title: MR Spectroscopy for Differentiating Benign From Malignant Solid Adnexal Tumors.
abstract: OBJECTIVE
  The purpose of this article is to investigate the proton MR spectroscopy ((1)H-MRS) features of solid adnexal tumors and to evaluate the efficacy of (1)H-MRS for differentiating benign from malignant solid adnexal tumors.
  
  
  METHODS
  Sixty-nine patients with surgically and histologically proven solid adnexal tumors (27 benign and 42 malignant) underwent conventional MRI and (1)H-MRS. Single-voxel spectroscopy was performed using the point-resolved spectroscopy localization technique with a voxel size of 2 × 2 × 2 cm(3). Resonance peak integrals of choline, N-acetyl aspartate (NAA), creatine, lactate, and lipid were analyzed, and the choline-tocreatine, NAA-to-creatine, lactate-to-creatine, and lipid-to-creatine ratios were recorded and compared between benign and malignant tumors.
  
  
  RESULTS
  A choline peak was detected in all 69 cases (100%), NAA peak in 67 cases (97%, 25 benign and 42 malignant), lipid peak in 47 cases (17 benign and 30 malignant), and lactate peak in eight cases (four benign and four malignant). The mean (± SD) choline-tocreatine ratio was 5.13 ± 0.6 in benign tumors versus 8.90 ± 0.5 in malignant solid adnexal tumors, a statistically significant difference (p = 0.000). There were no statistically significant differences between benign and malignant tumors in the NAA-to-creatine and lipid-to-creatine ratios (p = 0.263 and 0.120, respectively). When the choline-to-creatine threshold was 7.46 for differentiating between benign and malignant tumors, the sensitivity, specificity, and accuracy were 94.1%, 97.1%, and 91.2%, respectively.
  
  
  CONCLUSIONS
  Our preliminary study shows that the (1)H-MRS patterns of benign and malignant solid adnexal tumors differ. The choline-to-creatine ratio can help clinicians differentiate benign from malignant tumors.
authors.affiliation: 1 Department of Radiology, Jinshan Hospital, Shanghai Medical College, Fudan University, 1508 Longhang Rd, Jinshan District, Shanghai 201508, China.
authors.forename: Feng Hua
authors.initials: FH
authors.lastname: Ma
authors.forename: Jin Wei
authors.initials: JW
authors.lastname: Qiang
authors.forename: Song Qi
authors.initials: SQ
authors.lastname: Cai
authors.forename: Shu Hui
authors.initials: SH
authors.lastname: Zhao
authors.forename: Guo Fu
authors.initials: GF
authors.lastname: Zhang
authors.forename: Ya Min
authors.initials: YM
authors.lastname: Rao
mesh_terms: D000291:Adnexal Diseases / Q000175:diagnosis* / Q000378:metabolism*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000737:chemistry* / Q000175:diagnosis*; D066244:Proton Magnetic Resonance Spectroscopy / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor
keywords: MRI; adnexal tumors; ovarian tumors; spectroscopy