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Breast Cancer: In Vivo Proton MR Spectroscopy in the Characterization of Histopathologic Subtypes and Preliminary Observations in Axillary Node Metastases¹

¹ From the Departments of Clinical Oncology (D.K.W.Y.), Diagnostic Radiology and Organ Imaging (W.T.Y.), and Anatomical and Cellular Pathology (G.M.K.T.), Prince of Wales Hospital, 30-32 Ngan Shing St, Shatin, Hong Kong, China. Received September 11, 2001; revision requested October 22; revision received January 7, 2002; accepted February 26. Address correspondence to D.K.W.Y. (e-mail: dkyeung@cuhk.edu.hk).

View larger version (29K): [in a new window]   Figure 1a. (a) Spectra acquired at 1H MR spectroscopy with 135-msec TE in patient 38 shows that choline-containing compounds (3.2 ppm) were detected in both the breast lesion and axillary lymph node. The nominal voxel volume was 12 cm3 for the breast and 7.5 cm3 for the axillary lymph node. Residual water resonance (4.7 ppm) was removed in all spectra by means of time-domain Hankel-Lanczos singular value decomposition filtering. Resonances derived from mobile fatty acids were as follows: -C=C-, 5.3 ppm; -CH2-, 2.1 ppm; -(CH2)n-, 1.3 ppm; and -CH3, 0.9 ppm. (b) Transverse fat-suppressed subtraction MR image (450/12) obtained in the same patient shows four of a total of seven cancers in the left breast. All lesions are ovoid, have slightly indistinct margins, and show rim enhancement. The largest lesion (arrow) was selected for MR spectroscopic analysis. (c) Sagittal contrast-enhanced MR image (450/12) obtained in the same patient shows an enlarged 2-cm lymph node (arrow) with loss of the normal architecture and inhomogeneous enhancement.

View larger version (125K): [in a new window]   Figure 1b. (a) Spectra acquired at 1H MR spectroscopy with 135-msec TE in patient 38 shows that choline-containing compounds (3.2 ppm) were detected in both the breast lesion and axillary lymph node. The nominal voxel volume was 12 cm3 for the breast and 7.5 cm3 for the axillary lymph node. Residual water resonance (4.7 ppm) was removed in all spectra by means of time-domain Hankel-Lanczos singular value decomposition filtering. Resonances derived from mobile fatty acids were as follows: -C=C-, 5.3 ppm; -CH2-, 2.1 ppm; -(CH2)n-, 1.3 ppm; and -CH3, 0.9 ppm. (b) Transverse fat-suppressed subtraction MR image (450/12) obtained in the same patient shows four of a total of seven cancers in the left breast. All lesions are ovoid, have slightly indistinct margins, and show rim enhancement. The largest lesion (arrow) was selected for MR spectroscopic analysis. (c) Sagittal contrast-enhanced MR image (450/12) obtained in the same patient shows an enlarged 2-cm lymph node (arrow) with loss of the normal architecture and inhomogeneous enhancement.

View larger version (127K): [in a new window]   Figure 1c. (a) Spectra acquired at 1H MR spectroscopy with 135-msec TE in patient 38 shows that choline-containing compounds (3.2 ppm) were detected in both the breast lesion and axillary lymph node. The nominal voxel volume was 12 cm3 for the breast and 7.5 cm3 for the axillary lymph node. Residual water resonance (4.7 ppm) was removed in all spectra by means of time-domain Hankel-Lanczos singular value decomposition filtering. Resonances derived from mobile fatty acids were as follows: -C=C-, 5.3 ppm; -CH2-, 2.1 ppm; -(CH2)n-, 1.3 ppm; and -CH3, 0.9 ppm. (b) Transverse fat-suppressed subtraction MR image (450/12) obtained in the same patient shows four of a total of seven cancers in the left breast. All lesions are ovoid, have slightly indistinct margins, and show rim enhancement. The largest lesion (arrow) was selected for MR spectroscopic analysis. (c) Sagittal contrast-enhanced MR image (450/12) obtained in the same patient shows an enlarged 2-cm lymph node (arrow) with loss of the normal architecture and inhomogeneous enhancement.

