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DOI:10.2214/AJR.07.3521
AJR 2009; 192:1608-1617
© American Roentgen Ray Society

Original Research

In Vivo Proton MR Spectroscopy of the Breast Using the Total Choline Peak Integral as a Marker of Malignancy

Francesco Sardanelli1, Alfonso Fausto1,2, Giovanni Di Leo1, Robin de Nijs3, Marianne Vorbuchner4 and Franca Podo5

1 University of Milan School of Medicine, Department of Medical and Surgical Sciences, Radiology Unit, IRCCS Policlinico San Donato, Via Morandi 30, San Donato Milanese, Milan, Italy.
2 Present address: Department of Radiology, Vittorio Emanuele III Hospital, Gorizia, Italy.
3 Danish Research Centre for Magnetic Resonance, Section 340, Copenhagen University Hospital, Hvidovre, Denmark.
4 Siemens AG Medical, Application Development, MR Spectroscopy and Oncology, Erlangen, Germany.
5 Department of Cell Biology and Neurosciences, Istituto Superiore di Sanità, Rome, Italy.

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.

Keywords: breast neoplasms • choline-containing compounds • MR spectroscopy


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