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Proton (¹H) MR Spectroscopy of the Breast¹

¹ From the Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021. Received February 5, 2007; revision requested March 15 and received May 16; accepted June 21. Both authors have no financial relationships to disclose.

View larger version (168K): [in this window] [in a new window] [Download PPT slide]   Figure 1a.  (a) Sagittal non-fat-suppressed T1-weighted MR image (repetition time msec/ echo time msec = 6.4/3.1) of the right breast, obtained in a 65-year-old woman with a history of pseudoangiomatous stromal hyperplasia in the left breast, shows normal glandular parenchyma and fat. (b) Magnified spectrum illustrates a high lipid (Lip) peak, but no choline (Cho) resonance peak is observed at a frequency of 3.2 ppm. Lac = lactate.

 

View larger version (11K): [in this window] [in a new window] [Download PPT slide]   Figure 1b.  (a) Sagittal non-fat-suppressed T1-weighted MR image (repetition time msec/ echo time msec = 6.4/3.1) of the right breast, obtained in a 65-year-old woman with a history of pseudoangiomatous stromal hyperplasia in the left breast, shows normal glandular parenchyma and fat. (b) Magnified spectrum illustrates a high lipid (Lip) peak, but no choline (Cho) resonance peak is observed at a frequency of 3.2 ppm. Lac = lactate.

 

View larger version (129K): [in this window] [in a new window] [Download PPT slide]   Figure 2a.  (a) Sagittal non-fat-suppressed T1-weighted MR image (6.4/3.1) of the left breast, obtained in a 47-year-old woman during week 2 of the menstrual cycle, shows normal glandular parenchyma and little fat. The patient had undergone lumpectomy in the contralateral breast for cancer discovered at screening breast MR imaging performed owing to the patient’s high risk. (b) Magnified spectrum illustrates a high lipid (Lip) peak, but no choline (Cho) resonance peak is observed at a frequency of 3.2 ppm. Lac = lactate.

 

View larger version (11K): [in this window] [in a new window] [Download PPT slide]   Figure 2b.  (a) Sagittal non-fat-suppressed T1-weighted MR image (6.4/3.1) of the left breast, obtained in a 47-year-old woman during week 2 of the menstrual cycle, shows normal glandular parenchyma and little fat. The patient had undergone lumpectomy in the contralateral breast for cancer discovered at screening breast MR imaging performed owing to the patient’s high risk. (b) Magnified spectrum illustrates a high lipid (Lip) peak, but no choline (Cho) resonance peak is observed at a frequency of 3.2 ppm. Lac = lactate.

 

View larger version (147K): [in this window] [in a new window] [Download PPT slide]   Figure 3a.  (a) Sagittal non-fat-suppressed T1-weighted MR image (6.4/3.1) of the left breast obtained in a 53-year-old woman shows normal glandular parenchyma. The patient had undergone lumpectomy for cancer in the right breast that was discovered at screening breast MR imaging performed owing to the patient’s high risk. (b) Magnified spectrum illustrates a high lipid (Lip) peak, but no choline (Cho) resonance peak is observed at a frequency of 3.2 ppm. Lac = lactate.

 

View larger version (8K): [in this window] [in a new window] [Download PPT slide]   Figure 3b.  (a) Sagittal non-fat-suppressed T1-weighted MR image (6.4/3.1) of the left breast obtained in a 53-year-old woman shows normal glandular parenchyma. The patient had undergone lumpectomy for cancer in the right breast that was discovered at screening breast MR imaging performed owing to the patient’s high risk. (b) Magnified spectrum illustrates a high lipid (Lip) peak, but no choline (Cho) resonance peak is observed at a frequency of 3.2 ppm. Lac = lactate.

 

View larger version (135K): [in this window] [in a new window] [Download PPT slide]   Figure 4a.  (a) Sagittal non-fat-suppressed T1-weighted MR image (6.4/3.1) of the left breast obtained in a 56-year-old woman shows normal glandular parenchyma and little fat. The patient had undergone lumpectomy for atypical ductal hyperplasia that was discovered at screening breast MR imaging performed owing to the patient’s high risk. (b) Magnified spectrum illustrates a high lipid (Lip) peak, but no choline (Cho) resonance peak is observed at a frequency of 3.2 ppm. Lac = lactate.

