Sodano C, Clauser P, Dietzel M, et al. - The intent of this study was to investigate the additional value of quantitative tCho evaluation to diagnose malignancy and lymph node metastases in suspicious lesions on multiparametric breast MRI (mpMRI, BI-RADS 4, and BI-RADS 5). In this IRB-approved study, researchers recruited a total of 121 individuals that showed suspicious multiparametric breast MRI lesions using DCE, T2w, and diffusion-weighted (DW) images. For prediction of malignancy, the area under the ROC curve (AUC) was 0.816 (R1) and 0.809 (R2). The tCho measurements achieved an AUC of 0.760 (R1) and 0.788 (R2) for prediction of lymph node metastases. There were no metastatic lymph nodes at tCho levels < 2.4 mmol/l. The data showed that quantitative tCho evaluation from 1H-MRS provided diagnose malignancy and lymph node status in breast lesions suspicious on multiparametric breast MRI. Total choline hence showed the potential to downgrade suspicious mpMRI lesions and stratify the risk of lymph node metastases for enhanced individual management.