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Bae H, Shin YR, Rha SE. [Classification of Uterine Adenomyosis: A Pictorial Essay]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2024; 85:549-565. [PMID: 38873382 PMCID: PMC11166578 DOI: 10.3348/jksr.2023.0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/07/2023] [Accepted: 10/05/2023] [Indexed: 06/15/2024]
Abstract
MRI is a crucial tool for diagnosing adenomyosis and identifying its related pathologies. To accurately diagnose adenomyosis, it is necessary to recognize both the typical MRI findings and atypical features of the condition. Recently, a standardized classification system has been developed to facilitate precise presurgical diagnosis of adenomyosis and to determine the appropriate treatment method. Differentiating between various subtypes based on MRI-based classification and identifying different MRI phenotypes can aid in categorizing patients with adenomyosis into specific treatment groups and monitoring their response to therapy.
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Nogami Y, Banno K, Kobayashi Y, Tominaga E, Okuda S, Aoki D. Clinical utility of MR spectroscopy for gynecological pelvic abscesses using next-generation sequencing technology for the detection of causative bacteria. Exp Ther Med 2023; 25:96. [PMID: 36761007 PMCID: PMC9905653 DOI: 10.3892/etm.2023.11796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 11/30/2022] [Indexed: 01/14/2023] Open
Abstract
Due to the invasiveness of sample collection, treatment for an abscess in the pelvis, such as a gynecological abscess, is often started without a culture test. A test that could predict the appropriate antibiotic and clinical course without invasiveness prior to treatment initiation would be useful. Magnetic resonance spectroscopy (MRS) can be used to detect metabolites in an abscess and has the potential for evaluation of gynecological abscesses. The present study investigated the use of MRS for the evaluation of gynecological abscesses, using next-generation sequencing (NGS) for detection of true pathogenic bacteria. A total of 16 patients with a gynecological abscess who were treated at Keio University Hospital (Tokyo, Japan) from July 2015 to September 2016 and underwent MRS were recruited to the present study. If available, samples from drainage or surgery were used for detection of true pathogenic bacteria based on analyses of bacterial flora using NGS of 16S ribosomal DNA. MRS signals, NGS results and clinical course were then compared. All patients gave written informed consent after receiving an oral explanation of the study and the study was approved by the institutional research ethics committee. Of the 16 patients, six had MRS signals with a specific peak at 1.33 ppm, which suggested the presence of lipid or lactic acid. However, there was no significant association between metabolism, MRS signals, pathogenesis and clinical course. Only in cases of infectious lymphocele were there cases with a lactic acid peak that seemed to improve without drainage. In conclusion, the present study was not able to show marked usefulness of MRS for the identification of pathogenic bacteria and prediction of the clinical course; however, MRS may be useful for predicting the need for drainage in patients with infectious lymphocele. This study was registered as a clinical trial in the UMIN Clinical Trials Registry (registration no. UMIN000016705) on March 11, 2015.
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Affiliation(s)
- Yuya Nogami
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Kouji Banno
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, Japan,Correspondence to: Dr Kouji Banno, Department of Obstetrics and Gynecology, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo 160-8582, Japan
| | - Yusuke Kobayashi
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Eiichiro Tominaga
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Shigeo Okuda
- Department of Radiology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Daisuke Aoki
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, Japan
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Takeuchi M, Matsuzaki K, Harada M. Clinical value of N-acetyl mucinous compounds and lipid peaks in differentiating benign and malignant ovarian mucinous tumors by MR spectroscopy. Clin Imaging 2021; 78:127-135. [PMID: 33780785 DOI: 10.1016/j.clinimag.2021.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 03/14/2021] [Accepted: 03/16/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To retrospectively evaluate the clinical significance of the peaks of N-acetyl mucinous compounds (NAMC) at 2 ppm and lipid at 1.3 ppm in in-vivo proton magnetic resonance (MR) spectroscopy for distinguishing benign and malignant mucinous tumors in patients with ovarian masses. METHODS MR spectroscopy was performed in patients with pathologically diagnosed mucinous ovarian tumors at 3 T MRI system. The peaks of NAMC, lipid, and total choline compounds (tCho) were classified into three classes in comparison with the noise level by visual estimation. The NAMC concentration was quantified relative to unsuppressed water by using LCModel analysis. RESULTS A total of 27 ovarian mucinous tumors in 27 patients were included in this study. The NAMC peak was observed in all 27 mucinous tumors, and the lipid peak was observed in 14 of 27 tumors: 1 of 9 benign tumors (11%), and 13 of 18 malignant tumors (11 borderline malignancies and 7 carcinomas) (72%). The presence of the lipid peak for the diagnosis of malignant mucinous tumor showed generally better diagnostic ability than MR imaging, with a sensitivity of 72%, specificity of 89%, accuracy of 78%, PPV of 93%, and NPV of 62%. The concentration of the NAMC in malignant mucinous tumors tended to be higher than that in benign mucinous tumors, but there was no statistically significant difference. CONCLUSIONS The bimodal peaks of NAMC and lipid are suggestive of malignant mucinous tumors, and the presence of the lipid peak may be useful in distinguishing benign from malignant ovarian mucinous tumors.
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Affiliation(s)
- Mayumi Takeuchi
- Department of Radiology, Tokushima University, 3-18-15, Kuramoto-cho, Tokushima zip: 7708503, Japan.
| | - Kenji Matsuzaki
- Department of Radiological Technology, Tokushima Bunri University, 1314-1, Shido, Sanuki-city, Kagawa zip: 7692193, Japan.
| | - Masafumi Harada
- Department of Radiology, Tokushima University, 3-18-15, Kuramoto-cho, Tokushima zip: 7708503, Japan.
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Sheha AS, Keriakos NN, Faisal MM. The role of magnetic resonance spectroscopy in the differentiation of benign and malignant adnexal masses. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2019. [DOI: 10.1186/s43055-019-0108-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Ibrahim RSM, El Fattah MSA, Metwally ZM, Eldin LAS. Value of magnetic resonance spectroscopy in assessment of adnexal lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2019. [DOI: 10.1186/s43055-019-0094-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The purpose of this study is to investigate the role of proton MR spectroscopy (1H-MRS) in the characterization and diagnosis of ovarian lesions.
Results
From October 2015 to October 2017, a total of 57 female patients (65 adnexal lesions; 8 cases were bilateral) were included. The examined lesions were classified according to their histopathological findings, (37 (57%) benign lesions, 4 (6%) borderline lesions, and 24 (37%) malignant lesions). The mean choline/creatinine (CHO/Cr) ratio was 1.29 ± 0.98 SD for malignant lesions, while the mean value in borderline lesions was 0.63 ± 0.15 SD, and the mean value for the benign lesions was 0.65 ± 0.34. Therefore, the mean CHO/Cr ratio was much higher in malignant than in benign lesions, which was statistically significant (P ≤ 0.001) as well as between the borderline and invasive lesions (P = 0.05), but not between the benign and borderline lesions. The diagnostic performance of conventional MRI in diagnosing adnexal lesions was 100%, specificity was 76%, and accuracy was 86%. However, MRS individual diagnostic performances are the following: sensitivity 89%, specificity, and 100% with an accuracy of 95%.
Conclusion
MRS proved to be an accurate and efficient method for the analysis of adnexal lesions and in differentiation between benign and malignant tumors.