 

View larger version (12K): [in this window] [in a new window] [Download PPT slide]   Figure 4b.  (a) Sagittal non-fat-suppressed T1-weighted MR image (6.4/3.1) of the left breast obtained in a 56-year-old woman shows normal glandular parenchyma and little fat. The patient had undergone lumpectomy for atypical ductal hyperplasia that was discovered at screening breast MR imaging performed owing to the patient’s high risk. (b) Magnified spectrum illustrates a high lipid (Lip) peak, but no choline (Cho) resonance peak is observed at a frequency of 3.2 ppm. Lac = lactate.

 

View larger version (123K): [in this window] [in a new window] [Download PPT slide]   Figure 5a.  (a) Sagittal non-fat-suppressed T1-weighted MR image (6.4/3.1) of the left breast obtained in a 68-year-old woman shows normal glandular parenchyma and fat. The patient had undergone contralateral lumpectomy for breast cancer that was discovered at screening breast MR imaging performed owing to the patient’s high risk. (b) Magnified spectrum illustrates a high lipid (Lip) peak, but no choline (Cho) resonance peak is observed at a frequency of 3.2 ppm. Lac = lactate.

 

View larger version (12K): [in this window] [in a new window] [Download PPT slide]   Figure 5b.  (a) Sagittal non-fat-suppressed T1-weighted MR image (6.4/3.1) of the left breast obtained in a 68-year-old woman shows normal glandular parenchyma and fat. The patient had undergone contralateral lumpectomy for breast cancer that was discovered at screening breast MR imaging performed owing to the patient’s high risk. (b) Magnified spectrum illustrates a high lipid (Lip) peak, but no choline (Cho) resonance peak is observed at a frequency of 3.2 ppm. Lac = lactate.

 

View larger version (129K): [in this window] [in a new window] [Download PPT slide]   Figure 6a.  Benign fibrosis and ductal hyperplasia (true-negative findings) in a 43-year-old woman who presented with a new palpable mass in the right breast. (a) Sagittal contrast-enhanced fat-suppressed T1-weighted MR image (6.4/3.1) demonstrates a 4.2-cm irregular mass (arrow). A voxel was placed around the mass. (b) Magnified spectrum shows no positive choline (Cho) resonance peak, with only a noise level at a frequency of 3.2 ppm. Lac = lactate, Lip = lipid. MR-guided biopsy followed by surgical excision revealed benign fibrosis and ductal hyperplasia. (Fig 6 reprinted, with permission, from reference 23 .)

 

View larger version (11K): [in this window] [in a new window] [Download PPT slide]   Figure 6b.  Benign fibrosis and ductal hyperplasia (true-negative findings) in a 43-year-old woman who presented with a new palpable mass in the right breast. (a) Sagittal contrast-enhanced fat-suppressed T1-weighted MR image (6.4/3.1) demonstrates a 4.2-cm irregular mass (arrow). A voxel was placed around the mass. (b) Magnified spectrum shows no positive choline (Cho) resonance peak, with only a noise level at a frequency of 3.2 ppm. Lac = lactate, Lip = lipid. MR-guided biopsy followed by surgical excision revealed benign fibrosis and ductal hyperplasia. (Fig 6 reprinted, with permission, from reference 23.)

 

View larger version (106K): [in this window] [in a new window] [Download PPT slide]   Figure 7a.  Mammographically detected, biopsy-proved invasive ductal carcinoma (true-positive finding) of the left breast in a 52-year-old woman. (a) Sagittal fat-suppressed T1-weighted MR image (6.4/3.1) obtained immediately after the intravenous injection of gadolinium-based contrast material shows a 1.5-cm rim-enhancing mass. A voxel was placed around the mass. (b) Magnified spectrum illustrates a positive choline (Cho) resonance peak at a frequency of 3.2 ppm with an SNR greater than 2. Lac = lactate, Lip = lipid. (Fig 7 reprinted, with permission, from reference 23.)

