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Adding in Vivo Quantitative ¹H MR Spectroscopy to Improve Diagnostic Accuracy of Breast MR Imaging: Preliminary Results of Observer Performance Study at 4.0 T¹

¹ From the Department of Radiology, Center for Magnetic Resonance Research Medical School, 2021 Sixth St SE, Minneapolis, MN 55455 (S.M., P.J.B., E.H.B., M.G.P., M.G.). The complete list of author affiliations appears at the end of this article. From the 2004 RSNA Annual Meeting. Received May 7, 2004; revision requested Jul 8; revision received Sep 15; accepted Oct 12. Supported by NIH grants RR08079, CA92004, and RR00400; Tickle Family Land Grant Endowment in Breast Cancer Research; PHS Cancer Center Support grant P30 CA77398; and Lillian Quist-Joyce Henline Chair in Biomedical Research. Address correspondence to M.G. (e-mail: gar{at}cmrr.umn.edu).

PURPOSE: To determine whether the addition of in vivo quantitative hydrogen 1 (¹H) magnetic resonance (MR) spectroscopy can improve the radiologist's diagnostic accuracy in interpreting breast MR images to distinguish benign from malignant lesions.

MATERIALS AND METHODS: The study was approved by the institutional review board and, where appropriate, was compliant with the Health Insurance Portability and Accountability Act. All patients provided written informed consent. Fifty-five breast MR imaging cases—one lesion each in 55 patients aged 24–66 years with biopsy-confirmed findings—were retrospectively evaluated by four radiologists. Patients were examined with contrast material–enhanced fat-suppressed T1-weighted 4.0-T MR imaging. The concentration of total choline–containing compounds (tCho) was quantified by using single-voxel ¹H MR spectroscopy. For each case, the radiologists were asked to give the percentage probability of malignancy, the Breast Imaging and Reporting Data System category, and a recommendation for patient treatment. Two interpretations were performed for each case: The initial interpretation was based on the lesion's morphologic features and time–signal intensity curve, and the second interpretation was based on the lesion's morphologic features, time–signal intensity curve, and tCho concentration. Receiver operating characteristic (ROC), Wilcoxon signed rank, statistic, and accuracy (based on the area under the ROC curve) analyses were performed.

RESULTS: Of the 55 lesions evaluated, 35 were invasive carcinomas and 20 were benign. The addition of ¹H MR spectroscopy resulted in higher sensitivity, specificity, accuracy, and interobserver agreement for all four radiologists. More specifically, two of the four radiologists achieved a significant improvement in sensitivity (P = .03, P = .03), and all four radiologists achieved a significant improvement in accuracy (P = .01, P = .05, P = .009, P < .001).

CONCLUSION: Current study results suggest that the addition of quantitative ¹H MR spectroscopy to the breast MR imaging examination may help to improve the radiologist's ability to distinguish benign from malignant breast lesions.

© RSNA, 2005

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