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Breast Magnetic Resonance Spectroscopy at 3 T in Biopsy-Proven Breast Cancers

Does Choline Peak Correlate With Prognostic Factors?

Galati, Francesca MD, PhD; Luciani, Maria Laura MD, PhD; Caramanico, Claudia MD; Moffa, Giuliana MD; Catalano, Carlo MD; Pediconi, Federica MD

doi: 10.1097/RLI.0000000000000597
Original Articles

Objectives The role of functional techniques, such as magnetic resonance spectroscopy (1H-MRS), as noninvasive tools to increase breast MR imaging reliability has been widely investigated during the last 2 decades. Considering the growing interest in tumor biology and its influence on functional parameters, the aim of this study was to investigate the relationship between 1H-MRS parameters and breast cancer biomarkers and to evaluate whether the results of 1H-MRS at 3 T can correlate with established breast cancer prognostic factors in our clinical experience.

Materials and Methods One hundred two patients with biopsy-proven breast cancer underwent 3 T breast MR imaging. Single-voxel 1H-MRS was performed after the T1-weighted sequence, using a PRESS water-suppressed sequence (BREASE). Data were collected from a single rectangular volume of interest that encompassed the lesion. Magnetic resonance images and spectra of 102 Breast Imaging Reporting and Data System 6 lesions were prospectively evaluated by 2 radiologists in consensus. 1H-MRS results were considered positive if the choline peak signal-to-noise ratio was 2 or higher. 1H-MRS findings were then compared with morphological features and to histological findings, such as lesion size, nuclear grade, Ki-67, hormone receptor status, and Her2 expression.

Results Elevated levels of total choline were detectable in 68/102 cases (66.67%) and undetectable in 34/102 (33.33%). A statistically significant association between the presence of choline peak and higher tumor grading (P < 0.0001), greater Ki-67 value (P < 0.0001), and larger lesion size (P < 0.0001) was found. No statistically significant associations were observed between choline peak and the luminal subgroups, even if higher levels of choline were more frequent in nonluminal A lesions.

Conclusions Our study confirms that 3 T breast 1H-MRS can be a valid additional tool to obtain further information about breast cancer biology and to predict tumor aggressiveness, because the detection of elevated levels of total choline in the spectrum is associated with a biologically aggressive breast cancer phenotype (large dimensions, grade 3, high values of Ki-67). Our results need to be validated in standardized larger-scale studies.

From the Department of Radiological, Oncological, and Pathological Sciences, “Sapienza”–University of Rome, Rome, Italy.

Received for publication April 29, 2019; and accepted for publication, after revision, June 15, 2019.

Conflicts of interest and sources of funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors, including National Institutes of Health, Wellcome Trust, and Howard Hughes Medical Institute. The authors report no conflicts of interest.

Correspondence to: Francesca Galati, MD, PhD, Department of Radiological, Oncological and Pathological Sciences, “Sapienza”–University of Rome, V.le Regina Elena, 324, 00161 Rome, Italy. E-mail:

Online date: July 26, 2019

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