 

View larger version (15K): [in this window] [in a new window] [Download PPT slide]   Figure 7b.  Mammographically detected, biopsy-proved invasive ductal carcinoma (true-positive finding) of the left breast in a 52-year-old woman. (a) Sagittal fat-suppressed T1-weighted MR image (6.4/3.1) obtained immediately after the intravenous injection of gadolinium-based contrast material shows a 1.5-cm rim-enhancing mass. A voxel was placed around the mass. (b) Magnified spectrum illustrates a positive choline (Cho) resonance peak at a frequency of 3.2 ppm with an SNR greater than 2. Lac = lactate, Lip = lipid. (Fig 7 reprinted, with permission, from reference 23.)

 

View larger version (93K): [in this window] [in a new window] [Download PPT slide]   Figure 8a.  Fibroadenoma and fibroadenomatoid changes (false-positive findings) in a 43-year-old woman with biopsy-proved DCIS. A suspect lesion was detected at MR imaging performed to determine disease extent. (a) Sagittal contrast-enhanced fat-suppressed T1-weighted MR image (6.4/3.1) shows regional clumped enhancement in the outer portion of the left breast. (b) Magnified spectrum illustrates a choline (Cho) resonance peak with an SNR greater than 2. Lac = lactate, Lip = lipid. Excision revealed fibroadenoma and fibroadenomatoid changes. (Fig 8 reprinted, with permission, from reference 26.)

 

View larger version (11K): [in this window] [in a new window] [Download PPT slide]   Figure 8b.  Fibroadenoma and fibroadenomatoid changes (false-positive findings) in a 43-year-old woman with biopsy-proved DCIS. A suspect lesion was detected at MR imaging performed to determine disease extent. (a) Sagittal contrast-enhanced fat-suppressed T1-weighted MR image (6.4/3.1) shows regional clumped enhancement in the outer portion of the left breast. (b) Magnified spectrum illustrates a choline (Cho) resonance peak with an SNR greater than 2. Lac = lactate, Lip = lipid. Excision revealed fibroadenoma and fibroadenomatoid changes. (Fig 8 reprinted, with permission, from reference 26.)

 

View larger version (111K): [in this window] [in a new window] [Download PPT slide]   Figure 9a.  Chronic inflammatory lesion with atypia (false-positive findings) in a 51-year-old woman with a positive family history of breast cancer. The patient presented with a suspect lesion that had been detected at screening breast MR imaging performed owing to the patient’s high risk. (a) Sagittal contrast-enhanced fat-suppressed T1-weighted MR image (6.4/3.1) of the left breast shows ductal clumped enhancement in the retroareolar region. A voxel was placed around the area of enhancement. (b) Magnified spectrum illustrates a positive choline (Cho) resonance peak with an SNR greater than 2. Lac = lactate, Lip = lipid. Excision of the lesion demonstrated an atypical chronic inflammatory lesion. (Fig 9 reprinted, with permission, from reference 23.)

 

View larger version (13K): [in this window] [in a new window] [Download PPT slide]   Figure 9b.  Chronic inflammatory lesion with atypia (false-positive findings) in a 51-year-old woman with a positive family history of breast cancer. The patient presented with a suspect lesion that had been detected at screening breast MR imaging performed owing to the patient’s high risk. (a) Sagittal contrast-enhanced fat-suppressed T1-weighted MR image (6.4/3.1) of the left breast shows ductal clumped enhancement in the retroareolar region. A voxel was placed around the area of enhancement. (b) Magnified spectrum illustrates a positive choline (Cho) resonance peak with an SNR greater than 2. Lac = lactate, Lip = lipid. Excision of the lesion demonstrated an atypical chronic inflammatory lesion. (Fig 9 reprinted, with permission, from reference 23.)

