In vivo magnetic resonance spectroscopy of gynaecological tumours at 3.0 Tesla

Background  Magnetic resonance spectroscopy (MRS) uses the same hardware as MR imaging and allows us to analyse the biochemistry of tissues in vivo . Published data for gynaecological lesions are limited and are largely based on MRS carried out at the lower magnetic field strength of 1.5 Tesla (T).
Objective  The purpose of this study was to determine whether in vivo proton MRS could be performed at the higher magnetic field strength of 3 T to characterise the spectra of a variety of benign and malignant gynaecological lesions.
Design  Prospective, non-randomised study.
Setting  MRI department within a tertiary referral centre for gynaecological cancers.
Sample  All women with a pelvic mass under going 3T MRI.
Methods  We carried out MRS on nonrandomised women undergoing routine 3 T MRI within our MRI department during investigation for gynaecological lesions from February 2006 to April 2008. Only those women for whom histopathological data were available were included.
Main outcome measures  The presence of choline detected by in vivo 3T MRS.
Results  Eighty-seven women underwent MRS, 57 of whom had newly diagnosed neoplasms. MRS data for 39 of these new women (18 were excluded because of technical errors or missing data) were used to detect the presence of choline, an indicator of basement membrane turnover. Overall, choline was present in 13 of the 14 ovarian cancers, 8 of the 11 cervical tumours and all 4 of the uterine cancers. There was no statistical significant difference between choline levels in various lesion types ( P = 0.735) or between benign and malignant disease ( P = 0.550).
Conclusions  In vivo MRS can be performed at 3 T to provide biochemical information on pelvic lesions. The way in which this information can be utilised is less clear but may be incorporated into monitoring tissue response in cancer treatments.     

In vivo proton magnetic resonance spectroscopy in the evaluation of the endometrium

BACKGROUND: The purposes of this study were to compare proton magnetic resonance (MR) spectroscopic evaluation of the endometrium with histology obtained by endometrial biopsy in women undergoing diagnostic curettage and to determine whether screening with MR spectroscopy (MRS) might be useful in the evaluation of the endometrium. METHODS: Twenty-three consecutive women who were scheduled for endometrial biopsy were included in the study. The women were evaluated by MRS, performed immediately before the endometrial biopsy. The MRS results were compared with the histological findings obtained from the endometrial biopsy. RESULTS: All of the cases were proven by pathological examination, and their diagnoses were secretory endometrium (11 cases), proliferative endometrium (seven cases) and disordered proliferative endometrium (five cases). The characteristically obtained signals of choline (Cho) and lipid were detected in all subjects in the secretory endometrium group. In the same group, eight patients showed lactate signals and six showed creatine (Cr) signals. In the disordered proliferative endometrium group, four patients showed lipid plus Cho signals. Two patients in the same group demonstrated both lactate and Cr signals. All patients in the proliferative endometrium group showed Cho signals, two patients demonstrated lactate plus Cho signals, and none of the patients in this group showed lipid and Cr signals. CONCLUSION: Proton magnetic resonance spectra can register certain metabolic differences in human endometrium in its different stages.     

A comparative study of pre-operative procedures to assess cervical invasion by endometrial carcinoma

Objective To compare the accuracy of different diagnostic procedures currently used to assess cervical involvement in endometrial carcinoma.
Design Retrospective observational study.
Setting Department of Obstetrics and Gynecology, Shinshu University Hospital, Matsumoto, Japan.
Participants Sixty-four patients with endometrial carcinoma were evaluated pre-operatively for cervical involvement by six different diagnostic procedures: cervical cytology, endocervical curettage, transvaginal ultrasonography, hysteroscopy, magnetic resonance imaging, and serum levels of CA125. The number of positive and negative diagnoses of cervical invasion by each of these procedures were correlated with the actual invasion determined by histological examination.
Results Cervical invasion was confirmed in 12 (18.8%). Endocervical curettage showed high sensitivity (91%), the highest negative predictive value (96%), and the lowest negative likelihood ratio (0.14). Hysteroscopy showed high positive likelihood ratio (8.2) and low negative likelihood ratio (0.20). Magnetic resonance imaging showed the highest positive predictive value (75%) and the highest positive likelihood ratio (12.5). Magnetic resonance imaging was excellent for predicting stromal invasion, whereas hysteroscopy was superior for assessing mucosal involvement to magnetic resonance imaging.
Conclusion Endocervical curettage is a good test for excluding cervical involvement by endometrial carcinoma. Hysteroscopy is a good test in making both positive and negative diagnoses for cervical involvement. Magnetic resonance imaging is an excellent test for detecting cervical involvement, especially when the stroma is invaded.     

