Proton magnetic resonance spectroscopic (HMRS) imaging: Noninvasive diagnostic method of analyzing tissue metabolism
Yields chemical data reflecting tissue composition
Choline (Cho): Biomarker for active tumors
Cho peak at 3.2 ppm on resonance spectrum (at 1.5T)
Lipids: 0.6-2.8 ppm; large lipid peak can obscure Cho detection
Creatine and total choline (tCho): 2.9-3.35 ppm (center 3.2 ppm)
Water: 4.4-5.2 ppm
Single-voxel spectroscopy (SV-HMRS): Spectroscopy from single predefined voxel; most commonly used breast HMRS method
Advantages: Better shimming, more robust spectrum; less partial voluming than multivoxel spectroscopy
Disadvantages: Only single lesion at time, location of lesion should be known prior to HMRS (operator selects 1-cm³ volume); insensitive to lesions < 1 cm in diameter; user-defined region of interest
Multivoxel spectroscopy (MV-HMRS): Grid of multiple spectroscopic voxels acquired simultaneously; "mapping" of metabolites within given slice
Advantages: Simultaneously assesses multiple tissues/lesions, can be acquired precontrast, can show change of composition of metabolites in voxels → better depiction of lesion margins
Disadvantages: Difficulty shimming across large image field to produce robust spectrum, voxels not as precise as SV-HMRS, partial volume errors
Data transfer: HMRS data are transferred to workstation for baseline correction and Fourier transform to generate final spectrum
Internal water-referenced spectroscopy
Ratio of Cho to water amplitude commonly applied in United States to calculate Cho concentration, [Cho]
IMAGING
MR Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
DIAGNOSTIC CHECKLIST
Consider
Selected References
Montemezzi S et al: Is there a correlation between 3T multiparametric MRI and molecular subtypes of breast cancer? Eur J Radiol. 108:120-7, 2018
Zhou J et al: Predicting neoadjuvant chemotherapy in nonconcentric shrinkage pattern of breast cancer using 1H-magnetic resonance spectroscopic imaging. J Comput Assist Tomogr. 42(1):12-18, 2018
Bolan PJ et al: MR spectroscopy of breast cancer for assessing early treatment response: results from the ACRIN 6657 MRS trial. J Magn Reson Imaging. 46(1):290-302, 2017
Rahbar H et al: Multiparametric MR imaging of breast cancer. Magn Reson Imaging Clin N Am. 24(1):223-38, 2016
Pinker K et al: Improved diagnostic accuracy with multiparametric magnetic resonance imaging of the breast using dynamic contrast-enhanced magnetic resonance imaging, diffusion-weighted imaging, and 3-dimensional proton magnetic resonance spectroscopic imaging. Invest Radiol. 49(6):421-30, 2014
Baltzer PA et al: Breast lesions: diagnosis by using proton MR spectroscopy at 1.5 and 3.0 T--systematic review and meta-analysis. Radiology. 267(3):735-46, 2013
Bolan PJ: Magnetic resonance spectroscopy of the breast: current status. Magn Reson Imaging Clin N Am. 21(3):625-39, 2013
Tozaki M et al: Monitoring of early response to neoadjuvant chemotherapy in breast cancer with (1)H MR spectroscopy: comparison to sequential 2-[18F]-fluorodeoxyglucose positron emission tomography. J Magn Reson Imaging. 28(2):420-7, 2008
Bartella L et al: Proton (1H) MR spectroscopy of the breast. Radiographics. 27 Suppl 1:S241-52, 2007
Tse GM et al: In vivo proton magnetic resonance spectroscopy of breast lesions: an update. Breast Cancer Res Treat. 104(3):249-55, 2007
Meisamy S et al: Adding in vivo quantitative 1H MR spectroscopy to improve diagnostic accuracy of breast MR imaging: preliminary results of observer performance study at 4.0 T. Radiology. 236(2):465-75, 2005
Meisamy S et al: Neoadjuvant chemotherapy of locally advanced breast cancer: predicting response with in vivo (1)H MR spectroscopy--a pilot study at 4 T. Radiology. 233(2):424-31, 2004
Yeung DK et al: Breast cancer: in vivo proton MR spectroscopy in the characterization of histopathologic subtypes and preliminary observations in axillary node metastases. Radiology. 225(1):190-7, 2002
Related Anatomy
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Related Differential Diagnoses
