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Breast
Imaging
Special Topics in Screening and Diagnostic Imaging
MR Spectroscopy
MR Spectroscopy
Wendie A. Berg, MD, PhD, FACR, FSBI; Basak E. Dogan, MD
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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

              1. 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
              2. 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
              3. 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
              4. Rahbar H et al: Multiparametric MR imaging of breast cancer. Magn Reson Imaging Clin N Am. 24(1):223-38, 2016
              5. 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
              6. 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
              7. Bolan PJ: Magnetic resonance spectroscopy of the breast: current status. Magn Reson Imaging Clin N Am. 21(3):625-39, 2013
              8. 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
              9. Bartella L et al: Proton (1H) MR spectroscopy of the breast. Radiographics. 27 Suppl 1:S241-52, 2007
              10. Tse GM et al: In vivo proton magnetic resonance spectroscopy of breast lesions: an update. Breast Cancer Res Treat. 104(3):249-55, 2007
              11. 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
              12. 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
              13. 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

                          1. 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
                          2. 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
                          3. 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
                          4. Rahbar H et al: Multiparametric MR imaging of breast cancer. Magn Reson Imaging Clin N Am. 24(1):223-38, 2016
                          5. 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
                          6. 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
                          7. Bolan PJ: Magnetic resonance spectroscopy of the breast: current status. Magn Reson Imaging Clin N Am. 21(3):625-39, 2013
                          8. 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
                          9. Bartella L et al: Proton (1H) MR spectroscopy of the breast. Radiographics. 27 Suppl 1:S241-52, 2007
                          10. Tse GM et al: In vivo proton magnetic resonance spectroscopy of breast lesions: an update. Breast Cancer Res Treat. 104(3):249-55, 2007
                          11. 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
                          12. 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
                          13. 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