(1)H MR spectroscopy with external reference solution at 1.5 T for differentiating malignant and benign breast...

To compare the diagnostic capability of proton ((1)H) magnetic resonance spectroscopy (MRS) in differentiating benign from malignant breast lesions on the basis of qualitative and quantitative approaches.

We performed single-voxel (1)H MRS for 208 breast lesions, identified a clear total composite choline compounds (tCho) peak of signal-to-noise of ≥2 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.