Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender, Imaging, Medical University of Vienna, Waehringer-Guertel 18-20, A-1090, Vienna, Austria.
Institute of Radiology, Universitätsklinikum Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany.
Eur Radiol. 2020 Jun;30(6):3371-3382. doi: 10.1007/s00330-020-06678-z. Epub 2020 Feb 17.
To assess the additional value of quantitative tCho evaluation to diagnose malignancy and lymph node metastases in suspicious lesions on multiparametric breast MRI (mpMRI, BI-RADS 4, and BI-RADS 5).
One hundred twenty-one patients that demonstrated suspicious multiparametric breast MRI lesions using DCE, T2w, and diffusion-weighted (DW) images were prospectively enrolled in this IRB-approved study. All underwent single-voxel proton MR spectroscopy (H-MRS, point-resolved spectroscopy sequence, TR 2000 ms, TE 272 ms) with and without water suppression. The total choline (tCho) amplitude was measured and normalized to millimoles/liter according to established methodology by two independent readers (R1, R2). ROC-analysis was employed to predict malignancy and lymph node status by tCho results.
One hundred three patients with 74 malignant and 29 benign lesions had full H-MRS data. The area under the ROC curve (AUC) for prediction of malignancy was 0.816 (R1) and 0.809 (R2). A cutoff of 0.8 mmol/l tCho could diagnose malignancy with a sensitivity of > 95%. For prediction of lymph node metastases, tCho measurements achieved an AUC of 0.760 (R1) and 0.788 (R2). At tCho levels < 2.4 mmol/l, no metastatic lymph nodes were found.
Quantitative tCho evaluation from H-MRS allowed diagnose malignancy and lymph node status in breast lesions suspicious on multiparametric breast MRI. tCho therefore demonstrated the potential to downgrade suspicious mpMRI lesions and stratify the risk of lymph node metastases for improved patient management.
• Quantitative tCho evaluation can distinguish benign from malignant breast lesions suspicious after multiparametric MRI assessment. • Quantitative tCho levels are associated with lymph node status in breast cancer. • Quantitative tCho levels are higher in hormonal receptor positive compared to hormonal receptor negative lesions.
评估定量 tCho 评估在多参数乳腺 MRI（BI-RADS 4 和 BI-RADS 5 可疑病变）中诊断恶性肿瘤和淋巴结转移的额外价值。
本项 IRB 批准的前瞻性研究纳入了 121 例多参数乳腺 MRI 显示可疑病变的患者。所有患者均接受了单体素质子磁共振波谱（H-MRS，点分辨波谱序列，TR 2000 ms，TE 272 ms）检查，包括有和无（水抑制）。根据既定方法，两名独立读者（R1、R2）测量总胆碱（tCho）幅度并将其标准化为毫摩尔/升。通过 tCho 结果进行 ROC 分析以预测恶性肿瘤和淋巴结状态。
103 例患者中有 74 例恶性和 29 例良性病变具有完整的 H-MRS 数据。R1 和 R2 预测恶性肿瘤的 ROC 曲线下面积（AUC）分别为 0.816 和 0.809。tCho 截断值为 0.8 mmol/l 时，诊断恶性肿瘤的敏感度>95%。预测淋巴结转移时，tCho 测量的 AUC 分别为 0.760 和 0.788。当 tCho 值<2.4 mmol/l 时，未发现转移性淋巴结。
H-MRS 的定量 tCho 评估可诊断多参数乳腺 MRI 可疑的乳腺病变中的恶性肿瘤和淋巴结状态。因此，tCho 具有降低多参数 MRI 可疑病变的潜力，并为改善患者管理分层淋巴结转移的风险。
定量 tCho 评估可区分多参数 MRI 评估后可疑的乳腺良恶性病变。
tCho 水平与乳腺癌的淋巴结状态相关。
tCho 水平在激素受体阳性病变中高于激素受体阴性病变。
