Figure 6a. Breast MR imaging case in which the measured tCho concentration did not lead to a change in the recommended lesion management. (a) Sagittal high-spatial-resolution 3D fat-suppressed fast low-angle shot MR images of the breast (13.5/4.1) obtained before (left) and 7 minutes after (middle) gadopentetate dimeglumine injection and with subtraction (right) show a 0.39-cm3 lesion. The box surrounding the lesion depicts the MR spectroscopic voxel. (b) Time–signal intensity (SI) curve measured from the lesion depicted in a. All four readers described this curve as showing fast enhancement during the initial phase followed by an enhancement plateau during the delayed phase. After evaluating the morphologic features and time–signal intensity curve of the lesion, all four readers recommended biopsy. (c) 1H MR spectra measured from the lesion. The spectral peaks of mobile lipids, water, and tCho are labeled. The line above the tCho peak represents the minimal tCho concentration that is detectable with use of the quantification procedure. The mean tCho concentration measured from this lesion was 0 mmol/kg ± 1.73. When the tCho measurement was presented to the four readers in the second interpretation, none of them changed the recommendation of biopsy. This patient received a diagnosis of invasive ductal carcinoma.