# 23Na MRI: inter-reader reproducibility of normal fibroglandular sodium concentration measurements at 3 T

## TL;DR

This study shows that measuring sodium in breast tissue using 23Na MRI is highly reproducible, with results varying based on sampling methods and breast density.

## Contribution

The study demonstrates excellent inter-reader reproducibility of 23Na MRI measurements in healthy volunteers and identifies factors affecting sodium concentration values.

## Key findings

- Inter-reader reproducibility of TSC and FASC measurements was excellent, except for minimum TSC LROI measurements.
- Dense breasts showed higher TSC and FASC values compared to non-dense breasts.
- TSC correlated inversely with age but not with apparent diffusion coefficient (ADC) values.

## Abstract

To study the reproducibility of 23Na magnetic resonance imaging (MRI) measurements from breast tissue in healthy volunteers.

Using a dual-tuned bilateral 23Na/1H breast coil at 3-T MRI, high-resolution 23Na MRI three-dimensional cones sequences were used to quantify total sodium concentration (TSC) and fluid-attenuated sodium concentration (FASC). B1-corrected TSC and FASC maps were created. Two readers manually measured mean, minimum and maximum TSC and mean FASC values using two sampling methods: large regions of interest (LROIs) and small regions of interest (SROIs) encompassing fibroglandular tissue (FGT) and the highest signal area at the level of the nipple, respectively. The reproducibility of the measurements and correlations between density, age and FGT apparent diffusion coefficient (ADC) values were evaluatedss.

Nine healthy volunteers were included. The inter-reader reproducibility of TSC and FASC using SROIs and LROIs was excellent (intraclass coefficient range 0.945−0.979, p < 0.001), except for the minimum TSC LROI measurements (p = 0.369). The mean/minimum LROI TSC and mean LROI FASC values were lower than the respective SROI values (p < 0.001); the maximum LROI TSC values were higher than the SROI TSC values (p = 0.009). TSC correlated inversely with age but not with FGT ADCs. The mean and maximum FGT TSC and FASC values were higher in dense breasts in comparison to non-dense breasts (p < 0.020).

The chosen sampling method and the selected descriptive value affect the measured TSC and FASC values, although the inter-reader reproducibility of the measurements is in general excellent.

23Na MRI at 3 T allows the quantification of TSC and FASC sodium concentrations. The sodium measurements should be obtained consistently in a uniform manner.

• 23Na MRI allows the quantification of total and fluid-attenuated sodium concentrations (TSC/FASC).

• Sampling method (large/small region of interest) affects the TSC and FASC values.

• Dense breasts have higher TSC and FASC values than non-dense breasts.

• The inter-reader reproducibility of TSC and FASC measurements was, in general, excellent.

• The results suggest the importance of stratifying the sodium measurements protocol.

The online version contains supplementary material available at 10.1186/s41747-024-00465-x.