Background: 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 ( H-MRS) might have potential to differentiate borderline from malignant tumors.
Purpose: To investigate the ability of H-MRS to differentiate borderline from malignant EOTs.
Study Type: Prospective.
Population: In all, 278 patients with adnexal masses.
Field Strength/sequence: 1.5 T Siemens Avanto MRI system and H-MRS using a point-resolved spectroscopy sequence (PRESS).
Assessment: Resonance peak integrals of the most common metabolites were analyzed and compared between the two groups.
Statistical Tests: 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.
Results: 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.
Data Conclusion: The NAA/Cho ratio is a reliable biomarker for differentiating borderline from malignant EOTs.
Level Of Evidence: 2 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019;49:1684-1693.
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