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Mansour SM, Gomma MMM, Shafik PN. Proton MR spectroscopy and the detection of malignancy in ovarian masses. Br J Radiol 2019; 92:20190134. [PMID: 31287729 DOI: 10.1259/bjr.20190134] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To assess the impact of MR spectroscopy (MRS) on the detection of malignancy in ovarian masses. METHODS This prospective work included 230 females that had 245 adnexal/ovarian masses. Tumours were spotted by preliminary pelvic ultrasound. Masses assessed by MRI, multi- or single-voxel spectroscopy. Patients' spectra were assessed for peaks of lactate (Lac, 1.31 ppm), lipid (Lip, 1.33 ppm), N-acetyl aspartate (2.0 ppm), acetone (A, 2.05 ppm), choline (Cho, 3.23 ppm) and creatinine (Cr, 3.4 ppm) and the mean values of the (Cho/Cr) ratios were performed by a semi-quantitative approach. The operative pathology served as the standard of reference. RESULTS Cho peak twofold higher than the average noise level was detected in 72% of the malignant and only 5.4% of the benign masses with an accuracy of 83%. Adding lactate to the choline enhanced the accuracy to 93%. The mean Cho/Cr ratios of the malignant ovarian masses (2.8) were significantly higher than that of the benign ones (1.2) . We used a receiver operating characteristic curve to determine the best cut-off value (1.7) for the mean Cho/Cr ratio to discriminate malignancy with sensitivity: 81.2%, specificity: 93.3 %, positive-predictive value: 92.9 %, negative-predictive value: 82.4% and accuracy: 87.1%. CONCLUSION The simultaneous presence of choline and lactate peaks in MRS examination of the ovarian masses minimizes the overlap between benign and malignant categories. N-acetyl aspartate and acetone are the metabolites for diagnosing complex cystic masses as benign teratoma, endomterioma and tubo- ovarian abscess. ADVANCES IN KNOWLEDGE MRS is a non-contrast based and fast MR sequence that gives an idea about tissue components could be used to improve the sensitivity and the accuracy of detecting malignancy in ovarian masses.
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Affiliation(s)
- Sahar Mahmoud Mansour
- 1Department of Radiology (Women's imaging unit), Kasr ElAiny Hospital - Faculty of Medicine - Cairo University, Cairo, Egypt
| | | | - Peter Nashaat Shafik
- 2Department of Radiology, National Cancer Institute- Faculty of Medicine - Cairo University, Cairo, Egypt
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Emma Dávid R, Fechete R, Sfrângeu S, Moldovan D, Chelcea RI, Morar IA, Stamatian F, Kovacs T, Popoi P. In Vivo 1H Nuclear Magnetic Resonance Spectroscopy and Relaxometry Maps of the Human Female Pelvis. ANAL LETT 2019. [DOI: 10.1080/00032719.2018.1437169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Réka Emma Dávid
- County Emergency Hospital Radiology Department, University of Medicine and Pharmacy “Iuliu Haţieganu”, Cluj-Napoca, Romania
| | - Radu Fechete
- Physics and Chemistry Department, Technical University of Cluj-Napoca, Cluj-Napoca, Romania
| | | | - Dumitriţa Moldovan
- Physics and Chemistry Department, Technical University of Cluj-Napoca, Cluj-Napoca, Romania
| | - Ramona Ioana Chelcea
- Physics and Chemistry Department, Technical University of Cluj-Napoca, Cluj-Napoca, Romania
| | | | | | - Tunde Kovacs
- IMOGEN, County Emergency Hospital, Cluj-Napoca, Romania
| | - Paula Popoi
- Leon Daniello Pneumophthisiology Clinical Hospital, Cluj-Napoca, Romania
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Ma FH, Li YA, Liu J, Li HM, Zhang GF, Qiang JW. Role of proton MR spectroscopy in the differentiation of borderline from malignant epithelial ovarian tumors: A preliminary study. J Magn Reson Imaging 2018; 49:1684-1693. [PMID: 30353967 DOI: 10.1002/jmri.26541] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 09/27/2018] [Indexed: 02/04/2023] Open
Affiliation(s)
- Feng Hua Ma
- Department of Radiology, Jinshan Hospital, Shanghai Medical College Fudan University Shanghai P.R. China
- Department of Radiology, Obstetrics & Gynecology Hospital, Shanghai Medical College Fudan University Shanghai P.R. China
| | - Yong Ai Li
- Department of Radiology, Jinshan Hospital, Shanghai Medical College Fudan University Shanghai P.R. China
| | - Jia Liu
- Department of Radiology, Obstetrics & Gynecology Hospital, Shanghai Medical College Fudan University Shanghai P.R. China
| | - Hai Ming Li
- Department of Radiology, Jinshan Hospital, Shanghai Medical College Fudan University Shanghai P.R. China
| | - Guo Fu Zhang
- Department of Radiology, Obstetrics & Gynecology Hospital, Shanghai Medical College Fudan University Shanghai P.R. China
| | - Jin Wei Qiang
- Department of Radiology, Jinshan Hospital, Shanghai Medical College Fudan University Shanghai P.R. China
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Ytre-Hauge S, Esmaeili M, Sjøbakk TE, Grüner R, Woie K, Werner HM, Krakstad C, Bjørge L, Salvesen ØO, Stefansson IM, Trovik J, Bathen TF, Haldorsen IS. In vivo MR spectroscopy predicts high tumor grade in endometrial cancer. Acta Radiol 2018; 59:497-505. [PMID: 28927296 DOI: 10.1177/0284185117733297] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background In vivo magnetic resonance spectroscopy (MRS) enables non-invasive measurements of tumor metabolites. Choline-containing metabolites play a key role in tumor metabolism. Purpose To explore whether preoperative MRS-derived tumor choline levels are associated with clinical and histological features in endometrial carcinomas. Material and Methods Preoperative pelvic magnetic resonance imaging (MRI) (1.5T), including structural and diffusion-weighted imaging and localized multivoxel proton MR (1H-MR) spectroscopy, was performed in 77 prospectively included patients with histologically confirmed endometrial carcinomas. Relative levels of total choline-containing metabolites (tCho) in tumor and myometrium were measured using the ratios: tCho/Creatine; tCho/Water; and tCho/Noise. MRS parameters were analyzed in relation to histological subtype and grade, surgicopathological staging parameters, MRI-measured tumor volume, and tumor apparent diffusion coefficient (ADC) value and clinical outcome. Results Tumor tissue had significantly higher ratios for tCho/Creatine, tCho/Water, and tCho/Noise than normal myometrial tissue ( P < 0.001 for all). High tumor tCho/Water ratio was significantly associated with high tumor grade in endometrioid tumors ( P = 0.02). Tumor tCho/Creatine ratio was positively correlated to MRI-measured tumor volume (rs = 0.25; P = 0.03). Conclusion High choline levels in tumor are associated with high-risk features. In vivo MRS may potentially aid in the preoperative risk stratification in endometrial cancer.
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Affiliation(s)
- Sigmund Ytre-Hauge
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
- Section for Radiology, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Morteza Esmaeili
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology – NTNU, Trondheim, Norway
| | - Torill E Sjøbakk
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology – NTNU, Trondheim, Norway
| | - Renate Grüner
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
- Department of Physics and Technology, University of Bergen, Bergen, Norway
| | - Kathrine Woie
- Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway
- Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Henrica M Werner
- Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway
- Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Camilla Krakstad
- Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway
- Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Line Bjørge
- Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway
- Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Øyvind O Salvesen
- Unit for Applied Clinical Research, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Jone Trovik
- Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway
- Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Tone F Bathen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology – NTNU, Trondheim, Norway
| | - Ingfrid S Haldorsen
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
- Section for Radiology, Department of Clinical Medicine, University of Bergen, Bergen, Norway
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10
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Magnetic Resonance Spectroscopy and its Clinical Applications: A Review. J Med Imaging Radiat Sci 2017; 48:233-253. [PMID: 31047406 DOI: 10.1016/j.jmir.2017.06.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 04/30/2017] [Accepted: 06/22/2017] [Indexed: 12/25/2022]
Abstract
In vivo NMR spectroscopy is known as magnetic resonance spectroscopy (MRS). MRS has been applied as both a research and a clinical tool in order to detect visible or nonvisible abnormalities. The adaptability of MRS allows a technique that can probe a wide variety of metabolic uses across different tissues. Although MRS is mostly applied for brain tissue, it can be used for detection, localization, staging, tumour aggressiveness evaluation, and tumour response assessment of breast, prostate, hepatic, and other cancers. In this article, the medical applications of MRS in the brain, including tumours, neural and psychiatric disorder studies, breast, prostate, hepatic, gastrointestinal, and genitourinary investigations have been reviewed.
