Magnetic Resonance Imaging has gained popularity in
breast cancer diagnosis since the introduction of contrast media, and recent
developments in MRI have demonstrated a new potential use in diagnosis. Indeed,
the application of in vivo spectroscopy to mammary tissue has revealed that the spectral appearance of
choline could be a marker of malignancy, but early diagnosis and unambiguous
breast cancer characterization could benefit by a standardized protocol for the
simultaneous use of Dynamic Contrast Enhancement MRI and Magnetic Resonance
Spectroscopy and combined interpretation of associated markers.A total of 29 female patients took part
in the study. The combined protocol was performed on a General Electric Signa
HDtx 1.5 Tesla, and the DCE data analysis was performed through an evaluation
of the ROI signal intensity over time. The MRS data analysis evaluated choline
concentration and the signal to noise ratio of the choline peak. Sensitivity,
specificity and accuracy were assessed by the Receiver Operating
Characteristic methodology for Dynamic Contrast Enhancement, Magnetic Resonance
Spectroscopy and their linear combination. We performed a linear combination of
Dynamic Contrast Enhancement MRI and 1H-Magnetic Resonance Spectroscopy by distribution free approach to obtain a
high level diagnostic index. Combining the results of the two diagnostic tests has
resulted in a new, very effective, diagnostic index able to discriminate between
patients with and without malignant disease.
Cite this paper
Nicolosi, S. , Russo, G. , D’Angelo, I. , Vicari, G. , Gilardi, M. and Borasi, G. (2013) Combining DCE-MRI and 1H-MRS spectroscopy by distribution free approach results in a high performance marker: Initial study in breast patients. Journal of Biomedical Science and Engineering, 6, 357-364. doi: 10.4236/jbise.2013.63A045.
 Boetes, C., Barentsz, J.O., Mus, R.D., Van Der Sluis, R.F., van Erning, L.J., Hendriks, J.H., Holland, R. and Ruys, S.H. (1994) MR characterization of suspicious breast lesions with a gadolinium-enhanced TurboFLASH subtraction technique. Radiology, 193, 777-781.
 Saslow, D., Boetes, C., Burke, W., et al. (2007) American cancer society guidelines for breast screening with MRI as an adjunct to mammography. A Cancer Journal for Clinicians, 57, 75-89.
 Kuhl, C. (2007) The current status of breast MR imaging part I. Choice of technique, image interpretation, diagnostic accuracy, and transfer to clinical practice1. Radiology, 244, 356-378. doi:10.1148/radiol.2442051620
 Bartella, L., Morris, E.A., Dershaw, D.D., et al. (2006) Proton MR spectroscopy with choline peak as malignancy marker improves positive predictive value for breast cancer diagnosis: Preliminary study. Radiology, 239, 686- 692. doi:10.1148/radiol.2393051046
 Cecil, K.M., Schnall, M.D., Siegelman, E.S., et al. (2001) The evaluation of human breast lesions with magnetic resonance imaging and proton magnetic resonance spectroscopy. Breast Cancer Research and Treatment, 68, 45- 54. doi:10.1023/A:1017911211090
 Katz-Brull, R., Lavin, P.T. and Lenkinski, R.E. (2002) Clinical utility of proton magnetic resonance spectroscopy in characterizing breast lesions. Journal of the National Cancer Institute, 94, 1197-1203.
 Sardanelli, F., Fausto, A. and Podo, F. (2008) MR spectroscopy of the breast. La radiologia Medica, 113, 56-64.
 Sardanelli, F., Fausto, A., Di Leo, G., et al. (2009) In vivo proton MR spectroscopy of the breast using the total cho-line peak integral as a marker of malignancy. American Journal of Roentgenology, 192, 1608-1617.
 Esteban, L.M., Sanz, G. and Borque, A. (2011) A step- by-step algorithm for combining diagnostic tests. Journal of Applied Statistics, 38, 899-911.
 Pepe, M.S. and Thompson, M.L. (2000) Combining diagnostic test results to increase accuracy. Biostatistics, 1, 123-140. doi:10.1093/biostatistics/1.2.123
 Su, J.Q. and Liu, J.S. (1993) Linear combinations of multiple diagnostic markers. Journal of the American Statistical Association, 88, 1350-1355.
 Jacobs, M.A., Barker, P.B., Argani, P., et al. (2004) Combined dynamic contrast enhanced breast MR and proton spectroscopic imaging: A feasibility study. Journal of Magnetic Resonance Imaging, 21, 23-28.
 Dorrius, M.D., Pijnappel, R.M., van der Weide Jansen, M., et al. (2012) The added value of quantitative multi-voxel MR spectroscopy in breast magnetic resonance imaging. European radiology, 22, 915-922.