Pre-operative magnetic resonance imaging of stage 1 endometrial adenocarcinoma

Twelve women with stage I endometrial adenocarcinoma were examined by magnetic resonance imaging before definitive surgery. Using this technique the depth of myometrical invasion, tumour site and cervical involvement were assessed and the results compared with the operative and pathological findings. Magnetic resonance imaging is a unique non-invasive method of assessing the early stages of endometrial adenocarcinoma before radiotherapy and surgery.     

Preoperative assessment of deep myometrial and cervical invasion in endometrial carcinoma: Comparison of magnetic resonance imaging and gross visual inspection

Abstract. Cunha TM, Félix A, Cabral I. Preoperative assessment of deep myometrial and cervical invasion in endometrial carcinoma: Comparison of magnetic resonance imaging and gross visual inspection.
This study aimed to evaluate the accuracy of magnetic resonance imaging (MRI) in the detection of deep myometrial invasion and cervical extension by endometrial carcinoma. We also aimed to compare MRI results to surgical staging of endometrial carcinoma. Forty women with a histologic diagnosis of endometrial carcinoma underwent a preoperative pelvic MRI. In 33 cases intraoperative gross visual inspection (GVI) of the surgical specimen was also evaluated. The results obtained were compared with the histologic diagnosis. Pathologic evaluation of the myometrium determined that superficial invasion was present in 25 patients and deep invasion in 15. The uterine cervix was found to be involved in 12 cases. The accuracy, sensitivity, and specificity of MRI and GVI were 93%/91%, 80%/77%, and 100%/100%, respectively, in detecting deep myometrial invasion and 80%/79%, 33%/36% and 100%/100%, respectively, in determining cervical invasion. When the Kappa statistical measurement was applied, the results from each technique, MRI and GVI, showed an agreement on the evaluation of myometrial and cervical invasion by endometrial carcinoma. In conclusion, MRI, in this series, was demonstrated to be a reliable method for preoperative endometrial carcinoma "imagiological staging". The high accuracy achieved by MRI and GVI suggests that they may be used interchangeably.     

Magnetic resonance spectroscopy of premalignant and malignant endometrial disorders: a feasibility of in vivo study

OBJECTIVE: To assess the potential clinical utility of in vivo proton magnetic resonance spectroscopy (MRS) in patients with various endometrial lesions. METHODS: Twelve patients with untreated uterine bleeding were included in this study. In-vivo proton MRS was performed using a 1.5 T MR scanner. The metabolite levels were classified into three classes in comparison with the noise level by visual examination. All the patients have endometrial biopsy. For each type of lesions, chemical compound were described. RESULTS: Pathological examination resulted in three endometrial cancer, two simple hyperplasias, one complex hyperplasia, two partial hydatiform mole, two proliferative endometrium and two secretory endometrium. In women with endometrial carcinoma, high choline and lipid signals were detected, whereas no creatine and no lactate signals were found. In women with endometrial hyperplasia, choline signal was detectable in all cases but one case showed lactate signal in addition to choline. In women with partial hydatidiform mole, the only detectable signal was choline. Lipid signals were detected in none of the cases with endometrial hyperplasia and partial hidatidiform mole. In women with either secretory or proliferative endometrium, choline and lactate signals were detectable in all cases but one case showed solely choline. Lipid signals were not detected in any of subjects with secretory or proliferative endometrium. CONCLUSION: The observed difference is the presence of lipid signal only in endometrial carcinoma.     

子宫内膜组织人乳头瘤病毒感染的初步研究

目的了解正常子宫内膜，宫颈癌患者子宫内膜以及子宫内膜癌组织HPV感染情况。方法选择HPVL1区改良通用型引物Gp5＋／Gp6＋，通过HPV—DNA扩增和DNA测序法，对2004年9月-2006年3月我院妇科收治的25例宫颈癌、30例子宫内膜癌患者的石蜡包埋组织进行HPV检测，以20例子宫肌瘤患者作为对照组。每例宫颈癌取癌组织及正常子宫内膜；每例内膜癌取癌组织及正常宫颈粘膜；每例子宫肌瘤取正常子宫内膜及宫颈粘膜。结果①25例宫颈癌病例中，16例宫颈癌组织及1例子宫内膜组织检测出HPV感染。这例子宫内膜与其相应的宫颈癌组织均为HPV-16型感染；②30例子宫内膜癌组织及其相应的宫颈粘膜组织均未检测出HPV—DNA，检出率均为0（0／30）；③对照组正常子宫内膜及宫颈粘膜均未检出HPV—DNA，检出率均为0（0／20）。结论①子宫内膜HPV感染很少，说明其可能不是HPV复制、成熟的适宜宿主组织；②宫颈癌患者子宫内膜组织的HPV可能由上行感染所致，但感染率较低；③子宫内膜癌的发生、发展可能与HPV无关。     