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García-Figueiras R, Baleato-González S, Padhani AR, Oleaga L, Vilanova JC, Luna A, Cobas Gómez JC. Proton magnetic resonance spectroscopy in oncology: the fingerprints of cancer? Diagn Interv Radiol 2017; 22:75-89. [PMID: 26712681 DOI: 10.5152/dir.2015.15009] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Abnormal metabolism is a key tumor hallmark. Proton magnetic resonance spectroscopy (1H-MRS) allows measurement of metabolite concentration that can be utilized to characterize tumor metabolic changes. 1H-MRS measurements of specific metabolites have been implemented in the clinic. This article performs a systematic review of image acquisition and interpretation of 1H-MRS for cancer evaluation, evaluates its strengths and limitations, and correlates metabolite peaks at 1H-MRS with diagnostic and prognostic parameters of cancer in different tumor types.
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Affiliation(s)
- Roberto García-Figueiras
- Department of Radiology, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain.
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Abstract
Although endometrial cancer is surgicopathologically staged, preoperative imaging is recommended for diagnostic work-up to tailor surgery and adjuvant treatment. For preoperative staging, imaging by transvaginal ultrasound (TVU) and/or magnetic resonance imaging (MRI) is valuable to assess local tumor extent, and positron emission tomography-CT (PET-CT) and/or computed tomography (CT) to assess lymph node metastases and distant spread. Preoperative imaging may identify deep myometrial invasion, cervical stromal involvement, pelvic and/or paraaortic lymph node metastases, and distant spread, however, with reported limitations in accuracies and reproducibility. Novel structural and functional imaging techniques offer visualization of microstructural and functional tumor characteristics, reportedly linked to clinical phenotype, thus with a potential for improving risk stratification. In this review, we summarize the reported staging performances of conventional and novel preoperative imaging methods and provide an overview of promising novel imaging methods relevant for endometrial cancer care.
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Affiliation(s)
- Ingfrid S Haldorsen
- Department of Radiology, Haukeland University Hospital, Jonas Liesvei 65, Postbox 7800, 5021, Bergen, Norway.
- Section for Radiology, Department of Clinical Medicine, University of Bergen, 5020, Bergen, Norway.
| | - Helga B Salvesen
- Department of Obstetrics and Gynecology, Haukeland University Hospital, 5020, Bergen, Norway
- Department of Clinical Science, University of Bergen, 5020, Bergen, Norway
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Macnaught G, Ananthakrishnan G, Hinksman L, Yadavali R, Bryden F, Lassman S, Ritchie M, Gallacher K, Hay C, Moss JG. Can 1H MR Spectroscopy be Used to Assess the Success of Uterine Artery Embolisation? Cardiovasc Intervent Radiol 2015; 39:376-84. [DOI: 10.1007/s00270-015-1179-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 07/04/2015] [Indexed: 12/26/2022]
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MR Spectroscopy for Differentiating Benign From Malignant Solid Adnexal Tumors. AJR Am J Roentgenol 2015; 204:W724-30. [PMID: 26001263 DOI: 10.2214/ajr.14.13391] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Han X, Kang J, Zhang J, Xiu J, Huang Z, Yang C, Sun X, Fu C, Liu Q. Can the signal-to-noise ratio of choline in magnetic resonance spectroscopy reflect the aggressiveness of endometrial cancer? Acad Radiol 2015; 22:453-9. [PMID: 25641318 DOI: 10.1016/j.acra.2014.12.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 09/11/2014] [Accepted: 12/09/2014] [Indexed: 12/13/2022]
Abstract
RATIONALE AND OBJECTIVES To differentiate endometrial cancer (ECa) from benign lesions in endometrial or in submucosa (BLs-ESm), and investigate whether the signal-to-noise ratio (SNR) of choline-containing compounds (Cho) obtained from three-dimensional (1)H magnetic resonance spectroscopy (MRS) is associated with the aggressiveness of ECa. MATERIALS AND METHODS Thirty-three patients with ECa and 15 patients with BLs-ESm underwent preoperative multivoxel (1)H MRS at 3 T MR. The amplitude of Cho peak of each voxel was recorded, and the corresponding SNR of Cho peak (ChoSNR) was calculated. The maximum ChoSNR (max ChoSNR) for each lesion was identified. The max ChoSNR of ECa and BLs-ESm, as well as type I ECa and type II ECa, was compared. The relationship between max ChoSNR and pathologic characteristics of tumors, including tumor grade, stage, type, and tumor size, was analyzed. RESULTS The mean max ChoSNR (±standard deviation [SD]) was 30.93 ± 16.89 for ECa and 10.40 ± 3.07 for BLs-ESm (P < .001). The mean max ChoSNR for type II ECa (48.54 ± 21.46) was higher than that for type I ECa (26.19 ± 12.02, P = .001). There were no significant differences among different grades (P = .449). The Spearman coefficient between max ChoSNR and stage was 0.423 (P = .014); the difference existed only between Ia and III ECa (P = .048). The Pearson coefficient between ChoSNR and tumor size was 0.515 (P = .002). CONCLUSIONS The max ChoSNR obtained from MRS can differentiate ECa from BLs and type I ECa and type II ECa, but cannot differentiate between each grade ECa and each International Federation of Gynecology and Obstetrics stage ECa. However, max ChoSNR increased with the increase in International Federation of Gynecology and Obstetrics stage and size of ECa.
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Affiliation(s)
- Xue Han
- Department of Radiology, Provincial Hospital Affiliated to Shandong University, 324#, Jingwu Weiqi Road, Jinan, PR China
| | - Jingxia Kang
- Department of Radiology, Linyi People's Hospital, Linyi, PR China
| | - Jie Zhang
- Department of Radiology, Provincial Hospital Affiliated to Shandong University, 324#, Jingwu Weiqi Road, Jinan, PR China
| | - Jianjun Xiu
- Department of Radiology, Provincial Hospital Affiliated to Shandong University, 324#, Jingwu Weiqi Road, Jinan, PR China
| | - Zhaoqin Huang
- Department of Radiology, Provincial Hospital Affiliated to Shandong University, 324#, Jingwu Weiqi Road, Jinan, PR China
| | - Chunrun Yang
- Department of Obstetrics and Gynecology, Provincial Hospital Affiliated to Shandong University, Jinan, PR China
| | - Xichao Sun
- Department of Pathology, Provincial Hospital Affiliated to Shandong University, Jinan, PR China
| | - Caixia Fu
- Siemens MRI Center, Shenzhen, PR China
| | - Qingwei Liu
- Department of Radiology, Provincial Hospital Affiliated to Shandong University, 324#, Jingwu Weiqi Road, Jinan, PR China.