 

View larger version (107K): [in this window] [in a new window] [Download PPT slide]   Figure 10a.  Palpable, mammographically detected, biopsy-proved invasive lobular carcinoma (true-positive finding) in the left breast of a 56-year-old woman. (a) Sagittal fat-suppressed T1-weighted MR image (6.4/3.1) obtained immediately after the intravenous injection of gadopentetate dimeglumine shows a 5-cm area of regional clumped enhancement in the 12-o’clock axis. (b) Magnified spectrum illustrates a choline (Cho) resonance peak at a frequency of 3.2 ppm with an SNR greater than 2. Lac = lactate, Lip = lipid. (Fig 10 reprinted, with permission, from reference 26.)

 

View larger version (15K): [in this window] [in a new window] [Download PPT slide]   Figure 10b.  Palpable, mammographically detected, biopsy-proved invasive lobular carcinoma (true-positive finding) in the left breast of a 56-year-old woman. (a) Sagittal fat-suppressed T1-weighted MR image (6.4/3.1) obtained immediately after the intravenous injection of gadopentetate dimeglumine shows a 5-cm area of regional clumped enhancement in the 12-o’clock axis. (b) Magnified spectrum illustrates a choline (Cho) resonance peak at a frequency of 3.2 ppm with an SNR greater than 2. Lac = lactate, Lip = lipid. (Fig 10 reprinted, with permission, from reference 26.)

 

View larger version (157K): [in this window] [in a new window] [Download PPT slide]   Figure 11a.  Non–mass-enhancing lesion (true-negative finding) in a 38-year-old woman with a BRCA1 gene. A suspect lesion was detected at screening MR imaging. (a) Sagittal contrast-enhanced fat-suppressed T1-weighted MR image (6.4/3.1) obtained on day 11 of the menstrual cycle shows focal clumped enhancement in the upper inner portion of the left breast. (b) Magnified spectrum illustrates a high lipid (Lip) peak, but no choline (Cho) resonance peak is observed at a frequency of 3.2 ppm. Lac = lactate.

 

View larger version (14K): [in this window] [in a new window] [Download PPT slide]   Figure 11b.  Non–mass-enhancing lesion (true-negative finding) in a 38-year-old woman with a BRCA1 gene. A suspect lesion was detected at screening MR imaging. (a) Sagittal contrast-enhanced fat-suppressed T1-weighted MR image (6.4/3.1) obtained on day 11 of the menstrual cycle shows focal clumped enhancement in the upper inner portion of the left breast. (b) Magnified spectrum illustrates a high lipid (Lip) peak, but no choline (Cho) resonance peak is observed at a frequency of 3.2 ppm. Lac = lactate.

 

View larger version (118K): [in this window] [in a new window] [Download PPT slide]   Figure 12a.  Spectroscopy of non–mass-enhancing lesions. (a) A suspect lesion was detected at screening in the left breast of a 20-year-old woman with a positive family history of breast cancer. Sagittal contrast-enhanced fat-suppressed T1-weighted MR image (6.4/3.1) shows focal clumped enhancement in the upper inner quadrant of the left breast. A voxel was placed around the area of enhancement. Spectroscopy did not demonstrate a choline resonance peak. MR-guided biopsy showed fibroadenomatoid change and breast parenchyma. (b) Benign findings in a 43-year-old woman with a family history of breast cancer (sister, age 41 years) who presented with nipple discharge and breast pain. Mammography showed dense breasts without suspect findings. Sagittal contrast-enhanced fat-suppressed T1-weighted MR image (6.4/3.1) of the right breast demonstrates unilateral regional enhancement at the 12-o’clock position. A voxel was placed around the area of enhancement. MR spectroscopy did not demonstrate a positive choline resonance peak. MR-guided biopsy showed benign breast parenchyma. (c) DCIS in a 57-year-old woman who presented with bloody nipple discharge from the right breast. No malignant findings were seen at mammography. Sagittal contrast-enhanced fat-suppressed T1-weighted MR image (6.4/3.1) of the right breast demonstrates segmental clumped enhancement of the entire lower outer quadrant. A voxel was placed around the area of enhancement. Spectroscopy demonstrated a positive choline resonance peak at a frequency of 3.2 ppm with an SNR greater than 2. MR-guided biopsy and subsequent mastectomy revealed extensive DCIS with a high nuclear grade. (d) Fibrocystic change and ductal hyperplasia in a 60-year-old woman with a history of lumpectomy of the right breast for DCIS. Sagittal contrast-enhanced fat-suppressed T1-weighted MR image (6.4/3.1) of the left breast shows ductal clumped enhancement in the retroareolar region. A voxel was placed around the area of enhancement. No choline resonance peak was detected at spectroscopy. Excision revealed fibrocystic change and ductal hyperplasia. (Fig 12 reprinted, with permission, from reference 26.)

