Advertisement

Can the Signal-to-Noise Ratio of Choline in Magnetic Resonance Spectroscopy Reflect the Aggressiveness of Endometrial Cancer?

Published:January 29, 2015DOI:https://doi.org/10.1016/j.acra.2014.12.010

      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 1H 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 1H 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.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Academic Radiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Nofech-Mozes S.
        • Ghorab Z.
        • Ismiil N.
        • et al.
        Endometrial endometrioid adenocarcinoma: a pathologic analysis of 827 consecutive cases.
        Am J Clin Pathol. 2008; 129: 110-114
        • Zhu H.L.
        • Liang X.D.
        • Wang J.L.
        • et al.
        Hysteroscopy and directed biopsy in the diagnosis of endometrial carcinoma.
        Chin Med J. 2010; 123: 3524-3528
        • Eddib A.
        • Allaf B.
        • Lee J.
        • et al.
        Risk for advanced-stage endometrial cancer in surgical specimens from patients with complex endometrial hyperplasia with atypia.
        Gynecol Obstet Invest. 2012; 73: 38-42
        • Karamursel B.S.
        • Guven S.
        • Tulunay G.
        • et al.
        Which surgical procedure for patients with atypical endometrial hyperplasia?.
        Int J Gynecol Cancer. 2005; 15: 127-131
        • Trimble C.L.
        • Kauderer J.
        • Zaino R.
        • et al.
        Concurrent endometrial carcinoma in women with a biopsy diagnosis of atypical endometrial hyperplasia: a Gynecologic Oncology Group study.
        Cancer. 2006; 106: 812-819
        • Harry V.N.
        • Deans H.
        • Ramage E.
        • et al.
        Magnetic resonance imaging in gynecological oncology.
        Int J Gynecol Cancer. 2009; 19: 186-193
        • Djurdjevic S.
        • Zivaljevic M.
        • Semnic R.
        • et al.
        Diagnostic significance of ultrasound and magnetic resonance imaging scan in the presurgical determination of FIGO stage of endometrial cancer.
        J BUON. 2010; 15: 382-388
        • Haldorsen I.S.
        • Salvesen H.B.
        Staging of endometrial carcinomas with MRI using traditional and novel MRI techniques.
        Clin Radiol. 2012; 67: 2-12
        • Vargas H.A.
        • Akin O.
        • Zheng J.
        • et al.
        The value of MR imaging when the site of uterine cancer origin is uncertain.
        Radiology. 2011; 258: 785-792
        • Thomassin-Naggara I.
        • Dechoux S.
        • Bonneau C.
        • et al.
        How to differentiate benign from malignant myometrial tumours using MR imaging.
        Eur Radiol. 2013; 23: 2306-2314
        • Sibtain N.A.
        • Howe F.A.
        • Saunders D.E.
        The clinical value of proton magnetic resonance spectroscopy in adult brain tumours.
        Clin Radiol. 2007; 62: 109-119
        • Gao F.
        • Edden R.A.
        • Li M.
        • et al.
        Edited magnetic resonance spectroscopy detects an age-related decline in brain GABA levels.
        Neuroimage. 2013; 78: 75-82
        • Bartella L.
        • Thakur S.B.
        • Morris E.A.
        • et al.
        Enhancing nonmass lesions in the breast: evaluation with proton (1H) MR spectroscopy.
        Radiology. 2007; 245: 80-87
        • Kobus T.
        • Vos P.C.
        • Hambrock T.
        • et al.
        Prostate cancer aggressiveness: in vivo assessment of MR spectroscopy and diffusion-weighted imaging at 3 T.
        Radiology. 2012; 265: 457-467
        • Zhang J.
        • Jing H.
        • Han X.
        • et al.
        Diffusion-weighted imaging of prostate cancer on 3T MR: relationship between apparent diffusion coefficient values and Ki-67 expression.
        Acad Radiol. 2013; 20: 1535-1541
        • Payne G.S.
        • Schmidt M.
        • Morgan V.A.
        • et al.
        Evaluation of magnetic resonance diffusion and spectroscopy measurements as predictive biomarkers in stage 1 cervical cancer.
        Gynecol Oncol. 2010; 116: 246-252
        • Takeuchi M.
        • Matsuzaki K.
        • Harada M.
        Differentiation of benign and malignant uterine corpus tumors by using proton MR spectroscopy at 3T: preliminary study.
        Eur Radiol. 2011; 21: 850-856
        • Celik O.
        • Hascalik S.
        • Sarac K.
        • et al.
        Magnetic resonance spectroscopy of premalignant and malignant endometrial disorders: a feasibility of in vivo study.
        Eur J Obstet Gynecol Reprod Biol. 2005; 118: 241-245
        • Okada T.
        • Harada M.
        • Matsuzaki K.
        • et al.
        Evaluation of female intrapelvic tumors by clinical proton MR spectroscopy.
        J Magn Reson Imaging. 2001; 13: 912-917
        • Mahon M.M.
        • Cox I.J.
        • Dina R.
        • et al.
        (1)H magnetic resonance spectroscopy of preinvasive and invasive cervical cancer: in vivo-ex vivo profiles and effect of tumor load.
        J Magn Reson Imaging. 2004; 19: 356-364
        • Booth S.J.
        • Pickles M.D.
        • Turnbull L.W.
        In vivo magnetic resonance spectroscopy of gynaecological tumours at 3.0 Tesla.
        BJOG. 2009; 116: 300-303
        • Glunde K.
        • Bhujwalla Z.M.
        • Ronen S.M.
        Choline metabolism in malignant transformation.
        Nat Rev Cancer. 2011; 11: 835-848
        • Danishad K.K.
        • Sharma U.
        • Sah R.G.
        • et al.
        Assessment of therapeutic response of locally advanced breast cancer (LABC) patients undergoing neoadjuvant chemotherapy (NACT) monitored using sequential magnetic resonance spectroscopic imaging (MRSI).
        NMR Biomed. 2010; 23: 233-241
        • McLean M.A.
        • Priest A.N.
        • Joubert I.
        • et al.
        Metabolic characterization of primary and metastatic ovarian cancer by 1H-MRS in vivo at 3T.
        Magn Reson Med. 2009; 62: 855-861
        • Baik H.M.
        • Su M.Y.
        • Yu H.
        • et al.
        Quantification of choline-containing compounds in malignant breast tumors by 1H MR spectroscopy using water as an internal reference at 1.5 T.
        Magma (New York, NY). 2006; 19: 96-104