Sunitha B Thakur1,2, Joao V Horvat2, Ileana Hancu3, Olivia M Sutton1,4, Blanca Bernard-Davila2, Michael Weber5, Jung Hun Oh1, Maria Adele Marino1,6, Daly Avendano1,7, Doris Leithner2, Sandra Brennan2, Dilip Giri8, Elizabeth Manderski2, Elizabeth A Morris2, Katja Pinker2,5. 1. Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA. 2. Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA. 3. GE Global Research, Niskayuna, New York, USA. 4. Weill Cornell University, New York, New York, USA. 5. Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria. 6. Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico Universitario G. Martino, University of Messina, Italy. 7. Department of Breast Imaging, Breast Cancer Center TecSalud, ITESM Monterrey, Nuevo Leon, Mexico. 8. Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Abstract
BACKGROUND: Breast magnetic resonance spectroscopy (1 H-MRS) has been largely based on choline metabolites; however, other relevant metabolites can be detected and monitored. PURPOSE: To investigate whether lipid metabolite concentrations detected with 1 H-MRS can be used for the noninvasive differentiation of benign and malignant breast tumors, differentiation among molecular breast cancer subtypes, and prediction of long-term survival outcomes. STUDY TYPE: Retrospective. SUBJECTS: In all, 168 women, aged ≥18 years. FIELD STRENGTH/SEQUENCE: Dynamic contrast-enhanced MRI at 1.5 T: sagittal 3D spoiled gradient recalled sequence with fat saturation, flip angle = 10°, repetition time / echo time (TR/TE) = 7.4/4.2 msec, slice thickness = 3.0 mm, field of view (FOV) = 20 cm, and matrix size = 256 × 192. 1 H-MRS: PRESS with TR/TE = 2000/135 msec, water suppression, and 128 scan averages, in addition to 16 reference scans without water suppression. ASSESSMENT: MRS quantitative analysis of lipid resonances using the LCModel was performed. Histopathology was the reference standard. STATISTICAL TESTS: Categorical data were described using absolute numbers and percentages. For metric data, means (plus 95% confidence interval [CI]) and standard deviations as well as median, minimum, and maximum were calculated. Due to skewed data, the latter were more adequate; unpaired Mann-Whitney U-tests were performed to compare groups without and with Bonferroni correction. ROC analyses were also performed. RESULTS: There were 111 malignant and 57 benign lesions. Mean voxel size was 4.4 ± 4.6 cm3 . Six lipid metabolite peaks were quantified: L09, L13 + L16, L21 + L23, L28, L41 + L43, and L52 + L53. Malignant lesions showed lower L09, L21 + L23, and L52 + L53 than benign lesions (P = 0.022, 0.027, and 0.0006). Similar results were observed for Luminal A or Luminal A/B vs. other molecular subtypes. At follow-up, patients were split into two groups based on median values for the six peaks; recurrence-free survival was significantly different between groups for L09, L21 + L23, and L28 (P = 0.0173, 0.0024, and 0.0045). DATA CONCLUSION: Quantitative in vivo 1 H-MRS assessment of lipid metabolism may provide an additional noninvasive imaging biomarker to guide therapeutic decisions in breast cancer. LEVEL OF EVIDENCE: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:239-249.
BACKGROUND: Breast magnetic resonance spectroscopy (1 H-MRS) has been largely based on choline metabolites; however, other relevant metabolites can be detected and monitored. PURPOSE: To investigate whether lipid metabolite concentrations detected with 1 H-MRS can be used for the noninvasive differentiation of benign and malignant breast tumors, differentiation among molecular breast cancer subtypes, and prediction of long-term survival outcomes. STUDY TYPE: Retrospective. SUBJECTS: In all, 168 women, aged ≥18 years. FIELD STRENGTH/SEQUENCE: Dynamic contrast-enhanced MRI at 1.5 T: sagittal 3D spoiled gradient recalled sequence with fat saturation, flip angle = 10°, repetition time / echo time (TR/TE) = 7.4/4.2 msec, slice thickness = 3.0 mm, field of view (FOV) = 20 cm, and matrix size = 256 × 192. 1 H-MRS: PRESS with TR/TE = 2000/135 msec, water suppression, and 128 scan averages, in addition to 16 reference scans without water suppression. ASSESSMENT: MRS quantitative analysis of lipid resonances using the LCModel was performed. Histopathology was the reference standard. STATISTICAL TESTS: Categorical data were described using absolute numbers and percentages. For metric data, means (plus 95% confidence interval [CI]) and standard deviations as well as median, minimum, and maximum were calculated. Due to skewed data, the latter were more adequate; unpaired Mann-Whitney U-tests were performed to compare groups without and with Bonferroni correction. ROC analyses were also performed. RESULTS: There were 111 malignant and 57 benign lesions. Mean voxel size was 4.4 ± 4.6 cm3 . Six lipid metabolite peaks were quantified: L09, L13 + L16, L21 + L23, L28, L41 + L43, and L52 + L53. Malignant lesions showed lower L09, L21 + L23, and L52 + L53 than benign lesions (P = 0.022, 0.027, and 0.0006). Similar results were observed for Luminal A or Luminal A/B vs. other molecular subtypes. At follow-up, patients were split into two groups based on median values for the six peaks; recurrence-free survival was significantly different between groups for L09, L21 + L23, and L28 (P = 0.0173, 0.0024, and 0.0045). DATA CONCLUSION: Quantitative in vivo 1 H-MRS assessment of lipid metabolism may provide an additional noninvasive imaging biomarker to guide therapeutic decisions in breast cancer. LEVEL OF EVIDENCE: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:239-249.
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