Department of Diagnostic Radiology, International Medical Center of Saitama Medical University, 1397-1 Yamane, Hidaka City, Saitama, Japan.
Eur Radiol. 2013 Jan;23(1):75-83. doi: 10.1007/s00330-012-2555-6. Epub 2012 Jul 10.
To compare the diagnostic capability of proton ((1)H) magnetic resonance spectroscopy (MRS) in differentiating benign from malignant breast lesions on the basis of qualitative and quantitative approaches.
We performed single-voxel (1)H MRS for 208 breast lesions, identified a clear total composite choline compounds (tCho) peak of signal-to-noise of ≥2 to represent malignancy (qualitative approach), and regarded tCho concentration equal to or greater than the cut-off value to represent malignancy (quantitative approach). We compared the diagnostic ability of both approaches using the Akaike information criterion (AIC) and McFadden's R (2).
Histologically, 169 lesions were malignant; 39 were benign. The qualitative approach demonstrated 84.6 % sensitivity and 51.3 % specificity for differentiating malignant and benign lesions. The mean tCho concentration was 1.13 mmol/kg for malignancy, 0.43 mmol/kg for benignity. The optimal cut-off point was 0.61 mmol/kg, use of which achieved 68.1 % sensitivity and 79.4 % specificity. Calculated AIC and R (2) score suggested the superiority of the quantitative approach for differentiating malignancy.
Quantitative MRS provides higher specificity than qualitative MRS for differentiating malignant from benign lesions and could be more useful as an additional examination in routine breast MR imaging.
比较质子((1)H)磁共振波谱（MRS）定性和定量方法在鉴别乳腺良恶性病变中的诊断能力。
对 208 个乳腺病变进行单体素((1)H)MRS 检查，选取信噪比≥2 的清晰总复合胆碱化合物（tCho）峰来代表恶性病变（定性方法），将 tCho 浓度等于或大于截止值来代表恶性病变（定量方法）。使用赤池信息量准则（AIC）和麦克法登 R（2）比较两种方法的诊断能力。
组织学上，169 个病变为恶性，39 个为良性。定性方法鉴别良恶性病变的敏感性为 84.6%，特异性为 51.3%。恶性病变的 tCho 浓度平均值为 1.13mmol/kg，良性病变的 tCho 浓度平均值为 0.43mmol/kg。最佳截断值为 0.61mmol/kg，使用该截断值的敏感性为 68.1%，特异性为 79.4%。计算 AIC 和 R（2）评分表明，定量 MRS 方法在鉴别良恶性病变方面具有更高的特异性。
定量 MRS 比定性 MRS 能更准确地鉴别乳腺良恶性病变，可能作为常规乳腺磁共振成像的附加检查更有用。