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Can magnetic resonance spectroscopy differentiate endometrial cancer? Eur Radiol 2014; 24:2552-60. [DOI: 10.1007/s00330-014-3237-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 04/28/2014] [Accepted: 05/13/2014] [Indexed: 12/15/2022]
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17
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Takeuchi M, Matsuzaki K, Harada M. Preliminary observations and clinical value of lipid peak in high-grade uterine sarcomas using in vivo proton MR spectroscopy. Eur Radiol 2013; 23:2358-63. [DOI: 10.1007/s00330-013-2856-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 03/06/2013] [Accepted: 03/14/2013] [Indexed: 12/25/2022]
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Kang YH, Kim MY, Kim KT, Kim YJ, Suh CH, Kim JM, Hwang SO, Park S, Cho JY. H1Magnetic Resonance Spectroscopy of Cystic Ovarian Lesions. ACTA ACUST UNITED AC 2013. [DOI: 10.13104/jksmrm.2013.17.4.326] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Young Hye Kang
- Department of Radiology, Inha University School of Medicine, Korea
| | - Mi Young Kim
- Department of Radiology, Inha University School of Medicine, Korea
| | - Kyung Tae Kim
- Department of Radiology, Inha University School of Medicine, Korea
| | - Yoon Jung Kim
- Department of Radiology, Inha University School of Medicine, Korea
| | - Chang Hae Suh
- Department of Radiology, Inha University School of Medicine, Korea
| | - Jun Mee Kim
- Department of Pathology, Inha University School of Medicine, Korea
| | - Sung Ook Hwang
- Department of Gynecology, Inha University School of Medicine, Korea
| | - Sunghyouk Park
- College of pharmacology, Seoul National University, Korea
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Role of diffusion-weighted imaging with ADC mapping and in vivo 1H-MR spectroscopy in thyroid nodules. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2012. [DOI: 10.1016/j.ejrnm.2012.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Takeuchi M, Matsuzaki K, Harada M. Preliminary observations and diagnostic value of lipid peak in ovarian thecomas/fibrothecomas using in vivo proton MR spectroscopy at 3T. J Magn Reson Imaging 2012; 36:907-11. [DOI: 10.1002/jmri.23711] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Accepted: 04/27/2012] [Indexed: 12/25/2022] Open
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Celik O, Yilmaz E, Boz M, Hascalik S, Karakas HM, Aydin NE. Spectroscopy analysis of cervical carcinoma originated from endometrial carcinoma. J OBSTET GYNAECOL 2012; 32:409-10. [DOI: 10.3109/01443615.2012.658891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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22
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Canese R, Pisanu ME, Mezzanzanica D, Ricci A, Paris L, Bagnoli M, Valeri B, Spada M, Venditti M, Cesolini A, Rodomonte A, Giannini M, Canevari S, Podo F, Iorio E. Characterisation of in vivo ovarian cancer models by quantitative 1H magnetic resonance spectroscopy and diffusion-weighted imaging. NMR IN BIOMEDICINE 2012; 25:632-642. [PMID: 22020805 DOI: 10.1002/nbm.1779] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Revised: 06/30/2011] [Accepted: 07/11/2011] [Indexed: 05/31/2023]
Abstract
Magnetic resonance imaging (MRI) and spectroscopy (MRS) offer powerful approaches for detecting physiological and metabolic alterations in malignancies and help investigate underlying molecular mechanisms. Research on epithelial ovarian carcinoma (EOC), the gynaecological malignancy with the highest death rate characterised by frequent relapse and onset of drug resistance, could benefit from application of these molecular imaging approaches. In this study, MRI/MRS were used to characterise solid tumour models obtained by subcutaneous (s.c.) or intraperitoneal (i.p.) implantation of human SKOV3.ip cells in severe combined immunodeficiency (SCID) mice. In vivo MRI/MRS, ex vivo magic-angle-spinning (MAS), and in vitro (1)H-NMR measurements were carried out at 4.7 T, 9.4 T, and 9.4/16.5 T, respectively. MRI evaluation was performed by T1-, T2-, and diffusion-weighted (DW) multislice spin-echo imaging. The in vivo (1)H spectra of all tumour models showed a prominent resonance of total choline-containing metabolites (tCho). Quantitative in vivo MRS of both i.p. and s.c. SKOV3.ip xenografts showed that the mean tCho content was in the 2.9-4.5 mM range, with a mean PCho/tCho ratio of 0.99 ± 0.01 [23 examinations, 14-34 days post injection (dpi)], in good agreement with ex vivo and in vitro analyses. Myo-inositol ranged between 11.7 and 17.0 mM, with a trend towards higher values in i.p. xenografts at 14-16 dpi. The average apparent diffusion coefficient (ADC) values of SKOV3.ip xenografts [1.64 ± 0.11 (n = 9, i.p.) and 1.58 ± 0.03 x10(-3) mm(2)/s (n = 7, s.c.)] were in agreement with values reported for tumours from patients with EOC, while the mean vascular signal fraction (VSF) was lower (≤ 4%), probably due to the more rapid growth of preclinical models. Both s.c. and i.p. xenografts are valuable preclinical models for monitoring biochemical and physiopathological changes associated with in vivo EOC tumour growth and response to therapy, which may serve as the basis for further clinical development of noninvasive MR approaches.
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Affiliation(s)
- Rossella Canese
- Department of Cell Biology and Neurosciences, Istituto Superiore di Sanità, Rome, Italy.
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El sorogy L, El gaber NA, Omran E, Elshamy M, Youssef H. Role of diffusion MRI and proton magnetic resonance spectroscopy in characterization of ovarian neoplasms. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2012. [DOI: 10.1016/j.ejrnm.2011.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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24
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Haldorsen I, Salvesen H. Staging of endometrial carcinomas with MRI using traditional and novel MRI techniques. Clin Radiol 2012; 67:2-12. [DOI: 10.1016/j.crad.2011.02.018] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Accepted: 02/21/2011] [Indexed: 10/15/2022]
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25
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Preliminary observations and clinical value of N-acetyl resonances in ovarian tumours using in-vivo proton MR spectroscopy at 3T. Eur Radiol 2011; 21:2640-6. [DOI: 10.1007/s00330-011-2215-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2011] [Revised: 06/08/2011] [Accepted: 07/02/2011] [Indexed: 11/28/2022]
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In Vivo Detection of Choline in Ovarian Tumors Using 3D Magnetic Resonance Spectroscopy. Invest Radiol 2011; 46:377-82. [DOI: 10.1097/rli.0b013e31821690ef] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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Lutz AM, Willmann JK, Drescher CW, Ray P, Cochran FV, Urban N, Gambhir SS. Early Diagnosis of Ovarian Carcinoma: Is a Solution in Sight? Radiology 2011; 259:329-45. [DOI: 10.1148/radiol.11090563] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Metabolomic Characterization of Ovarian Epithelial Carcinomas by HRMAS-NMR Spectroscopy. JOURNAL OF ONCOLOGY 2011; 2011:174019. [PMID: 21577256 PMCID: PMC3090613 DOI: 10.1155/2011/174019] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 02/03/2011] [Accepted: 02/28/2011] [Indexed: 11/17/2022]
Abstract
Objectives. The objectives of the present study are to determine if a metabolomic study by HRMAS-NMR can (i) discriminate between different histological types of epithelial ovarian carcinomas and healthy ovarian tissue, (ii) generate statistical models capable of classifying borderline tumors and (iii) establish a potential relationship with patient's survival or response to chemotherapy. Methods. 36 human epithelial ovarian tumor biopsies and 3 healthy ovarian tissues were studied using (1)H HRMAS NMR spectroscopy and multivariate statistical analysis. Results. The results presented in this study demonstrate that the three histological types of epithelial ovarian carcinomas present an effective metabolic pattern difference. Furthermore, a metabolic signature specific of serous (N-acetyl-aspartate) and mucinous (N-acetyl-lysine) carcinomas was found. The statistical models generated in this study are able to predict borderline tumors characterized by an intermediate metabolic pattern similar to the normal ovarian tissue. Finally and importantly, the statistical model of serous carcinomas provided good predictions of both patient's survival rates and the patient's response to chemotherapy. Conclusions. Despite the small number of samples used in this study, the results indicate that metabolomic analysis of intact tissues by HRMAS-NMR is a promising technique which might be applicable to the therapeutic management of patients.
