MR SPECTROSCOPY OF SUSPICIOUS BREAST MASSES

乳腺癌发病率的上升已达到流行病的程度。 在美国国立卫生研究院最近的共识发展中， 据了解，在20世纪90年代， 美国将有100万妇女被诊断出患有乳腺癌， 大约30%的人会死于这种疾病（1）。据估计 每9名女性中就有1人会在一生中患上乳腺癌。 一般来说，检测时病变越小越好 预后。 磁共振成像（MRI）提供令人兴奋的 与其他成像相比，可能增加组织表征 方式。 该提案的主要目标是提高特异性 乳腺病变的特征是良性的， 恶性的基础上分析其代谢使用局部 磁共振波谱（MRS）。 目前，X射线乳房X光检查 是筛查乳腺癌的主要方法。 的妇女 没有致密的乳房，乳房X光检查的总体灵敏度为 约90%，阳性预测值约为20 - 30%。 为 由于成本和可用性的原因，乳房MRI不太可能 尽管乳房X光检查将取代乳房X光检查作为主要筛查测试， 使用MRI的初步研究发现， 其可变的特异性显著高于乳房X线摄影。 有迹象表明，MRI的特异性将继续 通过技术进步和改进， 放射科医师解读图像的能力。 由于其多 特异性更高，更有可能采用MRI来提供 改善乳腺X线摄影或 临床高度怀疑疾病的患者（例如，具有可触摸的 结节）。 图像引导磁共振成像技术的发展 波谱（MRS）技术提供了一种获得代谢产物的方法， 可以在MRI上识别的病变信息。 我们已经验证 获得溶剂抑制质子空间定位方法 来自小至（6 mm）3的病变的光谱， 适用于研究乳腺疾病。 我们的核心假设是， 单独的代谢信息，或与MRI标准结合， 用于提高测试的特异性。 的这种改善 特异性将减少阴性活检的数量 从而节省成本，而不会对患者产生不利影响 在乎

The rising incidence of breast cancer has reached epidemic proportions. In a recent National Institutes of Health consensus development conference, it was emphasized that during the 1990's, more than 1.5 million women in the U.S. will be diagnosed with breast cancer and that approximately 30% of them will die of the disease (1). It is estimated that 1 out of every 9 women will develop breast cancer during her lifetime. In general, the smaller the lesion is at the time of detection, the better the prognosis. Magnetic Resonance Imaging (MRI) offers exciting potential for increased tissue characterization compared to other imaging modalities. The major goal of this proposal is to improve the specificity of the characterization of lesions in the breast as either benign or malignant based on an analysis of their metabolism using localized magnetic resonance spectroscopy (MRS). Currently, X-ray mammography is the major modality used for screening breast cancer. For women who do not have dense breasts mammography has an overall sensitivity of about 90%, with a positive predictive value of about 20-30%. For reasons of cost and availability, it is unlikely that MRI of the breast will replace mammography as the primary screening test even though preliminary studies using MRI have found about equivalent sensitivity with variable specifities that are significantly higher than mammography. There are indications that the specificity of MRI will continue to increase through both technical advances and improvements in the ability of radiologists to interpret the images. Because of its much higher specificity it is more likely that MRI will be employed to provide improved characterization of lesions visualized on mammography or in patients with a high clinical suspicion of disease (e.g. with a palapable nodule). The development of image-guided Magnetic Resonance spectroscopy (MRS) techniques provides a means for obtaining metabolic information for lesions that can be identified on MRI. We have validated spatial localization methods for acquiring solvent-suppressed proton spectra from lesions as small as (6 mm)3 which make this modality applicable to study breast disease. Our central hypothesis is that this metabolic information alone, or in combination with MRI criteria, can be employed to improve the specificity of the test. This improvement in specificity will reduce the number of negative biopsies performed resulting in cost saving without having an adverse impact on patient care.