Objective To evaluate the role of 1H spetral selected point-resolved spectroscopy (SS-PRESS) sequence in distinguishing benign from malignant breast lesions by the malignancy marker of choline peak and to investigate the factors influencing the diagnosis.Methods A total of 131 patients (aged 24-83 years,average 44.8 years) were enrolled in this study.The examinations were performed on a 1.5T scanner with four-channel phased array breast coil.Single-voxel proton magnetic resonance spectroscopy (1H MRS) was acquired by SS-PRESS sequence in these patients referred to surgical or biopsy consultation.Results Among these patients,74 were proved to have breast carcinomas and 57 have benign lesions by histopathological examinations.Thirty-one elevated choline peaks were observed in these 74 confirmed malignant lesions,and 5 detectable choline peaks were demonstrated in the 57 benign lesions.The sensitivity and specificity of 1H SS-PRESS MRS were 41.9% and 91.2%,respectively.The main factors influencing the diagnosis were signal-to-noise ratio and pathological type.Conclusions 1H SS-PRESS MRS can provide a noninvasive,biochemical measurement of metabolism and improve the specificity of breast magnetic resonance imaging.Choline peak in vivo is a specific but not sensitive marker of malignancy.Technique factors and histopathological characterization of lesions influence the detection rate.