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Takeuchi M, Matsuzaki K. Adenomyosis: Usual and Unusual Imaging Manifestations, Pitfalls, and Problem-solving MR Imaging Techniques. Radiographics 2011; 31:99-115. [DOI: 10.1148/rg.311105110] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Differentiation of benign and malignant uterine corpus tumors by using proton MR spectroscopy at 3T: preliminary study. Eur Radiol 2010; 21:850-6. [DOI: 10.1007/s00330-010-1974-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2010] [Revised: 08/20/2010] [Accepted: 08/25/2010] [Indexed: 12/14/2022]
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31
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Kyriazi S, Kaye SB, deSouza NM. Imaging ovarian cancer and peritoneal metastases—current and emerging techniques. Nat Rev Clin Oncol 2010; 7:381-93. [DOI: 10.1038/nrclinonc.2010.47] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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McLean MA, Priest AN, Joubert I, Lomas DJ, Kataoka MY, Earl H, Crawford R, Brenton JD, Griffiths JR, Sala E. Metabolic characterization of primary and metastatic ovarian cancer by 1H-MRS in vivo at 3T. Magn Reson Med 2010; 62:855-61. [PMID: 19645005 DOI: 10.1002/mrm.22067] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
(1)H-MRS was performed on 12 women (age range 45-72) with ovarian cancer of FIGO stage 3 or above using a 3T MRI system with an 8-channel cardiac receive coil. Respiratory-triggered PRESS-localized spectra (TE = 144 ms) were obtained separately from an ovarian mass and from metastatic disease. Peak areas were quantified relative to unsuppressed water using LCModel and spectra were discarded if LCModel reported signal-to-noise ratio (SNR) < 3 or if no metabolites were reported with standard deviation (SD) < 30%. The cystic fraction of each voxel was estimated by thresholding T(2)-weighted images, and this was used both to correct the reported metabolite concentrations and to calculate an expected SNR of choline using the measured SNR of water. Choline was detected in 10/12 primary tumors and 5/11 metastatic lesions (range 2.0-16.6 mM). Of the 8/23 failures, 7 had a predicted choline SNR < 2, confirming that the failure to detect choline could be explained by technical problems. Glycine was observed in one benign lesion. (1)H-MRS can be used to quantify choline in primary and metastatic masses in ovarian cancer, but the moderately high rate of failure to detect choline necessitates careful recording of data quality parameters to discriminate true from false negatives.
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Affiliation(s)
- Mary A McLean
- Cancer Research UK Cambridge Research Institute, Li Ka Shing Centre, Cambridge, UK.
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Kolwijck E, Engelke UF, van der Graaf M, Heerschap A, Blom HJ, Hadfoune M, Buurman WA, Massuger LF, Wevers RA. N-acetyl resonances in in vivo and in vitro NMR spectroscopy of cystic ovarian tumors. NMR IN BIOMEDICINE 2009; 22:1093-9. [PMID: 19593761 DOI: 10.1002/nbm.1417] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
An unassigned and prominent resonance in the region from delta 2.0-2.1 ppm has frequently been found in the in vivo MR spectra of cancer patients. We demonstrated the presence of this resonance with in vivo MRS in the cyst fluid of a patient with an ovarian tumor. (1)H-NMRS on the aspirated cyst fluid of this patient confirmed the observation. A complex of resonances was observed between 2.0 and 2.1 ppm. It was also present in 11 additional ovarian cyst fluid samples randomly chosen from our biobank. The resonance complex was significantly more prominent in samples from mucinous tumors than in samples from other histological subtypes. A macromolecule (>10 kDa) was found responsible for this complex of resonances. A correlation spectroscopy (COSY) experiment revealed cross peaks of two different types of bound sialic acid suggesting that N-glycans from glycoproteins and/or glycolipids cause this resonance complex. In the literature, plasma alpha-1 acid glycoprotein (AGP), known for its high content of N-linked glycans, has been suggested to contribute to the delta 2.0-2.1 spectral region. The AGP cyst fluid concentration did not correlate significantly with the peak height of the delta 2.0-2.1 resonance complex in our study. AGP may be partly responsible for the resonance complex but other N-acetylated glycoproteins and/or glycolipids also contribute. After deproteinization of the cyst fluid, N-acetyl-L-aspartic acid (NAA) was found to contribute significantly to the signal in this spectral region in three of the 12 samples. GC-MS independently confirmed the presence of NAA in high concentration in the three samples, which all derived from benign serous tumors. We conclude that both NAA and N-acetyl groups from glycoproteins and/or glycolipids may contribute to the delta 2.0-2.1 ppm resonance complex in ovarian cyst fluid. This spectral region seems to contain resonances from biomarkers that provide relevant clinical information on the type of ovarian tumor.
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Affiliation(s)
- Eva Kolwijck
- Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
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Booth SJ, Pickles MD, Turnbull LW. In vivo magnetic resonance spectroscopy of gynaecological tumours at 3.0 Tesla. BJOG 2008; 116:300-3. [DOI: 10.1111/j.1471-0528.2008.02007.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Value of magnetic resonance imaging for the diagnosis of ovarian tumors: a review. J Comput Assist Tomogr 2008; 32:712-23. [PMID: 18830100 DOI: 10.1097/rct.0b013e31815881ef] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This article reviews the value of magnetic resonance imaging (MRI) for the diagnosis of ovarian tumors especially when ultrasonography is indeterminate. Although ultrasonography is the first imaging technique used to investigate suspected pelvic masses, it has a limited capacity for tissue characterization. In addition to morphological characteristics, many tissue parameters such as T1, T2, perfusion, and diffusion contribute to signal intensity, so MRI is able to identify various types of tissue contained in pelvic masses. Magnetic resonance imaging helps to locate large solid masses and to distinguish benign from malignant ovarian tumors, with an overall accuracy of 88% to 93% for the diagnosis of malignancy. The aims of this review are 3-fold. First, we review state-of-the-art and usual MRI techniques and published findings. Second, we recall the MR features most useful for assessing the main ovarian tumors. Finally, we discuss the relevance of various features for distinguishing between benign, borderline, and invasive ovarian tumors.
