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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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Eroğlu H, Tolunay HE, Tonyalı NV, Orgul G, Şahin D, Yücel A. Comparison of placental elasticity in normal and intrauterine growth retardation pregnancies by ex vivo strain elastography. Arch Gynecol Obstet 2020; 302:109-115. [PMID: 32430754 DOI: 10.1007/s00404-020-05596-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 05/06/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To compare the placental elasticity in fetuses with or without intrauterine growth restriction (IUGR). MATERIALS AND METHODS One hundred pregnant women (50 IUGR and 50 healthy) with anteriorly located placenta were evaluated during the third trimester of pregnancy. Measurements were carried out by a machine that has a real-time elastographic ultrasonography feature. After obtaining the optimum image, three areas (subcutaneous tissue, center, and the edge of the placenta) were provided to identify the placental strain values. Then, the placental strain ratio (PSR) value was calculated automatically. Two groups compared in terms of their PSR values. RESULTS There was a significant difference in placental elasticity between the groups (P < 0.001). PSR value was 2.8 ± 1.2 in the IUGR group and 1.3 ± 0.6 in the control group. A PSR value of 1.78 had an 86% sensitivity (OR 4.3) and 80% specificity (OR 0.17) in IUGR cases. The positive predictive value was 81.1% and the negative predictive value was 85.1% for this cut-off value. CONCLUSIONS We have shown that placental strain ratio is increased during the third trimester of pregnancy in fetuses with IUGR. Increased stiffness and elasticity may be responsible for the onset of IUGR in some cases.
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Affiliation(s)
- Hasan Eroğlu
- Perinatology Department, Training and Research Hospital, Etlik Zubeyde Hanim Women's Health Care, Ankara, Turkey.
| | - Harun Egemen Tolunay
- Perinatology Department, Training and Research Hospital, Etlik Zubeyde Hanim Women's Health Care, Ankara, Turkey
| | - Nazan Vanlı Tonyalı
- Perinatology Department, Training and Research Hospital, Etlik Zubeyde Hanim Women's Health Care, Ankara, Turkey
| | - Gokcen Orgul
- Perinatology Department, Training and Research Hospital, Etlik Zubeyde Hanim Women's Health Care, Ankara, Turkey
| | - Dilek Şahin
- Perinatology Department, Training and Research Hospital, Etlik Zubeyde Hanim Women's Health Care, Ankara, Turkey
| | - Aykan Yücel
- Perinatology Department, Training and Research Hospital, Etlik Zubeyde Hanim Women's Health Care, Ankara, Turkey
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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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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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Song F, Wu W, Qian Z, Zhang G, Cheng Y. Assessment of the Placenta in Intrauterine Growth Restriction by Diffusion-Weighted Imaging and Proton Magnetic Resonance Spectroscopy. Reprod Sci 2016; 24:575-581. [PMID: 27647687 DOI: 10.1177/1933719116667219] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Placental insufficiency is a major cause of intrauterine growth restriction (IUGR) and seriously affects fetal development. When placental insufficiency happened, the diffusion of water molecule was restricted and the metabolic balance was destroyed in the placenta. In this prospective study, we aimed to evaluate the diagnostic value of diffusion-weighted imaging (DWI) in combination with proton magnetic resonance spectroscopy (1H MRS) for placental insufficiency in IUGR. The apparent diffusion coefficient (ADC) values were calculated using DWI, and the metabolism of N-acetylaspartate (NAA), choline, and lipid and their ratios in the placenta were calculated using 1H MRS. Data were statistically analyzed by receiver operating characteristic (ROC) curves and logistic regression analysis. The NAA and choline peaks were decreased in IUGR placentas compared with normal placentas, while lipid peaks showed an opposite trend. The average ADC value and the NAA/lipid and choline/lipid ratios were lower in the IUGR group than in the normal group ( P < .01). Logistic regression with multiple parameters showed that combination of the ADC value and choline/lipid ratio was more favorable than either parameter alone in analyzing placental insufficiency of IUGR ( P < .05). The area under the ROC curve for the combination was 0.939, indicating reasonably good discrimination. We concluded that reduced ADC and NAA/lipid and choline/lipid ratios could serve as potential markers for placental insufficiency of IUGR. Furthermore, the combination of ADC value and choline/lipid ratio greatly improved the diagnostic value.