View larger version (25K): [in a new window]   Figure 2a. (a) Spectra acquired at 1H MR spectroscopy with 135-msec TE in patient 17 are positive for choline in the breast and negative for choline in the axillary lymph node. The nominal voxel volume was 3.4 cm3 for both the breast and the axillary lymph node. (b) Transverse fat-suppressed subtraction MR image (450/12) obtained in the same patient shows two carcinomas in the left breast. The larger lesion (arrow) is slightly lobulated, has an indistinct margin, and shows the characteristic peripheral enhancement with a central nonenhancing nidus. This lesion was selected for MR spectroscopic analysis. (c) Sagittal contrast-enhanced MR image (450/12) obtained in the same patient shows a 1-cm lymph node (arrow). (d) Close-up sagittal contrast-enhanced MR image (450/12) of the node shown in c shows preservation of the nodal architecture, including the hyperintense central hilum and the hypointense peripheral cortex.

View larger version (106K): [in a new window]   Figure 2b. (a) Spectra acquired at 1H MR spectroscopy with 135-msec TE in patient 17 are positive for choline in the breast and negative for choline in the axillary lymph node. The nominal voxel volume was 3.4 cm3 for both the breast and the axillary lymph node. (b) Transverse fat-suppressed subtraction MR image (450/12) obtained in the same patient shows two carcinomas in the left breast. The larger lesion (arrow) is slightly lobulated, has an indistinct margin, and shows the characteristic peripheral enhancement with a central nonenhancing nidus. This lesion was selected for MR spectroscopic analysis. (c) Sagittal contrast-enhanced MR image (450/12) obtained in the same patient shows a 1-cm lymph node (arrow). (d) Close-up sagittal contrast-enhanced MR image (450/12) of the node shown in c shows preservation of the nodal architecture, including the hyperintense central hilum and the hypointense peripheral cortex.

View larger version (137K): [in a new window]   Figure 2c. (a) Spectra acquired at 1H MR spectroscopy with 135-msec TE in patient 17 are positive for choline in the breast and negative for choline in the axillary lymph node. The nominal voxel volume was 3.4 cm3 for both the breast and the axillary lymph node. (b) Transverse fat-suppressed subtraction MR image (450/12) obtained in the same patient shows two carcinomas in the left breast. The larger lesion (arrow) is slightly lobulated, has an indistinct margin, and shows the characteristic peripheral enhancement with a central nonenhancing nidus. This lesion was selected for MR spectroscopic analysis. (c) Sagittal contrast-enhanced MR image (450/12) obtained in the same patient shows a 1-cm lymph node (arrow). (d) Close-up sagittal contrast-enhanced MR image (450/12) of the node shown in c shows preservation of the nodal architecture, including the hyperintense central hilum and the hypointense peripheral cortex.

View larger version (127K): [in a new window]   Figure 2d. (a) Spectra acquired at 1H MR spectroscopy with 135-msec TE in patient 17 are positive for choline in the breast and negative for choline in the axillary lymph node. The nominal voxel volume was 3.4 cm3 for both the breast and the axillary lymph node. (b) Transverse fat-suppressed subtraction MR image (450/12) obtained in the same patient shows two carcinomas in the left breast. The larger lesion (arrow) is slightly lobulated, has an indistinct margin, and shows the characteristic peripheral enhancement with a central nonenhancing nidus. This lesion was selected for MR spectroscopic analysis. (c) Sagittal contrast-enhanced MR image (450/12) obtained in the same patient shows a 1-cm lymph node (arrow). (d) Close-up sagittal contrast-enhanced MR image (450/12) of the node shown in c shows preservation of the nodal architecture, including the hyperintense central hilum and the hypointense peripheral cortex.

View larger version (29K): [in a new window]   Figure 3a. (a) All three spectra acquired at 1H MR spectroscopy with different TEs in patient 9, who had a diagnosis of pure DCIS, show an absence of detectable choline at 3.2 ppm. The nominal voxel volume was 36 cm3. (b) Transverse fat-suppressed subtraction MR image (450/12) obtained in the same patient shows a large (5-cm) area of clumped segmental enhancement (arrow) in the left breast; this finding is consistent with DCIS.

View larger version (117K): [in a new window]   Figure 3b. (a) All three spectra acquired at 1H MR spectroscopy with different TEs in patient 9, who had a diagnosis of pure DCIS, show an absence of detectable choline at 3.2 ppm. The nominal voxel volume was 36 cm3. (b) Transverse fat-suppressed subtraction MR image (450/12) obtained in the same patient shows a large (5-cm) area of clumped segmental enhancement (arrow) in the left breast; this finding is consistent with DCIS.