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Evaluation of Ovarian Tumors by Proton Magnetic Resonance Spectroscopy at Three Tesla. Invest Radiol 2008; 43:745-51. [DOI: 10.1097/rli.0b013e31817e9104] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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37
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Lutz AM, Willmann JK, Cochran FV, Ray P, Gambhir SS. Cancer screening: a mathematical model relating secreted blood biomarker levels to tumor sizes. PLoS Med 2008; 5:e170. [PMID: 18715113 PMCID: PMC2517618 DOI: 10.1371/journal.pmed.0050170] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2008] [Accepted: 07/04/2008] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Increasing efforts and financial resources are being invested in early cancer detection research. Blood assays detecting tumor biomarkers promise noninvasive and financially reasonable screening for early cancer with high potential of positive impact on patients' survival and quality of life. For novel tumor biomarkers, the actual tumor detection limits are usually unknown and there have been no studies exploring the tumor burden detection limits of blood tumor biomarkers using mathematical models. Therefore, the purpose of this study was to develop a mathematical model relating blood biomarker levels to tumor burden. METHODS AND FINDINGS Using a linear one-compartment model, the steady state between tumor biomarker secretion into and removal out of the intravascular space was calculated. Two conditions were assumed: (1) the compartment (plasma) is well-mixed and kinetically homogenous; (2) the tumor biomarker consists of a protein that is secreted by tumor cells into the extracellular fluid compartment, and a certain percentage of the secreted protein enters the intravascular space at a continuous rate. The model was applied to two pathophysiologic conditions: tumor biomarker is secreted (1) exclusively by the tumor cells or (2) by both tumor cells and healthy normal cells. To test the model, a sensitivity analysis was performed assuming variable conditions of the model parameters. The model parameters were primed on the basis of literature data for two established and well-studied tumor biomarkers (CA125 and prostate-specific antigen [PSA]). Assuming biomarker secretion by tumor cells only and 10% of the secreted tumor biomarker reaching the plasma, the calculated minimally detectable tumor sizes ranged between 0.11 mm(3) and 3,610.14 mm(3) for CA125 and between 0.21 mm(3) and 131.51 mm(3) for PSA. When biomarker secretion by healthy cells and tumor cells was assumed, the calculated tumor sizes leading to positive test results ranged between 116.7 mm(3) and 1.52 x 10(6) mm(3) for CA125 and between 27 mm(3) and 3.45 x 10(5) mm(3) for PSA. One of the limitations of the study is the absence of quantitative data available in the literature on the secreted tumor biomarker amount per cancer cell in intact whole body animal tumor models or in cancer patients. Additionally, the fraction of secreted tumor biomarkers actually reaching the plasma is unknown. Therefore, we used data from published cell culture experiments to estimate tumor cell biomarker secretion rates and assumed a wide range of secretion rates to account for their potential changes due to field effects of the tumor environment. CONCLUSIONS This study introduced a linear one-compartment mathematical model that allows estimation of minimal detectable tumor sizes based on blood tumor biomarker assays. Assuming physiological data on CA125 and PSA from the literature, the model predicted detection limits of tumors that were in qualitative agreement with the actual clinical performance of both biomarkers. The model may be helpful in future estimation of minimal detectable tumor sizes for novel proteomic biomarker assays if sufficient physiologic data for the biomarker are available. The model may address the potential and limitations of tumor biomarkers, help prioritize biomarkers, and guide investments into early cancer detection research efforts.
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Affiliation(s)
- Amelie M Lutz
- Department of Radiology, Stanford University School of Medicine, Stanford, California, United States of America
| | - Juergen K Willmann
- Department of Radiology, Stanford University School of Medicine, Stanford, California, United States of America
| | - Frank V Cochran
- Department of Radiology, Stanford University School of Medicine, Stanford, California, United States of America
| | - Pritha Ray
- Department of Radiology, Stanford University School of Medicine, Stanford, California, United States of America
| | - Sanjiv S Gambhir
- Department of Radiology, Stanford University School of Medicine, Stanford, California, United States of America
- Department of Bioengineering, the Bio-X Program, Stanford University School of Medicine, Stanford, California, United States of America
- * To whom correspondence should be addressed. E-mail:
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Gupta N, Kakar AK, Chowdhury V, Gulati P, Shankar LR, Vindal A. Magnetic resonance spectroscopy as a diagnostic modality for carcinoma thyroid. Eur J Radiol 2007; 64:414-8. [PMID: 17462842 DOI: 10.1016/j.ejrad.2007.03.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2006] [Revised: 12/16/2006] [Accepted: 03/09/2007] [Indexed: 10/23/2022]
Abstract
AIM The aim of this study was to observe the findings of magnetic resonance spectroscopy of solitary thyroid nodules and its correlation with histopathology. MATERIALS AND METHODS In this study, magnetic resonance spectroscopy was carried out on 26 patients having solitary thyroid nodules. Magnetic resonance spectroscopy (MRS) was performed on a 1.5T super conductive system with gradient strength of 33mTs. Fine needle aspiration cytology was done after MRS. All 26 patients underwent surgery either because of cytopathologically proven malignancy or because of cosmetic reasons. Findings of magnetic resonance spectroscopy were compared with histopathology of thyroid specimens. RESULTS AND CONCLUSION It was seen that presence or absence of choline peak correlates very well with presence or absence of malignant foci with in the nodule (sensitivity=100%; specificity=88.88%). These results indicate that magnetic resonance spectroscopy may prove to be an useful diagnostic modality for carcinoma thyroid.
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Affiliation(s)
- Nikhil Gupta
- Department of Surgery, Maulana Azad Medical College, Lok Nayak Hospital, New Delhi, India.
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Hascalik S, Celik O, Erdem G, Ara C, Kirimlioglu H. Proton magnetic resonance spectroscopy findings of a sacrococcygeal schwannoma. Int J Gynecol Cancer 2006; 16 Suppl 1:344-8. [PMID: 16515619 DOI: 10.1111/j.1525-1438.2006.00224.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Schwannoma is tumor of peripheral nerves, originating from Schwann cells. It is a rare nerve sheath tumor, which frequently occurs in the intracranial acoustic nerve and spinal nerves. We report on a 28-year-old woman who suffered from a large pelvic mass that was diagnosed to be sacrococcygeal schwannoma. The features of proton magnetic resonance spectroscopy (MRS) study are discussed. The magnetic resonance imaging instrument was a 1.5 T, Gyroscan Intera with a body coil as a radiofrequency transmitter and a signal receiver. T2-weighted images were obtained under the following conditions-turbo spin echo (TSE) T2: turbo spin echo repeat time (TR) = 4500 msec, echo time (TE) = 96 msec. Single voxel MRS was performed by the point-resolved spectroscopy technique with a long TE (136 msec). MRS measurement was performed on two different parts of the tumor. As well as strongly elevated choline and lipid signals, the tumor spectrum showed increased N-acetylaspartate resonances. MRS can be used effectively in the preoperative diagnosis of retroperitoneal and pelvic masses, which demonstrate unusual clinical features.
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Affiliation(s)
- S Hascalik
- Department of Obstetrics and Gynecology, Medical Faculty, Inonu University, Malatya, Turkey.
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Hascalik S, Celik O, Sarac K, Alkan A, Mizrak B. Clinical significance of N-acetyl-L-aspartate resonance in ovarian mucinous cystadenoma. Int J Gynecol Cancer 2006; 16:423-6. [PMID: 16445669 DOI: 10.1111/j.1525-1438.2006.00200.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Magnetic resonance spectroscopy (MRS) provides a noninvasive measurement of the biochemistry of living tissue. We report spectroscopy analysis of a 26-year-old woman affected by right ovarian lesion diagnosed as mucinous cystadenoma. MRS was performed by the point-resolved spectroscopy technique with a long echo time (TE) (136 msec). MRS measurements were performed on the two distinct component of the right ovarian tumor. The classification of metabolite peaks area in this study was performed according to the technique described by Okada et al. The features of proton MRS studies are discussed. As well as strongly elevated lactate and N-acetyl-L-aspartate signals, the tumor spectrum showed lipid resonances. Proton MRS imaging may be helpful for the investigation of the underlying pathophysiology of ovarian mucinous cystadenomas.
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Affiliation(s)
- S Hascalik
- Department of Obstetrics and Gynecology, Medical Faculty, Turgut Ozal Medical Center, Inonu University, 44069 Malatya, Turkey.
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Hascalik S, Celik O, Karakas HM, Parlakpinar H, Firat AK, Ozsahin M. Protective role of melatonin in pinealectomized rat brains: in vivo magnetic resonance spectroscopic analysis. J Pineal Res 2005; 39:342-5. [PMID: 16207288 DOI: 10.1111/j.1600-079x.2005.00255.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The goal of this study was to investigate the effect of melatonin on basic cerebral metabolites in pinealectomized (Px) rat brains. Twenty-one rats were randomly divided into three groups with seven rats per group. The study groups included sham-operated rats, Px rats and Px rats treated with melatonin. Melatonin administration began at 60 days following pinealectomy and continued for 21 days. At the end of the study, in vivo single voxel magnetic resonance spectroscopy was performed on whole brains to determine choline (Cho), creatine and N-acetyl aspartate (NAA) concentrations. Px rats had significantly lower NAA levels (P<0.05), and significantly higher Cho levels (P<0.05) when compared with sham-operated rats. Administration of melatonin had normalized NAA and Cho levels in Px rats. We propose that pinealectomy causes significant changes in cerebral metabolites which are compatible with neural loss. Melatonin administration prevents the disruptive effects of pinealectomy on brain tissue.
