Clauser Paola, Marcon Magda, Dietzel Matthias, Baltzer Pascal A T
Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria; Institute of Radiology, Department of Medical and Biological Sciences, University of Udine, P.le S. Maria della Misericordia, Udine, Italy.
Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, Zurich, Switzerland.
Eur J Radiol. 2017 Jul;92:51-57. doi: 10.1016/j.ejrad.2017.04.014. Epub 2017 Apr 27.
To investigate whether the evaluation of multiple spectral regions can increase the diagnostic performance of H-MRS of the breast and reduce false positive findings.
93 patients (mean age 56 years, range 23-79) undergoing breast MRI for routine clinical indications on a 1.5T scanner were eligible for this IRB-approved prospective study. Suspicious enhancing lesions ≥8mm underwent single-voxel point-resolved H-MRS (PRESS, TR=2000ms, TE=272ms). Histology showed 69 malignant and 24 benign lesions. The Signal-to-Noise ratio of choline, olefinic acids and the water-to-methylene ratio were measured. The area under the ROC-curve (AUC) was used to evaluate single measurements. Combined diagnostic accuracy was explored using a 10-fold cross-validated Chi-squared automatic interaction detection (CHAID) analysis. Inter-reader agreement was evaluated in a subset of patients.
A significant AUC for differentiation between benign and malignant lesions was identified for choline (0.733, P=0.001), olefinic acids (0.769, P=0.0001) and water-to-methylene ratio (0.704, P=0.003). All three variables were included in a classification algorithm using CHAID methodology. Using this classification, 70.8% (17/24) false positive diagnoses in benign lesions would have been avoided. Inter-reader agreement was almost perfect.
The combined evaluation of multiple spectral regions can increase the diagnostic performance of H-MRS and potentially reduce false positive findings.
研究多光谱区域评估是否能提高乳腺氢质子磁共振波谱（H-MRS）的诊断性能并减少假阳性结果。
93例（平均年龄56岁，范围23 - 79岁）因常规临床指征在1.5T扫描仪上接受乳腺磁共振成像（MRI）检查的患者符合本机构审查委员会批准的前瞻性研究要求。对直径≥8mm的可疑强化病变进行单体素质点分辨H-MRS检查（点分辨表面线圈采集序列，TR = 2000ms，TE = 272ms）。组织学检查显示69个恶性病变和24个良性病变。测量胆碱、烯酸的信噪比以及水与亚甲基的比值。采用ROC曲线下面积（AUC）评估单项测量结果。使用10折交叉验证的卡方自动相互作用检测（CHAID）分析探索联合诊断准确性。在部分患者中评估阅片者间的一致性。
胆碱（0.733，P = 0.001）、烯酸（0.769，P = 0.0001）和水与亚甲基比值（0.704，P = 0.003）在鉴别良性和恶性病变方面具有显著的AUC。使用CHAID方法的分类算法纳入了所有这三个变量。采用这种分类方法，可避免70.8%（17/24）的良性病变假阳性诊断。阅片者间的一致性几乎达到完美。
多光谱区域的联合评估可提高H-MRS的诊断性能，并有可能减少假阳性结果。
