Diffusion-Weighted Imaging-guided MR Spectroscopy in Breast Lesions using Readout-Segmented Echo-Planar Imaging

Purpose To investigate the feasibility and effectiveness of diffusion-weighted imaging (DWI)-guided magnetic resonance spectroscopy (MRS) using readout-segmented echo-planar imaging (RS-EPI) to characterise breast lesions. Materials and methods A total of 258 patients with 258 suspicious breast lesions larger than 1 cm in diameter were examined using DWI-guided, single-voxel MRS with RS-EPI. The mean total choline-containing compound (tCho) signal-to-noise ratio (SNR) and concentration were used for the interpretation of MRS data. T-tests, χ 2 -tests, receiver operating characteristic (ROC) curve analyses and Pearson correlations were conducted for statistical analysis. Results Histologically, 183 lesions were malignant, and 75 lesions were benign. Both the mean tCho SNR and concentration of malignant lesions were higher than those of benign lesions (6.23 ± 3.30 AU/mL vs. 1.26 ± 1.75 AU/mL and 3.17 ± 2.03 mmol/kg vs. 0.86 ± 0.83 mmol/kg, respectively; P < 0.0001). For a tCho SNR of 2.0 AU/mL and a concentration of 1.76 mmol/kg, the corresponding areas under the ROC curves were 0.93 and 0.90, respectively. The mean tCho SNR and concentration negatively correlated with apparent diffusion coefficients calculated from RS-EPI, with correlation coefficients of −0.54 and −0.48, respectively. Conclusion DWI-guided MRS using RS-EPI is feasible and accurate for characterising breast lesions. Key Points • The mean tCho SNR and concentration negatively correlated with ADCs . • DWI - guided MRS using RS - EPI is feasible . • DWI - guided MRS using RS - EPI accurately characterises breast lesions .