Proton MR spectroscopy with choline peak as malignancy marker improves positive predictive value for breast cancer diagnosis: Preliminary study
Proton MR spectroscopy with choline peak as malignancy marker improves positive predictive value for breast cancer diagnosis: Preliminary study
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DOI：
10.1148/radiol.2393051046
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发表时间：
2006-06-01
期刊：
影响因子：
19.7
通讯作者：
Huang, W
中科院分区：
文献类型：
--
作者：
Bartella, L;Morris, EA;Huang, W
目的：以组织学结果为参考标准，前瞻性评价磁共振波谱在可疑病变或活检证实的癌症患者中的诊断性能。材料和方法：在这项符合HIPAA标准的研究获得机构评审委员会批准和知情同意后，对MRI可疑或活检证实的恶性病变直径大于或等于1 cm的患者进行磁共振波谱检查。单体素磁共振波谱数据是从围绕病变的单个矩形感兴趣体积中收集的。如果胆碱共振峰的信噪比大于或等于2，磁共振波谱结果被定义为阳性，在所有其他情况下被定义为阴性。结果：共56例患者(年龄20-77岁)共57个病灶被成像。MR检查病灶大小中位数为2.3 cm(1~15 cm)。组织学上，57个病变中31个(54%)为恶性，26个(46%)为良性。胆碱峰出现在57个病变中的34个(包括所有癌症)和26个良性病变中的3个，使磁共振波谱的敏感性为100%，特异性为88%。在40个组织类型未知的病变中，使用磁共振波谱作为磁共振成像的辅助手段将使活检的阳性预测值从35%提高到82%(P<；0.01)。如果只对磁共振波谱上有胆碱峰的病变进行活检，40个病变中有23个(58%)可以免于活检，没有一例癌被漏诊。结论：质子磁共振波谱成功地结合到了直径为1厘米或更大的病变的磁共振成像研究中。这项技术可能有助于减少在磁共振成像中发现的需要活组织检查的病变数量。
Purpose: To prospectively evaluate the diagnostic performance of magnetic resonance (MR) spectroscopy in patients with suspicious lesions or biopsy-proved cancers at MR imaging by using histologic findings as the reference standard.Materials and Methods: After institutional review board approval and informed consent were obtained for this HIPAA-compliant study, breast MR spectroscopy was performed in patients with suspicious or biopsy-proved malignant lesions measuring 1 cm or larger at MR imaging. Single-voxel MR spectroscopy data were collected from a single rectangular volume of interest that encompassed the lesion. MR spectroscopy findings were defined as positive if the signal-to-noise ratio of the choline resonance peak was greater than or equal to 2 and as negative in all other cases. MR spectroscopy findings were then compared with histologic findings.Results: A total of 56 patients (age range, 20 - 77 years) with 57 lesions were imaged. The median lesion size at MR imaging was 2.3 cm (range, 1 - 15 cm). Histologically, 31 (54%) of 57 lesions were malignant, and 26 (46%) were benign. A choline peak was present in 34 of 57 lesions ( including all cancers) and in three of 26 benign lesions, giving MR spectroscopy a sensitivity of 100% and a specificity of 88%. In 40 lesions of unknown histologic type, the use of MR spectroscopy as an adjunct to MR imaging would have significantly (P < .01) increased the positive predictive value of biopsy from 35% to 82%. If biopsy had been performed only on those lesions with a choline peak at MR spectroscopy, biopsy may have been spared in 23 (58%) of 40 lesions, and none of the cancers would have been missed.Conclusion: Proton MR spectroscopy was successfully incorporated into breast MR imaging studies for lesions measuring 1 cm or larger. This technique may be useful in reducing the number of lesions detected at MR imaging that require biopsy.