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¹H MR Spectroscopy and Diffusion-Weighted Imaging of the Breast: Are They Useful Tools for Characterizing Breast Lesions Before Biopsy?

¹ Division of Diagnostic Imaging, Breast Center, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba 296-8602, Japan.
² Division of Breast Surgery, Breast Center, Kameda Medical Center, Kamogawa, Chiba, Japan.

OBJECTIVE. The objective of our study was to determine whether proton (¹H) MR spectroscopy (MRS) and diffusion-weighted imaging might be useful tools for characterizing breast lesions before biopsy.

MATERIALS AND METHODS. Single-voxel ¹H MRS and diffusion-weighted imaging were performed in 171 suspicious or highly suspicious lesions. Using the residual water signal as a reference (4.7 ppm), a choline peak at 3.22–3.23 ppm was defined as malignant. If a high-signal-intensity lesion was detected in high-b-value (b = 1,500 s/mm²) images, that lesion was defined as positive for malignancy. Among the patients with positive results on diffusion-weighted imaging, the apparent diffusion coefficient (ADC) values of the mass or focus were calculated from two different gradient factors (b₁ = 500 s/mm² and b² = 1,500 s/mm²).

RESULTS. The diagnostic sensitivity and specificity of ¹H MRS were 44% (40/91) and 85% (68/80), respectively (p < 0.001). If ¹H MRS was applied for mass lesions larger than 15 mm, the diagnostic sensitivity and specificity were 82% (28/34) and 69% (11/16), respectively. Of the high-b-value images, 24 benign lesions and eight nonmass ductal carcinoma in situ were visually negative. With the use of a cutoff ADC value of 1.13 x 10^–3 mm²/s, a specificity of 67% (43/64) and sensitivity of 97% (61/63) was obtained on diffusion-weighted imaging.

CONCLUSION. ¹H MRS was useful for characterizing breast lesions measuring 15 mm or larger, and diffusion-weighted imaging was useful for characterizing lesions of any size. However, these two techniques still have potential pitfalls in relation to the diagnosis of nonmass breast lesions.

Keywords: apparent diffusion coefficient • breast biopsy • breast neoplasms • diffusion-weighted imaging • MRI • proton MR spectroscopy

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