title: Diagnostic value of 3.0T (1)H MRS with choline-containing compounds ratio (∆CCC) in primary malignant hepatic tumors.
abstract: BACKGROUND
  The purpose of this study was to investigate the diagnostic value of 3.0-T (1)H magnetic resonance spectroscopy ((1)H MRS) in primary malignant hepatic tumors and to compare the effects of (1)H MRS on the diagnostic accuracy of liver-occupying lesions between junior and experienced radiologists.
  
  
  METHODS
  This study included 50 healthy volunteers and 40 consecutive patients (50 lesions). Informed consent was obtained from each subject. Images were obtained on clinical whole-body 3.0-T MR system. Point -Resolved Spectroscopy was used to obtain the spectroscopy image. All conventional images were reviewed blindly by junior radiologist and experienced radiologist, respectively. The choline-containing compounds peak area (CCC-A) was measured with SAGE software, and the choline-containing compound ratio (∆CCC) was calculated. The efficacy of CCC-A and ∆CCC in the diagnosis of primary malignant hepatic tumors was determined by plotting receiver operating characteristic (ROC) curves. We also compared the effects of MRS on the diagnostic accuracy of liver-occupying lesions with junior and experienced radiologist.
  
  
  RESULTS
  A significant increase in mean CCC-A was observed in malignant tumors compared with benign tumors. The ROC curve showed ∆CCC had a high discriminatory ability in diagnosing primary malignant hepatic tumors with a sensitivity and specificity of 94.3 and 93.3 %, respectively. The ∆CCC area under the curve (AUC) was 0.97 that was larger than that of both junior and experienced radiologist, while the significantly statistical difference was only obtained between ∆CCC and junior radiologist (P = 0.01).
  
  
  CONCLUSIONS
  (1)H MRS with ∆CCC demonstrates good efficacy in diagnosing primary malignant hepatic tumors. The technique improves the accuracy of diagnosing liver-occupying lesions, particularly for junior radiologists.
authors.affiliation: Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17, Pan Jia Yuan Nan-li, PO Box 2258, Beijing, 100021, China.
authors.forename: Li
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17, Pan Jia Yuan Nan-li, PO Box 2258, Beijing, 100021, China.
authors.forename: Xinming
authors.initials: X
authors.lastname: Zhao
authors.affiliation: Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17, Pan Jia Yuan Nan-li, PO Box 2258, Beijing, 100021, China.
authors.forename: Han
authors.initials: H
authors.lastname: Ouyang
authors.affiliation: Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17, Pan Jia Yuan Nan-li, PO Box 2258, Beijing, 100021, China.
authors.forename: Shuang
authors.initials: S
authors.lastname: Wang
authors.affiliation: Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17, Pan Jia Yuan Nan-li, PO Box 2258, Beijing, 100021, China. cjr.zhouchunwu@vip.163.com.
authors.forename: Chunwu
authors.initials: C
authors.lastname: Zhou
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002794:Choline; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity
chemical_list: D002794:Choline
keywords: Diagnosis; Liver neoplasms; Magnetic resonance image; Magnetic resonance spectroscopy; Sensitivity and specificity