In vivo detection of choline in ovarian tumors using 3D magnetic resonance spectroscopy

Anastassia Esseridou, Esseridou A, Giovanni Di Leo, Di Leo G, Luca M Sconfienza, Sconfienza LM, Valentina Caldiera, Caldiera V, Francesco Raspagliesi, Barbara Grijuela, Grijuela B, Francesco Hanozet, Hanozet F, Podo F, Franca Podo, Sardanelli F, Francesco Sardanelli
Investigative radiology · 2011 · vol. 46(6) , pp. 377–82 · doi:10.1097/RLI.0b013e31821690ef · PMID:21467947
Non-randomised trial OA: closed public-domain-us
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This study evaluated the clinical feasibility of 3D magnetic resonance spectroscopy for detecting choline peaks in ovarian masses, finding 89% sensitivity for malignancy and 84% specificity.

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This study assessed the clinical feasibility of using 3D proton magnetic resonance spectroscopy to detect choline peaks in ovarian masses at 1.5 Tesla. Researchers prospectively evaluated 23 ovarian masses in 16 patients, comparing spectral findings against histopathological results from surgery. The technique demonstrated an 89% sensitivity for malignancy and an 84% specificity, with choline peaks present in most malignant tumors but absent in healthy pelvic tissues. However, three benign tumors also showed choline peaks, limiting the method's specificity for distinguishing cancer from non-cancerous conditions. Relevance to endometriosis: one of the four benign lesions included in the study was identified as endometriosis, which did not exhibit a choline peak.

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Abstract

OBJECTIVES: To assess the clinical feasibility of 3-dimensional (3D) proton magnetic resonance spectroscopy (MRS) of ovarian masses at 1.5 T. MATERIALS AND METHODS: We prospectively evaluated 16 patients with 23 ovarian masses using contrast-enhanced magnetic resonance imaging and 3D chemical shift imaging MRS (time of reception/time of echo = 700/135 ms, number of excitations = 6, interpolated voxel = 5 × 5 × 5 mm(3), water and fat suppression). Spectral editing consisted of water reference, filtering, zero-filling, Fourier transformation, frequency shift, automatic baseline and phase correction, and curve fitting. The volume of interest was placed to encompass both solid and cystic tumor components as well as apparently healthy pelvic tissues. The presence of a choline peak at 3.14 to 3.34 ppm was considered as a marker of malignancy. All patients underwent surgery and histopathological evaluation. RESULTS: Of 23 masses, 19 were malignant and the remaining 4 benign lesions were a fibrothecoma, an endometriosis, a cyst, and a cystadenofibroma. A choline peak was detected in 17/19 malignant tumors (sensitivity 89%), absent in 2 G1 tumors. It was visible in 16 solid components of 19 malignant tumors (in one of them, a choline peak was detected only in the cystic component, in 6 in both solid and cystic components). The choline peak was absent in 20/21 apparently healthy pelvic tissues, with a very low choline peak being detected in one intraperitoneal fluid collection with malignant cells at cytologic analysis; 3/4 benign tumors showed a choline peak (overall specificity 21/25 = 84%). A significant difference between the mean choline peak integral detected within the solid component and that within the cystic component was observed (P = 0.002). No correlation between the choline peak integral and the tumor size was found (r = 0.120, P = 0.615). CONCLUSIONS: 3D MRS of ovarian masses is clinically feasible at 1.5 T. This opens new research strategies for early diagnosis of ovarian cancer.
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Objectives

To assess the clinical feasibility of 3-dimensional (3D) proton magnetic resonance spectroscopy (MRS) of ovarian masses at 1.5 T.

Materials and methods

We prospectively evaluated 16 patients with 23 ovarian masses using contrast-enhanced magnetic resonance imaging and 3D chemical shift imaging MRS (time of reception/time of echo = 700/135 ms, number of excitations = 6, interpolated voxel = 5 × 5 × 5 mm3, water and fat suppression). Spectral editing consisted of water reference, filtering, zero-filling, Fourier transformation, frequency shift, automatic baseline and phase correction, and curve fitting. The volume of interest was placed to encompass both solid and cystic tumor components as well as apparently healthy pelvic tissues. The presence of a choline peak at 3.14 to 3.34 ppm was considered as a marker of malignancy. All patients underwent surgery and histopathological evaluation.

Results

Of 23 masses, 19 were malignant and the remaining 4 benign lesions were a fibrothecoma, an endometriosis, a cyst, and a cystadenofibroma. A choline peak was detected in 17/19 malignant tumors (sensitivity 89%), absent in 2 G1 tumors. It was visible in 16 solid components of 19 malignant tumors (in one of them, a choline peak was detected only in the cystic component, in 6 in both solid and cystic components). The choline peak was absent in 20/21 apparently healthy pelvic tissues, with a very low choline peak being detected in one intraperitoneal fluid collection with malignant cells at cytologic analysis; 3/4 benign tumors showed a choline peak (overall specificity 21/25 = 84%). A significant difference between the mean choline peak integral detected within the solid component and that within the cystic component was observed (P = 0.002). No correlation between the choline peak integral and the tumor size was found (r = 0.120, P = 0.615).

Conclusions

3D MRS of ovarian masses is clinically feasible at 1.5 T. This opens new research strategies for early diagnosis of ovarian cancer.

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Condition tags

endometriosis

MeSH descriptors

Biomarkers, Tumor Biomarkers, Tumor Biomarkers, Tumor Choline Magnetic Resonance Spectroscopy Magnetic Resonance Spectroscopy Ovarian Neoplasms Ovarian Neoplasms Adult Adult Choline Choline Feasibility Studies Feasibility Studies Female Female Humans Humans Middle Aged Middle Aged

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pubmed
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