Contribution of advanced magnetic resonance imaging techniques in diagnosis of breast lesions

PurposeConvantional mammography and ultrasonography are the first and easily performed diagnostic techniques in characterization of breast lesions. Convantional enhanced magnetic resonance imaging (MRI) is used as a problem solving tool to identify and characterize breast lesions in selected cases. Because of this reason advanced MRI application such as diffusion MRI and MR spectroscopy may have important contributions on the diagnosis, since convantional MRI has a high sensitivity but relatively low specifity.In this study we aimed to determine diagnostic contribution of diffusion MRI and MR spectroscopy which were identified either with mammography, ultrasonography or convantional enhanced MRI to the cases who applied with palpable breast lesions or for routine control.Materials and MethodWe included 50 female patients who applied to our clinic between November 2009- April 2010 with different endications. We appilied convantional breast MRI with 1.5 Tesla MR device Signa HDx; General Electric, Milwaukee, WI, USA). The routine sequences were axial Short TI Inversion Recovery (STIR), sagittal Fast Spin Echo (FSE) Fat Saturated T2W, sagittal 3D VIBRANT (Postcontrast Fat Saturated T1W). We added diffusion weighted imaging (DWI) with b=0 - b=600 values and BREASE (single Voxel MR Spectroscopy) to the cases in our study. After MRI examination postprocessing applications were applied.In 10 cases no focal lesion was found. In 3 cases MRI images were non diagnostic because of motion artifacts. As a result 13 cases were excluded from the study. 52 breast lesions in 37 cases which were included in our study were evaluated.FindingsThe breast lesions were classified according to BI-RADS characteristics and dynamic curves indicating enhancement characteristics were obtained.In DWI we measured ADC values. When the cut off value was accepted as 1.44 x10-3mm2/sn, the sensitivity was found as %91.3 and the specifity was found as %62.1 in discrimination of malignant and benign lesions.When the lesions which have choline pick at 3.2 ppm were accepted as malignant and the lesions which do not have choline pick were accepted as benign lesions in spectroscopic examination, the specifity was %80, the sensitivity was %31,8, - ppv was %44,4 and + ppv was found as %70.ConclusionMorphologic BI-RADS classification and dynamic findings of convantional MRI examination in our study were compatible with the literature.In the literature proton (1H) MR spectroscopy examination sensitivity differs between %70- %100, specitfity differs between %67-%100 and +ppv differs between %82-%100 (95, 99, 102, 103, 165, 166, 196). In our study specifity was compatible with the literature but sensitivity and +ppv were lower than the litearture.According to ADC value results, the findins in our study were competible with the literature.Key words: Enhanced breast MRI, Diffusion Weighted Imaging, proton (1H) MR spectroscopy.