title: Can the signal-to-noise ratio of choline in magnetic resonance spectroscopy reflect the aggressiveness of endometrial cancer?
abstract: OBJECTIVE
  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 (1)H magnetic resonance spectroscopy (MRS) is associated with the aggressiveness of ECa.
  
  
  METHODS
  Thirty-three patients with ECa and 15 patients with BLs-ESm underwent preoperative multivoxel (1)H 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.
authors: Department of Radiology, Provincial Hospital Affiliated to Shandong University, 324#, Jingwu Weiqi Road, Jinan, PR China.
authors: Xue
authors: X
authors: Han
authors: Department of Radiology, Linyi People's Hospital, Linyi, PR China.
authors: Jingxia
authors: J
authors: Kang
authors: Department of Radiology, Provincial Hospital Affiliated to Shandong University, 324#, Jingwu Weiqi Road, Jinan, PR China.
authors: Jie
authors: J
authors: Zhang
authors: Department of Radiology, Provincial Hospital Affiliated to Shandong University, 324#, Jingwu Weiqi Road, Jinan, PR China.
authors: Jianjun
authors: J
authors: Xiu
authors: Department of Radiology, Provincial Hospital Affiliated to Shandong University, 324#, Jingwu Weiqi Road, Jinan, PR China.
authors: Zhaoqin
authors: Z
authors: Huang
authors: Department of Obstetrics and Gynecology, Provincial Hospital Affiliated to Shandong University, Jinan, PR China.
authors: Chunrun
authors: C
authors: Yang
authors: Department of Pathology, Provincial Hospital Affiliated to Shandong University, Jinan, PR China.
authors: Xichao
authors: X
authors: Sun
authors: Siemens MRI Center, Shenzhen, PR China.
authors: Caixia
authors: C
authors: Fu
authors: Department of Radiology, Provincial Hospital Affiliated to Shandong University, 324#, Jingwu Weiqi Road, Jinan, PR China. Electronic address: doctorlqw@163.com.
authors: Qingwei
authors: Q
authors: Liu
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000378:metabolism; D002794:Choline / Q000378:metabolism*; D016889:Endometrial Neoplasms / Q000378:metabolism* / Q000473:pathology*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D009682:Magnetic Resonance Spectroscopy; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011446:Prospective Studies; D059629:Signal-To-Noise Ratio
chemical_list: D014408:Biomarkers, Tumor; D002794:Choline
keywords: Endometrial cancer; aggressiveness; choline; magnetic resonance imaging; magnetic resonance spectroscopy