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Affiliation(s)
- Seyma Hascalik
- Department of Obstetrics and Gynecology, Inonu University Medical Faculty, Malatya, Turkey.
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Iorio E, Mezzanzanica D, Alberti P, Spadaro F, Ramoni C, D'Ascenzo S, Millimaggi D, Pavan A, Dolo V, Canevari S, Podo F. Alterations of Choline Phospholipid Metabolism in Ovarian Tumor Progression. Cancer Res 2005; 65:9369-76. [PMID: 16230400 DOI: 10.1158/0008-5472.can-05-1146] [Citation(s) in RCA: 216] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Recent characterization of abnormal phosphatidylcholine metabolism in tumor cells by nuclear magnetic resonance (NMR) has identified novel fingerprints of tumor progression that are potentially useful as clinical diagnostic indicators. In the present study, we analyzed the concentrations of phosphatidylcholine metabolites, activities of phosphocholine-producing enzymes, and uptake of [methyl-14C]choline in human epithelial ovarian carcinoma cell lines (EOC) compared with normal or immortalized ovary epithelial cells (EONT). Quantification of phosphatidylcholine metabolites contributing to the 1H NMR total choline resonance (3.20-3.24 ppm) revealed intracellular [phosphocholine] and [total choline] of 2.3 +/- 0.9 and 5.2 +/- 2.4 nmol/10(6) cells, respectively, with a glycerophosphocholine/phosphocholine ratio of 0.95 +/- 0.93 in EONT cells; average [phosphocholine] was 3- to 8-fold higher in EOC cells (P < 0.0001), becoming the predominant phosphatidylcholine metabolite, whereas average glycerophosphocholine/phosphocholine values decreased significantly to < or =0.2. Two-dimensional (phosphocholine/total choline, [total choline]) and (glycerophosphocholine/total choline, [total choline]) maps allowed separate clustering of EOC from EONT cells (P < 0.0001, 95% confidence limits). Rates of choline kinase activity in EOC cells were 12- to 24-fold higher (P < 0.03) than those in EONT cells (basal rate, 0.5 +/- 0.1 nmol/10(6) cells/h), accounting for a consistently elevated (5- to 15-fold) [methyl-14C]choline uptake after 1-hour incubation (P < 0.0001). The overall activity of phosphatidylcholine-specific phospholipase C and phospholipase D was also higher ( approximately 5-fold) in EOC cells, suggesting that both biosynthetic and catabolic pathways of the phosphatidylcholine cycle likely contribute to phosphocholine accumulation. Evidence of abnormal phosphatidylcholine metabolism might have implications in EOC biology and might provide an avenue to the development of noninvasive clinical tools for EOC diagnosis and treatment follow-up.
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Affiliation(s)
- Egidio Iorio
- Section of Molecular and Cellular Imaging, Department of Cell Biology and Neurosciences, Istituto Superiore di Sanità, Rome, Italy
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Hascalik S, Celik O, Sarac K, Meydanli MM, Alkan A, Mizrak B. Metabolic Changes in Pelvic Lesions: Findings at Proton MR Spectroscopic Imaging. Gynecol Obstet Invest 2005; 60:121-7. [PMID: 15920339 DOI: 10.1159/000086003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2004] [Accepted: 02/28/2005] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The purpose of this study is to investigate the in vivo magnetic resonance spectroscopic (MRS) features of pelvic lesions using long echo time and to characterize the spectral patterns of various pathological entities. MATERIALS AND METHODS 17 patients with surgically and histopathologically confirmed pelvic lesions underwent long echo-time MRS, and the results obtained were analyzed. Before laparotomy, choline (Cho), lactate, lipid and creatine (Cr) levels of all lesions were measured by single voxel MRS (point-resolved spectroscopy technique, TE 136 ms). Voxels were placed in the center of the lesions. The MRS results of lesions were compared with the final histopathological diagnoses. RESULTS Spectroscopy analysis of serous, mucinous and undifferentiated carcinoma of the ovary revealed Cho, lactate and lipid signals, but granulosa-theca cell tumor showed only a lipid signal. The Cho signal was obtained from only 3 patients with mature cystic teratoma but none of the other benign ovarian tumors and pelvic abscesses. A lipid signal was detected in 3 patients diagnosed with pelvic abscess and all benign ovarian tumors. In addition to the lipid signal, a lactate signal was detected in the spectra of two pelvic abscesses. One case of endometrioma and 1 case of teratoma did not show any signal. CONCLUSION MRS demonstrates significant differences in metabolite concentration between benign and malignant ovarian tumors and pelvic abscesses. MRS may therefore be helpful in the differential diagnosis of adnexal lesions.
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Affiliation(s)
- Seyma Hascalik
- Department of Obstetrics and Gynecology, Inonu University Medical Faculty, Malatya, Turkey.
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Celik O, Erdem G, Hascalik S, Karakas HM, Tamser M. Magnetic resonance spectroscopic comparison of the effects of resveratrol (3,4',5-trihydroxy stilbene) to conjugated equine estrogen, tibolone and raloxifene on ovariectomized rat brains. Eur J Obstet Gynecol Reprod Biol 2005; 120:73-9. [PMID: 15866090 DOI: 10.1016/j.ejogrb.2004.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2004] [Revised: 10/08/2004] [Accepted: 10/20/2004] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate the effects of resveratrol on basic cerebral metabolites of in the brains of ovariectomized rats. MATERIALS AND METHODS Twenty-four bilaterally ovariectomized rats were randomly assigned into six groups with four rats in each group. The groups consisted of sham-operated (control), ovariectomized, resveratrol, conjugated equine estrogen (CEE), tibolone and raloxifene treated rats. Drug administration started at the 5th day following ovariectomy and continued for 35 days. At the end of the entire course, in vivo single voxel magnetic resonance spectroscopy was performed on whole brains to determine choline, creatine and N-acetyl aspartate (NAA) concentrations. RESULTS Compared to sham-operated group, ovariectomized group had significantly lower NAA (P<0.008) but significantly higher choline levels (P<0.031). Administration of CEE and resveratrol resulted in NAA levels that were similar to those in the sham-operated group, showing that the NAA decrease due to ovariectomy was prevented. Treatment with tibolone and raloxifene resulted in a smaller increase in NAA and the effect failed to reach significance. Administration of resveratrol, CEE, tibolone and raloxifene resulted in choline levels similar to those in sham-operated group, showing that the increase in the ovariectomy group was prevented. CONCLUSION Resveratrol causes levels of cerebral metabolites that is similar to conventional hormone replacement agents. This finding may suggest that neuronal function in the postmenopausal state was preserved. More detailed investigation of this issue should be the task of future research.
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Affiliation(s)
- Onder Celik
- Inonu University, Medical Faculty, Department of Obstetric and Gynecology, Malatya, Turkey
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Hascalik S, Celik O, Erdem G, Usta U, Alkan A, Karakas HM, Mizrak B. Synchronous endometrial and cervical tumors in a 26-year-old nullipara: diagnostic modalities updated. Gynecol Obstet Invest 2005; 60:171-6. [PMID: 15995344 DOI: 10.1159/000086706] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2004] [Accepted: 04/25/2005] [Indexed: 11/19/2022]
Abstract
Proton magnetic resonance spectroscopy (MRS), performed on conventional magnetic resonance imaging (MRI) scanners, provides useful information at the biochemical level. MRS has been used to measure tissue concentrations of proton-containing compounds such as organic and amino acids, and sugars in living tissues. We have used MRS in a 26-year-old female with suspected cervical and endometrial carcinomas. With the use of the above mentioned technique, biochemical differences in the endometrium and the cervix tissues were detected. The presented case is the first virgin patient in the relevant literature in whom endometrial and cervical carcinoma was detected. Choline (Cho), creatine (Cr), N-acetylaspartate (NAA), lipid and lactate region of the MRS spectrum suggested that the technique could be used as an indicator of metabolic alterations in the cervical and endometrial tumor cells.
