data less reliable. These effects, though small, are measurable and vary among the different clips evaluated.
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Affiliation(s)
- Charles C Genson
- Department of Radiology, University of Michigan Health System, B1 D520 UH, 1500 E Medical Center Dr., Ann Arbor, MI 48109-0030, USA
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Abstract
Imaging has a significant role in diagnosing, treating, and monitoring breast cancer. Advances in this field are having a great impact in the clinical management of this disease. Breast cancer has now become an "outpatient cancer". This article describes the role and advances of imaging in breast cancer.
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Affiliation(s)
- Lia Bartella
- Department of Radiology, Breast Imaging Section H-118, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
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Kwock L, Smith JK, Castillo M, Ewend MG, Collichio F, Morris DE, Bouldin TW, Cush S. Clinical role of proton magnetic resonance spectroscopy in oncology: brain, breast, and prostate cancer. Lancet Oncol 2006; 7:859-68. [PMID: 17012048 DOI: 10.1016/s1470-2045(06)70905-6] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Standardised proton magnetic resonance spectroscopic imaging (MRSI) was initially developed for routine in-situ clinical assessment of human brain tumours, and its use was later extended for examination of prostate and breast cancers. MRSI coupled with both routine and functional MRI techniques provides more detailed information about a tumour's location and extent of its infiltration than any other modality alone. Information obtained by adding MRSI data to anatomical and functional MRI findings aid in clinical management decisions (such as watchful waiting vs immediate intervention). In this Review, we discuss the current status of proton MRSI, with emphasis on its clinical use to map the location and extent of tumour processes for spectroscopic image-guided biopsy procedures and to monitor treatment paradigms for brain, prostate, and breast cancer.
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Affiliation(s)
- Lester Kwock
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA.
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Tse GM, Yeung DKY, King AD, Cheung HS, Yang WT. In vivo proton magnetic resonance spectroscopy of breast lesions: an update. Breast Cancer Res Treat 2006; 104:249-55. [PMID: 17051424 DOI: 10.1007/s10549-006-9412-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2006] [Accepted: 09/17/2006] [Indexed: 11/24/2022]
Abstract
In vivo proton magnetic resonance spectroscopy ((1)H-MRS) has been demonstrated to be successful in the differentiation of benign and malignant breast lesions in a non-invasive manner by detecting increased levels of composite choline (Cho) compounds. Currently there is molecular evidence of increased Cho metabolism in breast cancer cells. In breast malignancies, (1)H-MRS achieved a high-overall sensitivity (82%). Most test cases were infiltrating duct carcinoma, but infiltrating lobular, medullary, mucinous and adenoid cystic carcinomas were also positive by (1)H-MRS. Large lesional size is a pre-requisite for (1)H-MRS testing, and technical problems account for some of the false negative results. Another potential of (1)H-MRS is to assess patients' response to neoadjuvant chemotherapy. In ductal carcinoma in situ, the results of (1)H-MRS on the limited number of cases were negative. Most of the assessed benign breast lesions including fibroadenoma, fibrocystic changes, cysts and galactoceles, papilloma, tubular adenoma and phyllodes tumours and were mostly negative by (1)H-MRS, with an overall false positive rate was about 8%. Normal breast tissue was almost always negative by (1)H-MRS, whereas, lactating breast tissue showed positivity with a slightly different spectrum on further analysis. With the clinical use of stronger field MR scanners and better coils, the sensitivity of (1)H-MRS may be further improved. With these improvements, (1)H-MRS may potentially be useful in detection of smaller malignant lesions, characterization of malignant lesions into non-invasive or invasive, and as an invaluable tool in disease progression monitoring.
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Affiliation(s)
- Gary M Tse
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong.
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Abstract
Magnetic resonance imaging (MRI) of the breast is rapidly becoming incorporated into clinical practice. Indications for breast MRI include staging of known breast cancer, monitoring response to chemotherapy, assessing recurrence, problem solving, and high-risk screening. Magnetic resonance spectroscopy is a promising technique that may decrease the number of benign biopsies generated by breast MRI in the clinical setting.
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Affiliation(s)
- Lia Bartella
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, Weill Medical College Of Cornell University, 1275 York Avenue, New York 10021 NY, USA.
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