Role of proton MR spectroscopy in the differentiation of borderline from malignant epithelial ovarian tumors: A preliminary study.

Abstract

Due to the overlapping imaging appearances between borderline and malignant epithelial ovarian tumors (EOTs), borderline EOTs often represent a diagnostic challenge on conventional MRI. Proton magnetic resonance spectroscopy (1 H-MRS) might have potential to differentiate borderline from malignant tumors. To investigate the ability of 1 H-MRS to differentiate borderline from malignant EOTs. Prospective. In all, 278 patients with adnexal masses. 1.5 T Siemens Avanto MRI system and 1 H-MRS using a point-resolved spectroscopy sequence (PRESS). Resonance peak integrals of the most common metabolites were analyzed and compared between the two groups. The ratios of metabolites between borderline and malignant EOTs were compared with the Mann-Whitney U-test. A receiver operating characteristic (ROC) curve was used to determine their differential diagnosis performances. In the solid components of borderline and malignant EOTs, the mean Cho/Cr, NAA/Cr, and NAA/Cho ratios were 4.4 ± 1.1 and 9.9 ± 2.8; 10.4 ± 3.0 and 2.2 ± 1.0; and 2.4 ± 0.7 and 0.3 ± 0.1, respectively (all P < 0.001). The sensitivity, specificity, and area under the curve (AUC) were 91%, 100%, and 0.98 for the Cho/Cr ratio; 100%, 98%, and 0.99 for the NAA/Cr ratio; and 100%, 100%, and 1.00 for the NAA/Cho ratio, respectively. In the cystic components, the mean Cho/Cr, NAA/Cr, and NAA/Cho ratios were 3.2 ± 0.8 and 5.1 ± 1.2; 9.1 ± 3.4 and 2.3 ± 1.4; and 2.9 ± 1.2 and 0.5 ± 0.4, respectively (all P < 0.001). The sensitivity, specificity, and AUC were 84%, 82%, and 0.89 for the Cho/Cr ratio; 94%, 97%, and 0.99 for the NAA/Cr ratio; and 94%, 97%, and 0.99 for the NAA/Cho ratio, respectively. The NAA/Cho ratio is a reliable biomarker for differentiating borderline from malignant EOTs. 2 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019;49:1684-1693.