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
TERMINOLOGY
Definitions
Proton magnetic resonance spectroscopic (HMRS) imaging: Noninvasive diagnostic method of analyzing tissue metabolism
Yields chemical data reflecting tissue composition
Choline (Cho): Biomarker for active tumors
Cho peak at 3.2 ppm on resonance spectrum (at 1.5T)
Lipids: 0.6-2.8 ppm; large lipid peak can obscure Cho detection
Creatine and total choline (tCho): 2.9-3.35 ppm (center 3.2 ppm)
Water: 4.4-5.2 ppm
Single-voxel spectroscopy (SV-HMRS): Spectroscopy from single predefined voxel; most commonly used breast HMRS method
Advantages: Better shimming, more robust spectrum; less partial voluming than multivoxel spectroscopy
Disadvantages: Only single lesion at time, location of lesion should be known prior to HMRS (operator selects 1-cm³ volume); insensitive to lesions < 1 cm in diameter; user-defined region of interest
Multivoxel spectroscopy (MV-HMRS): Grid of multiple spectroscopic voxels acquired simultaneously; "mapping" of metabolites within given slice
Advantages: Simultaneously assesses multiple tissues/lesions, can be acquired precontrast, can show change of composition of metabolites in voxels → better depiction of lesion margins
Disadvantages: Difficulty shimming across large image field to produce robust spectrum, voxels not as precise as SV-HMRS, partial volume errors
Data transfer: HMRS data are transferred to workstation for baseline correction and Fourier transform to generate final spectrum
Internal water-referenced spectroscopy
Ratio of Cho to water amplitude commonly applied in United States to calculate Cho concentration, [Cho]
IMAGING
MR Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
DIAGNOSTIC CHECKLIST
Consider
Selected References
Montemezzi S et al: Is there a correlation between 3T multiparametric MRI and molecular subtypes of breast cancer? Eur J Radiol. 108:120-7, 2018
Zhou J et al: Predicting neoadjuvant chemotherapy in nonconcentric shrinkage pattern of breast cancer using 1H-magnetic resonance spectroscopic imaging. J Comput Assist Tomogr. 42(1):12-18, 2018
Bolan PJ et al: MR spectroscopy of breast cancer for assessing early treatment response: results from the ACRIN 6657 MRS trial. J Magn Reson Imaging. 46(1):290-302, 2017
Rahbar H et al: Multiparametric MR imaging of breast cancer. Magn Reson Imaging Clin N Am. 24(1):223-38, 2016
Pinker K et al: Improved diagnostic accuracy with multiparametric magnetic resonance imaging of the breast using dynamic contrast-enhanced magnetic resonance imaging, diffusion-weighted imaging, and 3-dimensional proton magnetic resonance spectroscopic imaging. Invest Radiol. 49(6):421-30, 2014
Baltzer PA et al: Breast lesions: diagnosis by using proton MR spectroscopy at 1.5 and 3.0 T--systematic review and meta-analysis. Radiology. 267(3):735-46, 2013
Bolan PJ: Magnetic resonance spectroscopy of the breast: current status. Magn Reson Imaging Clin N Am. 21(3):625-39, 2013
Tozaki M et al: Monitoring of early response to neoadjuvant chemotherapy in breast cancer with (1)H MR spectroscopy: comparison to sequential 2-[18F]-fluorodeoxyglucose positron emission tomography. J Magn Reson Imaging. 28(2):420-7, 2008
Bartella L et al: Proton (1H) MR spectroscopy of the breast. Radiographics. 27 Suppl 1:S241-52, 2007
Tse GM et al: In vivo proton magnetic resonance spectroscopy of breast lesions: an update. Breast Cancer Res Treat. 104(3):249-55, 2007
Meisamy S et al: Adding in vivo quantitative 1H MR spectroscopy to improve diagnostic accuracy of breast MR imaging: preliminary results of observer performance study at 4.0 T. Radiology. 236(2):465-75, 2005
Meisamy S et al: Neoadjuvant chemotherapy of locally advanced breast cancer: predicting response with in vivo (1)H MR spectroscopy--a pilot study at 4 T. Radiology. 233(2):424-31, 2004
Yeung DK et al: Breast cancer: in vivo proton MR spectroscopy in the characterization of histopathologic subtypes and preliminary observations in axillary node metastases. Radiology. 225(1):190-7, 2002
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