A comparative analysis of cross sectional imaging techniques in minimal deviation adenocarcinoma of the uterine cervix

A pre-operative diagnosis of minimal deviation adenocarcinoma of the cervix is often difficult. We assessed transvaginal sonography, computed tomography and magnetic resonance imaging in 16 women with histologically confirmed minimal deviation adenocarcinoma. Increased fluid accumulation was frequently observed within the endometrial cavity and/or vagina by all three techniques. A multicystic cervical lesion was occasionally detected by transvaginal sonography or by computed tomography. On T₂-weighted magnetic resonance images, a noncystic fine villous or multicystic lesion was noted in most cases. Among the three imaging techniques used, T₂-weighted magnetic resonance images showed the most detailed features and the best correlation with the histology.     

Proton magnetic resonance spectroscopy findings of a sacrococcygeal schwannoma

Abstract.   Hascalik S, Celik O, Erdem G, Ara C, Kirimlioglu H. Proton magnetic resonance spectroscopy findings of a sacrococcygeal schwannoma. Int J Gynecol Cancer 2006; 16(Suppl. 1): 344–348.
Schwannoma is tumor of peripheral nerves, originating from Schwann cells. It is a rare nerve sheath tumor, which frequently occurs in the intracranial acoustic nerve and spinal nerves. We report on a 28-year-old woman who suffered from a large pelvic mass that was diagnosed to be sacrococcygeal schwannoma. The features of proton magnetic resonance spectroscopy (MRS) study are discussed. The magnetic resonance imaging instrument was a 1.5T, Gyroscan Intera with a body coil as a radiofrequency transmitter and a signal receiver. T2-weighted images were obtained under the following conditions—turbo spin echo (TSE) T2: turbo spin echo repeat time (TR) = 4500 msec, echo time (TE) = 96 msec. Single voxel MRS was performed by the point-resolved spectroscopy technique with a long TE (136 msec). MRS measurement was performed on two different parts of the tumor. As well as strongly elevated choline and lipid signals, the tumor spectrum showed increased N -acetylaspartate resonances. MRS can be used effectively in the preoperative diagnosis of retroperitoneal and pelvic masses, which demonstrate unusual clinical features.     

岩藻糖基抗原在宫颈鳞癌的表达及意义

目的 探讨人宫颈鳞癌组织的岩藻糖基(fucose，Fuc)化的水平及其意义。方法 1992年1月至1996年12月采用凝集素组织化学染色技术，以能与糖链α—Fuc特异性结合的生物素标记的荆豆凝集素(biotinylated ulex europeaus agglutinin，BUEA)检测了100例宫颈鳞癌、150例宫颈不典型增生及50例正常宫颈组织的Fue表达，应用图像分析系统定量分析其表达水平。结果 Fuc在非癌组织中无表达，在宫颈癌组织中的表达率为76％，Fuc在细胞分化程度低、临床分期晚、有转移、复发及预后差的患者中的显著高表达(P＜0．01或{＜0.05)。结论 Fuc的表达可作为反映宫颈癌恶性潜能和患者预后的一项新的指标。     

Magnetic resonance imaging in endometrial carcinoma staging

Correct evaluation of myometrial infiltration is essential in patients with stage I and II endometrial cancer who are candidates for hysterectomy without lymphadenectomy, if extensive infiltration of the myometrium is not present. The aim of this study was to evaluate the use of magnetic resonance imaging (MRI) to improve staging of patients with endometrial cancer. Thirty patients with histological diagnosis of endometrial cancer were studied with MRI at 1.5 T and subsequently underwent abdominal hysterectomy. The MRI results were compared with those of the histological tests. MRI was performed with a 1.5-T magnet and spin-echo (SE) technique [repetition time/echo time (msec) = 2.000/35-90]. Contiguous 4-mm sections of were obtained from the sagittal plane. Clinical staging was not confirmed in two patients who presented with cervical extension of the tumor. The overall accuracy of MRI in determining the grade of myometrial and cervical invasion was 86 and 90%, respectively.     

