1H-MRS鉴别良性与交界性囊性上皮性卵巢肿瘤的价值

Proton MR spectroscopy in differentiating benign from borderline cystic epithelial ovarian tumors

目的:探讨氢质子磁共振波谱(proton magnetic resonance spectroscopy,1H-MRS)鉴别良性与交界性囊性上皮性卵巢肿瘤(epithelial ovarian tumor,EOT)的价值。方法:回顾性分析64例经手术和病理证实的囊性EOT患者(良性33个、交界性31个)的1H-MRS资料,波谱序列采用点分辨自旋回波波谱,用波谱后处理软件自动获取各代谢物[胆碱(choline,Cho)、N-乙酰天冬氨酸(N-acetyl aspartate,NAA)、脂质(lipid,Lip)、乳酸(lactate,Lac)]的峰值积分,以肌酸(creatine,Cr)为内参照,计算各代谢物与Cr的比值。采用Mann-Whitney U检验比较良性与交界性EOT代谢物峰值积分比值的差异,采用受试者工作特征(receiver operating characteristic,ROC)曲线评价峰值积分比值鉴别良性与交界性EOT的效能,并确定鉴别两者的阈值。结果:良性和交界性囊性EOT的Cho/Cr比值分别为1.39±0.90(1.02~1.54)和3.31±1.60(2.12~3.92),有显著性差异(P<0.001);NAA/Cr比值为2.54±2.20(1.43~3.45)和9.43±5.20(5.3~11.41),有显著性差异(P<0.001)。Cho/Cr和NAA/Cr鉴别良性与交界性囊性EOT的曲线下面积(area under curve,AUC)分别为0.901和0.907。结论:卵巢良性和交界性囊性EOT的1H-MRS模式不同,Cho/Cr和NAA/Cr比值在交界性囊性EOT中明显高于良性肿瘤,是较好的鉴别诊断生物标记。

Objective: To investigate the ability of proton magnetic resonance spectroscopy(1H-MRS) in differentiating benign from borderline cystic epithelial ovarian tumors(EOTs). Methods: Sixty-four patients with surgically and histologically proven cystic EOT(33 benign and 31 borderline) underwent 1H-MRS. Single voxel spectroscopy(SVS) or multi-voxel 2D-chemical shift imaging(CSI) was performed using point-resolved echo spin spectroscopy(PRESS). Resonance peak integrals of choline(Cho), N-acetyl aspartate(NAA), creatine(Cr), lactate(Lac), and lipid(Lip) were analyzed and the Cho/Cr, NAA/Cr, Lac/Cr and Lip/Cr ratios were compared between the two groups using Mann-Whitney U test. Receiver operating characteristic(ROC) curve was used to evaluate the diagnostic performance of 1H-MRS in differentiating benign from borderline EOTs. Results: The mean Cho/Cr ratios of benign and borderline EOTs were 1.39±0.90 and 3.31±1.60, respectively, with a statistically significant difference between the two groups(P<0.001). The mean NAA/Cr ratios of benign and borderline EOTs were 2.54±2.20 and 9.43±5.20, respectively, with a statistically significant difference between the two groups(P<0.001). Area under the curves of Cho/Cr and NAA/Cr ratios was 0.901 and 0.907 for differentiating benign from borderline EOTs. Conclusion: The 1H-MRS patterns of benign and borderline cystic EOTs are different. The Cho/Cr and NAA/Cr ratios are higher in borderline EOT than benign cystic EOT and are perfect differential biomarkers.