 

View larger version (63K): [in this window] [in a new window] [Download PPT slide]   Figure 12b.  Spectroscopy of non–mass-enhancing lesions. (a) A suspect lesion was detected at screening in the left breast of a 20-year-old woman with a positive family history of breast cancer. Sagittal contrast-enhanced fat-suppressed T1-weighted MR image (6.4/3.1) shows focal clumped enhancement in the upper inner quadrant of the left breast. A voxel was placed around the area of enhancement. Spectroscopy did not demonstrate a choline resonance peak. MR-guided biopsy showed fibroadenomatoid change and breast parenchyma. (b) Benign findings in a 43-year-old woman with a family history of breast cancer (sister, age 41 years) who presented with nipple discharge and breast pain. Mammography showed dense breasts without suspect findings. Sagittal contrast-enhanced fat-suppressed T1-weighted MR image (6.4/3.1) of the right breast demonstrates unilateral regional enhancement at the 12-o’clock position. A voxel was placed around the area of enhancement. MR spectroscopy did not demonstrate a positive choline resonance peak. MR-guided biopsy showed benign breast parenchyma. (c) DCIS in a 57-year-old woman who presented with bloody nipple discharge from the right breast. No malignant findings were seen at mammography. Sagittal contrast-enhanced fat-suppressed T1-weighted MR image (6.4/3.1) of the right breast demonstrates segmental clumped enhancement of the entire lower outer quadrant. A voxel was placed around the area of enhancement. Spectroscopy demonstrated a positive choline resonance peak at a frequency of 3.2 ppm with an SNR greater than 2. MR-guided biopsy and subsequent mastectomy revealed extensive DCIS with a high nuclear grade. (d) Fibrocystic change and ductal hyperplasia in a 60-year-old woman with a history of lumpectomy of the right breast for DCIS. Sagittal contrast-enhanced fat-suppressed T1-weighted MR image (6.4/3.1) of the left breast shows ductal clumped enhancement in the retroareolar region. A voxel was placed around the area of enhancement. No choline resonance peak was detected at spectroscopy. Excision revealed fibrocystic change and ductal hyperplasia. (Fig 12 reprinted, with permission, from reference 26.)

 

View larger version (109K): [in this window] [in a new window] [Download PPT slide]   Figure 12c.  Spectroscopy of non–mass-enhancing lesions. (a) A suspect lesion was detected at screening in the left breast of a 20-year-old woman with a positive family history of breast cancer. Sagittal contrast-enhanced fat-suppressed T1-weighted MR image (6.4/3.1) shows focal clumped enhancement in the upper inner quadrant of the left breast. A voxel was placed around the area of enhancement. Spectroscopy did not demonstrate a choline resonance peak. MR-guided biopsy showed fibroadenomatoid change and breast parenchyma. (b) Benign findings in a 43-year-old woman with a family history of breast cancer (sister, age 41 years) who presented with nipple discharge and breast pain. Mammography showed dense breasts without suspect findings. Sagittal contrast-enhanced fat-suppressed T1-weighted MR image (6.4/3.1) of the right breast demonstrates unilateral regional enhancement at the 12-o’clock position. A voxel was placed around the area of enhancement. MR spectroscopy did not demonstrate a positive choline resonance peak. MR-guided biopsy showed benign breast parenchyma. (c) DCIS in a 57-year-old woman who presented with bloody nipple discharge from the right breast. No malignant findings were seen at mammography. Sagittal contrast-enhanced fat-suppressed T1-weighted MR image (6.4/3.1) of the right breast demonstrates segmental clumped enhancement of the entire lower outer quadrant. A voxel was placed around the area of enhancement. Spectroscopy demonstrated a positive choline resonance peak at a frequency of 3.2 ppm with an SNR greater than 2. MR-guided biopsy and subsequent mastectomy revealed extensive DCIS with a high nuclear grade. (d) Fibrocystic change and ductal hyperplasia in a 60-year-old woman with a history of lumpectomy of the right breast for DCIS. Sagittal contrast-enhanced fat-suppressed T1-weighted MR image (6.4/3.1) of the left breast shows ductal clumped enhancement in the retroareolar region. A voxel was placed around the area of enhancement. No choline resonance peak was detected at spectroscopy. Excision revealed fibrocystic change and ductal hyperplasia. (Fig 12 reprinted, with permission, from reference 26.)

