Diagnostic value of MR spectroscopy in suspicious breast lesions

Background: MRI has an essential role in breast imaging, along with mammography and ultrasonography. DCE- MRI is not 100% accurate in discriminating benign from malignant lesions. In attempt to improve the specificity of DCE-MRI, multiparametric MRI (mp-MRI) with additional functional parameters had been introduced. Objectives: To assess the added diagnostic value of MR spectroscopy in evaluation of suspicious breast lesions. Patients and methods: This prospective study included 60 females, their mean age was 42.1 ± 12 SD with 75 breast lesions categorized as BI-RADS 3 or BI-RADS 4 based on sonomamography. They were subjected to multiparametric breast MRI (T2WI, dynamic contrast-enhanced MR imaging, diffusion-weighted images, and MR spectroscopy). ROC-analysis was employed for comparison between the diagnostic accuracy of mp-MRI and mp-MRI combined with MRS to predict the malignant lesions using the histopathological results as a standard of reference. Results: 33 (55 %) patients had histopathologically diagnosed 43 (58%) benign breast lesions and 27 (45%) patients had 32 (42%) malignant lesions. Using mp-MRI (dynamic contrast-enhanced MR imaging, T2-weighted images and diffusion-weighted images) had 98% accuracy of with 97.8%, sensitivity and 98.6%, specificity in differentiating malignant from benign lesions. A higher diagnostic 99.2% accuracy was obtained from combined mp-MRI and MRS with 99.5% sensitivity, 98.6% specificity. Conclusion: Despite of its limitations, MRS is a promising functional MRI technique thus improves the diagnostic accuracy of MRI for characterization of suspicious breast lesions when combined to mp-MRI to avoid unnecessary biopsy.