 Meisamy, S., Bolan, P.J., Baker, E.H., et al. (2005) 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, 465-475. doi:10.1148/radiol.2362040836
 Lipnick, S., Liu, X., Sayre, J., et al. (2010) Combined DCE-MRI and single voxel 2D MRS for differentiation between benign and malignant breast lesions. NMR in Biomedicine, 23, 922-930. doi:10.1002/nbm.1511
 Huang, W., Fisher, P.R., Dulaimy, K., et al. (2004) Detection of breast malignancy: Diagnostic MR protocol for improved specificity. Radiology, 232, 585-591.
 Bottomley, P.A. (1987) Spatial localization in NMR spectroscopy in vivo. Annals of the New York Academy of Sciences, 508, 333-348.
 Ordidge, R.J., Bendall, M.R., Gordon, R.E., et al. (1985) Volume selection for in vivo biological spectroscopy. In: Govil, G., Khetrapal, C.L. and Saran, A., Eds., Magnetic Resonance in Biology and Medicine, McGraw-Hill, New Delhi, 387-397.
 Kuhl, C.K., Mielcareck, P., Klaschik, S., et al. (1999) Dynamic breast MR imaging: Are signal intensity time course data useful for differential diagnosis of enhancing lesions? Radiology, 211, 101-110.
 Baik, H.M., Su, M.Y., Yu, H., et al. (2006) Quantification of choline-containing compounds in malignant breast tumors by 1 H MR spectroscopy using water as an internal reference at 1.5 T. Magnetic Resonance Materials in Physics, Biology and Medicine, 19, 96-104.
 Jagannathan, N. (2009) Quantitative estimate of in-vivo metabolites in breast and prostate tissues by MR spectroscopy. Medical Physics, 36, 2768.
 Vanhamme, L., Van Den Boogaart, A. and Van Huffel, S. (1997) Improved method for accurate and efficient quantification of MRS data with use of prior knowledge. Journal of Magnetic Resonance, 129, 35-43.
 Stefan, D., Di Cesare, F., Andrasescu, A., et al. (2009) Quantitation of magnetic resonance spectroscopy signals: The jMRUI software package. Measurement Science and Technology, 20, 104035.
 Begg, C.B. (2006) Advances in statistical methodology for diagnostic medicine in the 1980’s. Statistics in Medicine, 10, 1887-1895. doi:10.1002/sim.4780101205
 Swets, J.A. and Pickett, R.M. (1982) Evaluation of diagnostic systems: Methods from signal detection theory. Academic Press, New York.
 Bolan, P.J., Meisamy, S., Baker, E.H., et al. (2003) In vivo quantification of choline compounds in the breast with 1H MR spectroscopy. Magnetic Resonance in Medicine, 50, 1134-1143. doi:10.1002/mrm.10654
 Haddadin, I.S., McIntosh, A., Meisamy, S., et al. (2009) Metabolite quantification and high field MRS in breast cancer. NMR in Biomedicine, 22, 65-76.
 Bakken, I.J., Gribbestad, I.S., Singstad, T.E., et al. (2001) External standard method for the in vivo quantification of choline containing compounds in breast tumors by proton MR spectroscopy at 1.5 Tesla. Magnetic Resonance in Medicine, 46, 189-192. doi:10.1002/mrm.1175
 Baek, H.M., Chen, J.H., Yu, H.J., et al. (2008) Detection of choline signal in human breast lesions with chemical shift imaging. Journal of Magnetic Resonance Imaging, 27, 1114-1121. doi:10.1002/jmri.21309
 Baik, H.M., Su, M.Y., Yu, H.J., et al. (2005) Proton chemical shift imaging for monitoring early treatment response of breast cancer to neoadjuvant chemotherapy. Proceedings of the 13th Annual ISMRM, 7-13 May 2005, Miami.
 Do, R., Moy, L., Salibi, N., et al. (2006) Can MRS improve our ability to distinguish between benign and malignant lesions? Proceedings of the 14th Annual ISMRM, 6-12 May 2006, Seattle, Washington DC.
 Jacobs, M.A., Barker, P.B., Bottomley, P.A., et al. (2004) Proton magnetic resonance spectroscopic imaging of human breast cancer: A preliminary study. Journal of Magnetic Resonance Imaging, 19, 68-75.
 Stanwell, P., Gluch, L., Clark, D., et al. (2005) Specificity of choline metabolites for in vivo diagnosis of breast cancer using 1 H MRS at 1.5 T. European Radiology, 15, 1037-1043. doi:10.1007/s00330-004-2475-1
 Huang, W., Tudorica, L.A., Li, X., et al. (2011) Discrimination of benign and malignant breast lesions by using shutter-speed dynamic contrast-enhanced MR imaging. Radiology, 261, 394-403.