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Affiliation(s)
- Seyma Hascalik
- Department of Obstetrics and Gynecology, Medical Faculty, Inonu University, Malatya, Turkey.
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Hascalik S, Celik O, Erdem G. Magnetic resonance spectral analysis of ovarian teratomas. Int J Gynaecol Obstet 2005; 90:152-4. [PMID: 15913617 DOI: 10.1016/j.ijgo.2005.02.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2004] [Accepted: 02/04/2005] [Indexed: 11/24/2022]
Affiliation(s)
- S Hascalik
- Department of Obstetric and Gynecology, Inonu University Medical School, Turgut Ozal Medical Center, 44069 Malatya, Turkey.
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Celik O, Hascalik S, Sarac K, Meydanli MM, Alkan A, Mizrak B. Magnetic resonance spectroscopy of premalignant and malignant endometrial disorders: a feasibility of in vivo study. Eur J Obstet Gynecol Reprod Biol 2005; 118:241-5. [PMID: 15653212 DOI: 10.1016/j.ejogrb.2004.06.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2004] [Revised: 06/02/2004] [Accepted: 06/30/2004] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To assess the potential clinical utility of in vivo proton magnetic resonance spectroscopy (MRS) in patients with various endometrial lesions. METHODS Twelve patients with untreated uterine bleeding were included in this study. In-vivo proton MRS was performed using a 1.5 T MR scanner. The metabolite levels were classified into three classes in comparison with the noise level by visual examination. All the patients have endometrial biopsy. For each type of lesions, chemical compound were described. RESULTS Pathological examination resulted in three endometrial cancer, two simple hyperplasias, one complex hyperplasia, two partial hydatiform mole, two proliferative endometrium and two secretory endometrium. In women with endometrial carcinoma, high choline and lipid signals were detected, whereas no creatine and no lactate signals were found. In women with endometrial hyperplasia, choline signal was detectable in all cases but one case showed lactate signal in addition to choline. In women with partial hydatidiform mole, the only detectable signal was choline. Lipid signals were detected in none of the cases with endometrial hyperplasia and partial hidatidiform mole. In women with either secretory or proliferative endometrium, choline and lactate signals were detectable in all cases but one case showed solely choline. Lipid signals were not detected in any of subjects with secretory or proliferative endometrium. CONCLUSION The observed difference is the presence of lipid signal only in endometrial carcinoma.
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Affiliation(s)
- Onder Celik
- Department of Obstetrics and Gynecology, Turgut Ozal Medical Center, School of Medicine, Inonu University, 44069 Malatya, Turkey.
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Morimoto T, Obata T, Ohno T, Suzuki Y, Ikehira H, Suhara T, Furukawa S, Tsujii H, Nakano T. Phosphorous-31 Magnetic Resonance Spectroscopy of Cervical Cancer Using Transvaginal Surface Coil. Magn Reson Med Sci 2005; 4:197-201. [PMID: 16543705 DOI: 10.2463/mrms.4.197] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
We developed a new transvaginal coil tuned for phosphorous-31 and measured its magnetic resonance spectroscopy ((31)P MRS) of uterine cervical cancer. In a 50-year-old woman with uterine cervical cancer (International Federation of Gynecology and Obstetrics [FIGO] stage IIIb), (31)P MRS with the new coil clearly differentiated the low intensity of phosphocreatinine (PCr) and high intensity of phosphomonoester (PME) in tumor from those in muscle. Results suggests that this method will be useful for assessing uterine cervical cancer.
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Affiliation(s)
- Takuya Morimoto
- Brain Imaging Project, National Institute of Radiological Sciences, Chiba, Japan.
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Celik O, Sarac K, Hascalik S, Alkan A, Mizrak B, Yologlu S. Magnetic resonance spectroscopy features of uterine leiomyomas. Gynecol Obstet Invest 2004; 58:194-201. [PMID: 15286450 DOI: 10.1159/000080020] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2003] [Accepted: 05/28/2004] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The purpose of this study is to investigate the in vivo magnetic resonance spectroscopy features of uterine leiomyomas using long echo time and to characterize the spectral patterns of these lesions. METHODS We calculated metabolites in 15 patients with uterine leiomyomas and myometrium of 20 healthy control subjects using single-voxel proton MR spectroscopy (point resolved spectroscopy technique, TE:136 ms). Voxels were placed at the center of the uterine leiomyomas. The peak areas of creatine, choline, lipid and lactate were determined. The MR spectroscopy results of uterine leiomyomas were compared with the spectroscopy results obtained from the myometrium of healthy control subjects. RESULTS The characteristically obtained signal was choline, which was detected not only in 14 of the 15 leiomyomas (93.3%) but also in 18 of the 20 myometrium of control subjects (90%). The lipid signals were determined in 9 of 15 patients with uterine leiomyomas (60%) and 8 of 20 control subjects (40%). The lactate signal was obtained from six of 15 patients with leiomyomas (40%) but only two of myometrium (10%). The creatine signal was obtained from 4 of 15 patients with leiomyomas (26.6%) and 5 of 20 myometrium (25%). Among the tested parameters only lactate peak was statistically significant (p < 0.05). CONCLUSION Proton MR spectroscopic imaging may be helpful for the investigation of the underlying pathophysiology of uterine leiomyomas. The presence of lactate and lipid signals in the spectrum may be a useful indicator of metabolic pathway of uterine leiomyomas.
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Affiliation(s)
- Onder Celik
- Department of Obstetrics and Gynecology, Inonu University, School of Medicine, Turgut Ozal Medical Center, TR-44069 Malatya, Turkey.
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Sarac K, Celik O, Hascalik S, Alkan A, Mizrak B. In vivo
proton magnetic resonance spectroscopy in the evaluation of the endometrium. Acta Obstet Gynecol Scand 2004; 83:751-7. [PMID: 15255848 DOI: 10.1111/j.0001-6349.2004.00435.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The purposes of this study were to compare proton magnetic resonance (MR) spectroscopic evaluation of the endometrium with histology obtained by endometrial biopsy in women undergoing diagnostic curettage and to determine whether screening with MR spectroscopy (MRS) might be useful in the evaluation of the endometrium. METHODS Twenty-three consecutive women who were scheduled for endometrial biopsy were included in the study. The women were evaluated by MRS, performed immediately before the endometrial biopsy. The MRS results were compared with the histological findings obtained from the endometrial biopsy. RESULTS All of the cases were proven by pathological examination, and their diagnoses were secretory endometrium (11 cases), proliferative endometrium (seven cases) and disordered proliferative endometrium (five cases). The characteristically obtained signals of choline (Cho) and lipid were detected in all subjects in the secretory endometrium group. In the same group, eight patients showed lactate signals and six showed creatine (Cr) signals. In the disordered proliferative endometrium group, four patients showed lipid plus Cho signals. Two patients in the same group demonstrated both lactate and Cr signals. All patients in the proliferative endometrium group showed Cho signals, two patients demonstrated lactate plus Cho signals, and none of the patients in this group showed lipid and Cr signals. CONCLUSION Proton magnetic resonance spectra can register certain metabolic differences in human endometrium in its different stages.
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Affiliation(s)
- Kaya Sarac
- Department of Radiology, Inonu University, School of Medicine, Malatya, Turkey
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