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Affiliation(s)
- Fuzhen Song
- 1 Department of Radiology, The Tenth People's Hospital of Tong Ji University, Shanghai, China.,2 Department of Radiology, The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weibin Wu
- 2 Department of Radiology, The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhaoxia Qian
- 2 Department of Radiology, The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guofu Zhang
- 3 Department of Radiology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Yingsheng Cheng
- 1 Department of Radiology, The Tenth People's Hospital of Tong Ji University, Shanghai, China.,4 Department of Radiology, The Sixth Affiliated Hospital of Shanghai Jiaotong University, Shanghai, China
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Foti PV, Attinà G, Spadola S, Caltabiano R, Farina R, Palmucci S, Zarbo G, Zarbo R, D'Arrigo M, Milone P, Ettorre GC. MR imaging of ovarian masses: classification and differential diagnosis. Insights Imaging 2016; 7:21-41. [PMID: 26671276 PMCID: PMC4729709 DOI: 10.1007/s13244-015-0455-4] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 11/18/2015] [Accepted: 11/27/2015] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE We propose a Magnetic Resonance Imaging (MRI) guided approach to differential diagnosis of ovarian tumours based on morphological appearance. BACKGROUND Characterization of ovarian lesions is of great importance in order to plan adequate therapeutic procedures, and may influence patient's management. Optimal assessment of adnexal masses requires a multidisciplinary approach, based on physical examination, laboratory tests and imaging techniques. Primary ovarian tumours can be classified into three main categories according to tumour origin: epithelial, germ cell and sex cord-stromal tumours. Ovarian neoplasms may be benign, borderline or malignant. Using an imaging-guided approach based on morphological appearance, we classified adnexal masses into four main groups: unilocular cyst, multilocular cyst, cystic and solid, predominantly solid. We describe MR signal intensity features and enhancement behaviour of ovarian lesions using pathologically proven examples from our institution. CONCLUSION MRI is an essential problem-solving tool to determine the site of origin of a pelvic mass, to characterize an adnexal mass, and to detect local invasion. The main advantages of MRI are the high contrast resolution and lack of ionizing radiation exposure. Although different pathological conditions may show similar radiologic manifestations, radiologists should be aware of MRI features of ovarian lesions that may orientate differential diagnosis. TEACHING POINTS • Diagnostic imaging plays a crucial role in detection, characterization and staging of adnexal masses. • Characterization of an ovarian lesion may influence patient's management. • Different pathological conditions may have similar radiologic manifestations. • Non-neoplastic lesions should always be taken into consideration.
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Affiliation(s)
- Pietro Valerio Foti
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy.
| | - Giancarlo Attinà
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Saveria Spadola
- Department G.F. Ingrassia - Institute of Pathology, University of Catania, Catania, Italy
| | - Rosario Caltabiano
- Department G.F. Ingrassia - Institute of Pathology, University of Catania, Catania, Italy
| | - Renato Farina
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Stefano Palmucci
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Giuseppe Zarbo
- Department of General Surgery and Medical-Surgical Specialties - Institute of Obstetrics and Ginecology, University of Catania, Catania, Italy
| | - Rosario Zarbo
- Department of General Surgery and Medical-Surgical Specialties - Institute of Obstetrics and Ginecology, University of Catania, Catania, Italy
| | - Maria D'Arrigo
- Pathology Unit, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Pietro Milone
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Giovanni Carlo Ettorre
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
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Macnaught G, Gray C, Walker J, Simpson M, Norman J, Semple S, Denison F. (1)H MRS: a potential biomarker of in utero placental function. NMR IN BIOMEDICINE 2015; 28:1275-1282. [PMID: 26313636 DOI: 10.1002/nbm.3370] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 06/30/2015] [Accepted: 07/07/2015] [Indexed: 06/04/2023]
Abstract
The placenta is a temporary organ that is essential for a healthy pregnancy. It performs several important functions, including the transport of nutrients, the removal of waste products and the metabolism of certain substances. Placental disorders have been found to account for over 50% of stillbirths. Despite this, there are currently no methods available to directly and non-invasively assess placental function in utero. The primary aim of this pilot study was to investigate the use of (1)H MRS for this purpose. (1)H MRS offers the possibility to detect several placental metabolites, including choline, lipids and the amino acids glutamine and glutamate (Glx), which are vital to fetal development and placental function. Here, in utero placental spectra were acquired from nine small for gestational age (SGA) pregnancies, a cohort who are at increased risk of perinatal morbidity and mortality, and from nine healthy gestation-matched pregnancies. All subjects were between 26 and 39 weeks of gestation. Placenta Glx, choline and lipids at 1.3 and 0.9 ppm were quantified as amplitude ratios to that of intrinsic H2O. Wilcoxon signed rank tests indicated a significant difference in Glx/H2O (p = 0.024) between the two groups, but not in choline/H2O (p = 0.722) or in either lipid/H2O ratio (1.3 ppm, p = 0.813; 0.9 ppm, p = 0.058). This study has demonstrated that (1)H MRS has potential for the detection of placental metabolites in utero. This warrants further investigation as a tool for the monitoring of placental function.
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Affiliation(s)
- Gillian Macnaught
- Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, UK
| | - Calum Gray
- Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, UK
| | - Jane Walker
- Simpson Centre for Reproductive Health, Royal Infirmary, Edinburgh, UK
| | - Mary Simpson
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Jane Norman
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Scott Semple
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Fiona Denison
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
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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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