 

View larger version (95K): [in this window] [in a new window] [Download PPT slide]   Figure 12d.  Spectroscopy of non–mass-enhancing lesions. (a) A suspect lesion was detected at screening in the left breast of a 20-year-old woman with a positive family history of breast cancer. Sagittal contrast-enhanced fat-suppressed T1-weighted MR image (6.4/3.1) shows focal clumped enhancement in the upper inner quadrant of the left breast. A voxel was placed around the area of enhancement. Spectroscopy did not demonstrate a choline resonance peak. MR-guided biopsy showed fibroadenomatoid change and breast parenchyma. (b) Benign findings in a 43-year-old woman with a family history of breast cancer (sister, age 41 years) who presented with nipple discharge and breast pain. Mammography showed dense breasts without suspect findings. Sagittal contrast-enhanced fat-suppressed T1-weighted MR image (6.4/3.1) of the right breast demonstrates unilateral regional enhancement at the 12-o’clock position. A voxel was placed around the area of enhancement. MR spectroscopy did not demonstrate a positive choline resonance peak. MR-guided biopsy showed benign breast parenchyma. (c) DCIS in a 57-year-old woman who presented with bloody nipple discharge from the right breast. No malignant findings were seen at mammography. Sagittal contrast-enhanced fat-suppressed T1-weighted MR image (6.4/3.1) of the right breast demonstrates segmental clumped enhancement of the entire lower outer quadrant. A voxel was placed around the area of enhancement. Spectroscopy demonstrated a positive choline resonance peak at a frequency of 3.2 ppm with an SNR greater than 2. MR-guided biopsy and subsequent mastectomy revealed extensive DCIS with a high nuclear grade. (d) Fibrocystic change and ductal hyperplasia in a 60-year-old woman with a history of lumpectomy of the right breast for DCIS. Sagittal contrast-enhanced fat-suppressed T1-weighted MR image (6.4/3.1) of the left breast shows ductal clumped enhancement in the retroareolar region. A voxel was placed around the area of enhancement. No choline resonance peak was detected at spectroscopy. Excision revealed fibrocystic change and ductal hyperplasia. (Fig 12 reprinted, with permission, from reference 26.)

 

View larger version (118K): [in this window] [in a new window] [Download PPT slide]   Figure 13a.  Biopsy-proved invasive ductal carcinoma in the left breast of a 57-year-old woman. (a) Sagittal contrast-enhanced fat-suppressed T1-weighted MR image (6.4/3.1) obtained immediately after the intravenous injection of gadopentetate dimeglumine shows a 1.4-cm irregular enhancing mass. (b) Magnified spectrum illustrates no choline (Cho) resonance peak at a frequency of 3.2 ppm. Lac = lactate, Lip = lipid. Patient motion during the examination is the most likely reason for the false-negative result.

 

View larger version (11K): [in this window] [in a new window] [Download PPT slide]   Figure 13b.  Biopsy-proved invasive ductal carcinoma in the left breast of a 57-year-old woman. (a) Sagittal contrast-enhanced fat-suppressed T1-weighted MR image (6.4/3.1) obtained immediately after the intravenous injection of gadopentetate dimeglumine shows a 1.4-cm irregular enhancing mass. (b) Magnified spectrum illustrates no choline (Cho) resonance peak at a frequency of 3.2 ppm. Lac = lactate, Lip = lipid. Patient motion during the examination is the most likely reason for the false-negative result.

 

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