Biochemical evaluation of endometrial biopsies by magnetic resonance spectroscopy--preliminary data

Spectroscopy analysis of endometrial metabolites is a powerful predictor of success of embryo transfer in women with implantation failure: a preliminary study

OBJECTIVE

To investigate whether prior endometrium spectroscopy predicts the success of embryo transfer in patients with recurrent implantation failure (RIF).

MATERIALS AND METHODS

Twenty women with RIF who were scheduled for IVF-ET and six fertile women were included the study. All women with RIF and fertile controls underwent endometrium spectroscopy before embryo transfer. A multi-voxel spectroscopy sequence was used for the detection of choline (Cho), creatine (Cr), lactate, and lipids. Women with RIF were divided into two subgroups as successful (n = 8) and unsuccessful RIF (n = 12) according to both Cho and Cr metabolite characteristics and whether pregnancy was achieved. Associations between the metabolite intensities of the RIF subjects and the implantation rate (IR) and clinical pregnancy rate (CPR) were assessed.

RESULTS

While 8 of 20 RIF cases became pregnant, pregnancy could not be achieved in 12 cases. The common spectroscopy finding in all 8 cases who conceived was high Cho and low lactate. The main metabolite change detected in 12 patients who could not conceive was the increase in lactate and lipid signals. The cutoff value of Cho, Cr, lactate and lipid were 1.01 ppm, 1.44 ppm, 0.86 ppm and 1.22 ppm respectively in patients who achieved pregnancy following ET. A positive and significant correlation was found between Cho and Cr intensities and IR or CPR.

CONCLUSIONS

Receptive endometrium represents some specific metabolites in spectroscopy that can be used for prediction of the success or failure of embryo transfer in women suffering implantation failure.

Magnetic resonance spectroscopy of premalignant and malignant endometrial disorders: a feasibility of in vivo study

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.

In vivo proton magnetic resonance spectroscopy in the evaluation of the endometrium

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.

13C NMR kinetic studies of the rapid stimulation of glucose metabolism by estrogen in immature rat uterus

Glucose metabolism in control and estrogen stimulated rat uteri was investigated using 13C NMR spectroscopy. By employing an NMR adapted perifusion system, and developing protocols and methods based on the application of [1-13C]glucose labeling, it was possible to measure, with a temporal resolution of 10 min, the kinetics of glucose consumption, lactate production and 13C incorporation into glutamate, alanine and glycogen. In control immature rat uteri, under aerobic conditions, the rates (+/- SEM) of [1-13C]glucose consumption and [3-13C]lactate production were 24 +/- 2 and 7.5 +/- 0.5 mmol/g wet weight/h. The rates of synthesis of [4-13C]glutamate, [3-13C]alanine and 13C labeling of glycogen at C1 of its glucose moieties were significantly lower and were in the range 0.3-0.6 mmol/g wet weight/h. Thus, ca 35% of the labeled glucose was accounted for by the glycolytic and other observed pathways. In vitro stimulation of the uteri by estrogen was found to increase significantly, within 1 h, glucose consumption by 80%, lactate production by 150% and glutamate and glycogen synthesis by 150%, in parallel to a rapid hormonal induction of mRNA for the brain type isozyme of creatine kinase.