1H MR spectroscopy with external reference solution at 1.5 T for differentiating malignant and benign breast lesions: comparison using qualitative and quantitative approaches

To compare the diagnostic capability of proton (H-1) magnetic resonance spectroscopy (MRS) in differentiating benign from malignant breast lesions on the basis of qualitative and quantitative approaches. We performed single-voxel H-1 MRS for 208 breast lesions, identified a clear total composite choline compounds (tCho) peak of signal-to-noise of a parts per thousand yen2 to represent malignancy (qualitative approach), and regarded tCho concentration equal to or greater than the cut-off value to represent malignancy (quantitative approach). We compared the diagnostic ability of both approaches using the Akaike information criterion (AIC) and McFadden's R (2). Histologically, 169 lesions were malignant; 39 were benign. The qualitative approach demonstrated 84.6 % sensitivity and 51.3 % specificity for differentiating malignant and benign lesions. The mean tCho concentration was 1.13 mmol/kg for malignancy, 0.43 mmol/kg for benignity. The optimal cut-off point was 0.61 mmol/kg, use of which achieved 68.1 % sensitivity and 79.4 % specificity. Calculated AIC and R (2) score suggested the superiority of the quantitative approach for differentiating malignancy. Quantitative MRS provides higher specificity than qualitative MRS for differentiating malignant from benign lesions and could be more useful as an additional examination in routine breast MR imaging. aEuro cent Magnetic resonance spectroscopy of the breast helps distinguish malignant from benign lesions. aEuro cent Magnetic resonance spectra demonstrate a choline signal even from benign lesions. aEuro cent Choline concentration is higher in breast carcinomas than in benign lesions. aEuro cent Quantitative magnetic resonance spectroscopy differentiates breast malignancies better than qualitative MRS.