Keywords:
Breast, Oncology, MR, MR-Diffusion/Perfusion, MR-Spectroscopy, Contrast agent-intravenous, Imaging sequences, Neoplasia
Authors:
S. Juvekar, A. Mahajan, M. Thakur; Mumbai/IN
DOI:
10.1594/ecr2013/C-1794
Conclusion
Discussion
• The known limitation of MRS is that it provides the metabolic composition of a given voxel,
which may include more than one type of tissue,
for example in breast cancer; the voxel on occasions,
includes in addition to pathologic cancer tissue,
normal glandular tissue and adipose tissue.
• The amplitude of choline peak is probably related to volume of pathologic tissue in a given voxel and hence the difference in the amplitude of choline peak,
depending on size of lesion.
•The absence of choline peak may also be a result of inadequate sampling due to patient movement during acquisition and its relatively large effect on very small lesions.
•On MRI,
diagnosis of primary malignant breast lesions is suggested,
based on characteristic morphologic features and type II or type III contrast kinetics.
Using detectability of choline peak within the lesion,
in vivo MR spectroscopy adds to the diagnostic confidence.
•Single Voxel in vivo MR spectroscopy is a robust technique ; however care should taken to see that within a voxel the volume of normal breast tissue is not larger than suspected disease volume.
Future of in vivo Breast MR spectroscopy:
Our results are promising and suggest that MRS,
along with MRI,
will have an increasingly important role in the clinical assessment of breast cancer in the future.
Further study is recommended in large series to decide if MR spectroscopy (Elevated Choline) can be used as a biomarker to make diagnostic decisions and if that is established,
it will still require further studies to see if it can be used to monitor therapeutic response.
Further refinements in MR systems and techniques (possibly Multivoxel Spectroscopy [CSI]) are needed to improve the quality and reliability of MRS data.