The Application Value Of Single-voxel ～1H MR Spectroscopy In The Diagnosis Of Benign And Malignant Breast Diseases

Objective1. To analyze the changes of major metabolites in signal intensities measured by proton magnetic resonance spectroscopy (~1H MRS) between benign and malignant breast diseases;To evaluate the application value of ~1H MRS in the diagnosis of breast cancers.2. With the combination of DCE-MRI and mammography ,To investigate the imaging characteristics of malignant breast diseases and compare the diagnostic sensitivity,specificity and accuracy of breast ~1H MRS, MRI and mammography . Materials and Methods48 mammary patients(56 lesions) were examined with dynamic contrast enhanced MRI(DCE-MRI),single voxel proton MR spectroscopy imaging and mammography.All lesions were confirmed by pathology or clinical follow-up results.All cases were grouped according to pathology and following-up.Benign group (23 cases,26 lesions): cyclomastopathy(11 cases), fibroadenoma(7 cases, 10 lesions), Adenomatoid hyperplasia(3 cases), inflammation(2 cases).Malignant group(25 cases,30 lesions): infitrating ductal carcinoma(IDC,16 cases, 18 lesions), infiltrating lobular carcinoma(ILC,4 cases), lymphoma(2 cases,5 lesions), intraductal carcinoma(3 cases). All the patients were examined on a 1.5 T MR scanner( Magnetom Sonata Maestro Class,Siemens company) with breast coils.Dynamic contrast enhanced MR and single-voxel ~1H MRS were performed .Data post-process and display were done with SPECTROSCOPY and MEANCURVE post-process software package in LEONARDO work stage.Two major metabolites (Cho,Cr) and hematodynamics characterizations were observed .Mammography were performed by GE Senographe digital mammography system. Routine CC and MLO position were shot. Results1. Increased choline-containing compounds peak were detected in thirty lesions containing twenty-two malignant tumors and eight benign lesions.The Cho peak located between 3.10ppm and 3.34ppm .There was statistic significance in Cho peak ratio between two groups (x~2=10.1455, P= 0.0014) . The sensitivity,specificity and accuracy of differentiating benign lesions from malignant breast lesions based on increased choline-containing compounds peak are 73.3% ,69.2%, 71.4%. There was no statistic significance in Cho peak integral between two groups(t=1.3388, P>0.05). Malignant tumors had higher Cho/Cr ratio than benign lesions (t=2.3913, P<0.05) .2. Increased choline-containing compounds peak were characteristic signs of maglinant breast tumors.MRI without ~1H MRS demonstrated malignant breast tumors in 26 lesions . The sensitivity, specificity and accuracy were 86.7%, 92.3 % and 89.3 %. With the combination of ~1H MRS and MRI,28 lesions were demonstrated. The sensitivity ,specificity and accuracy were 93.3%, 88.5 % and 91.1 %.While mammography revealed malignant breast diseases in 25 lesions . The sensitivity, specificity and accuracy were 83.3 % ,76.9% and 80.4 %. When ~1H MRS ,MRI and mammography were combined together,the sensitivity , specificity and accuracy could reach to 96. 7 % , 92.3 % and 94.6 % , respectively .Conlusions 1. Increased choline-containing compounds peak appeared in most maglinant breast tumors. The sensitivity,specificity and accuracy of differentiating benign lesions from malignant breast lesions based on increased choline-containing compounds peak are 73.3% ,69.2%, 71.4%. With the combination of ~1H MRS and MRI, the sensitivity ,specificity and accuracy were 93.3%, 88.5 % and 91.1 %. 2.According to the Cho peak integral can not differentiate breast lesions.3. Malignant tumors had higher Cho/Cr ratio than benign lesions4. Choline peak can be seen in several benign breast diseases.So, Choline is not specific features of malignant tumors and it can be got only if tumors grow rapidly regardless of their bionomics. Because most of malignant lesions grow faster than benign lesions,the differential diagnosis based on Cho peak were valuable.5. The diagnostic sensitivity and specificity were lower only by ~1H MRS.But as an adjunct method, ~1H MRS combined with MRI can greatly improve the MR value of diagnosis for malignant breast diseases.6. MRI have dominant diagnostic value compared with mammography.7. The combination of ~1H MRS ,MRI and mammography can increase the diagnostic sensitivity and accuracy of malignant breast diseases.