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Detection of Breast Malignancy: Diagnostic MR Protocol for Improved Specificity¹

¹ From the Departments of Radiology (W.H., P.R.F., K.D., L.A.T., T.M.B.) and Surgery (P.R.F., B.O.), State University of New York, Stony Brook. Received April 1, 2003; revision requested June 20; final revision received November 17; accepted January 5, 2004. Supported by the Susan G. Komen Breast Cancer Foundation. Address correspondence to W.H., Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021 (e-mail: huangw2@mskcc.org).

PURPOSE: To prospectively determine if a combined magnetic resonance (MR) protocol that includes T1-weighted dynamic contrast agent–enhanced (DCE) MR imaging, hydrogen 1 (¹H) MR spectroscopy, and T2*-weighted perfusion MR imaging improves specificity in the diagnosis of breast cancer.

MATERIALS AND METHODS: The combined MR imaging–MR spectroscopy protocol was performed in 50 patients after positive findings at mammography but prior to biopsy. Single-voxel proton MR spectroscopy and perfusion MR imaging were conducted only if DCE MR images showed rapid contrast enhancement in the lesion. Biopsy results were used as the reference for comparison with MR results and for calculation of sensitivity and specificity in the detection of breast malignancy.

RESULTS: DCE MR imaging alone showed 100% sensitivity and 62.5% specificity. The specificity improved to 87.5% with the addition of ¹H MR spectroscopy and to 100% with the further addition of perfusion MR imaging. Twenty-eight patients underwent both MR spectroscopy and perfusion MR imaging. Two patients underwent MR spectroscopy but declined to undergo perfusion MR imaging. The remaining 20 patients had negative results at DCE MR imaging and therefore did not undergo the additional examinations.

CONCLUSION: The combined MR protocol of DCE MR imaging, ¹H MR spectroscopy, and perfusion MR imaging has high sensitivity and specificity in the diagnosis of breast cancer.

© RSNA, 2004

Index terms: Breast neoplasms, diagnosis, 00.31, 00.32 • Breast neoplasms, MR, 00.12143, 00.12144, 00.12145 • Magnetic resonance (MR), contrast enhancement, 00.12143 • Magnetic resonance (MR), perfusion study, 00.12144 • Magnetic resonance (MR), spectroscopy, 00.12145

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