Reliability of diagnostic fluid hysteroscopy in the assessment of cervical invasion by endometrial carcinoma: a comparative study with transvaginal sonography and MRI

ObjectiveThis study aimed at comparing the reliability of diagnostic fluid hysteroscopy, transvaginal sonography (TVS), and magnetic resonance imaging (MRI) to assess pre-operatively the presence of cervical involvement by endometrial carcinoma.MethodsCervical involvement was assessed by diagnostic fluid mini-hysteroscopy, TVS and MRI before surgery in 100 patients with histological diagnosis of endometrial carcinoma. Results were compared with pathological examination on surgical specimen. The sensitivity, the specificity, the positive and negative predictive values, the accuracy, the positive and negative likelihood ratios (LR) of the three techniques for recognizing the cervical involvement by the carcinoma were calculated.ResultsAt histology cervical involvement was found in 15 cases. Compared to TVS and MRI, hysteroscopy showed the highest sensitivity (0.53, 0.67 and 0.93, respectively). The specificity of MRI was significantly higher than both hysteroscopy and TVS (0.95, 0.88 and 0.82, respectively). The diagnostic accuracy of hysteroscopy (0.89) and MRI (0.91) was similar and significantly higher than TVS (0.78). The LR for a positive result of MRI was 14.16, that was 2.08 and 4.68 times higher than that of hysteroscopy and TVS, respectively.ConclusionsIn conclusion, this study demonstrates that in women with endometrial carcinoma the exclusion of cervical canal involvement at hysteroscopy is more reliable than at MRI and TVS while MRI is the most reliable technique for predicting cervical involvement. In the pre-surgical work-up of patients affected by endometrial carcinoma hysteroscopy and MRI are both useful for staging and planning the correct surgical strategy.     

Metabolic changes in pelvic lesions: findings at proton MR spectroscopic imaging

OBJECTIVE: The purpose of this study is to investigate the in vivo magnetic resonance spectroscopic (MRS) features of pelvic lesions using long echo time and to characterize the spectral patterns of various pathological entities. MATERIALS AND METHODS: 17 patients with surgically and histopathologically confirmed pelvic lesions underwent long echo-time MRS, and the results obtained were analyzed. Before laparotomy, choline (Cho), lactate, lipid and creatine (Cr) levels of all lesions were measured by single voxel MRS (point-resolved spectroscopy technique, TE 136 ms). Voxels were placed in the center of the lesions. The MRS results of lesions were compared with the final histopathological diagnoses. RESULTS: Spectroscopy analysis of serous, mucinous and undifferentiated carcinoma of the ovary revealed Cho, lactate and lipid signals, but granulosa-theca cell tumor showed only a lipid signal. The Cho signal was obtained from only 3 patients with mature cystic teratoma but none of the other benign ovarian tumors and pelvic abscesses. A lipid signal was detected in 3 patients diagnosed with pelvic abscess and all benign ovarian tumors. In addition to the lipid signal, a lactate signal was detected in the spectra of two pelvic abscesses. One case of endometrioma and 1 case of teratoma did not show any signal. CONCLUSION: MRS demonstrates significant differences in metabolite concentration between benign and malignant ovarian tumors and pelvic abscesses. MRS may therefore be helpful in the differential diagnosis of adnexal lesions.     

Clinical application of magnetic resonance imaging in gynecology

Thirty-five women were examined with female pelvic magnetic resonance imaging (MRI). 5 cases demonstrated normal pelvis structures, 3 had physiological atrophic changes, and one had an underdeveloped uterus. The other 26 cases consisted of 8 leiomyoma of uterus, 11 ovarian benign tumor, 3 ovarian cancer, 2 cervical and 2 endometrial carcinoma. Images of normal uterus as well as those pathological conditions mentioned above were depicted, and compared with the operative findings. By means of MRI, we were able to demonstrate the origin of most of the pelvic masses, number, size and location of leiomyoma, myometrial penetration, parametrial extension and lymph node metastasis of endometrial carcinoma. Cervical malignancy could be accurately staged, and serous cyst was possibly distinguished from hemorrhagic cyst. However, one case of mucinous cystadenoma was misdiagnosed as dermoid cyst; one myoma, 1 cm in diameter, in same density as the uterine muscle was overlooked and one mesonephroma of 0.3 cm in diameter situated deep in the cervical fibrous tissue was not detected.     

钙通道TRPV6基因在子宫内膜癌表达及其临床意义的初步研究

目的:研究TRPV6在子宫内膜癌组织的表达及其与临床病理特征的关系。方法:选取58例子宫内膜癌石蜡切片,用免疫组化法测定TRPV6的分布及表达,分析其与临床病理之间的关系;另取31例正常子宫内膜及13例不典型增生内膜石蜡切片为对照。选取15例子宫内膜腺癌及11例正常子宫内膜新鲜组织标本,以实时定量PCR方法检测TRPV6的表达。结果:(1)TRPV6在子宫内膜癌组织的表达主要位于胞膜及胞浆内,阳性表达率77.6%,显著低于非绝经期子宫内膜组织(100%)及不典型增生子宫内膜组织(100%)(P0.05),且前者表达强度显著低于后二者(P0.01)。mRNA水平研究表明TRPV6在内膜癌组织中的表达也显著低于正常内膜组织(P0.05);(2)绝经后子宫内膜癌患者TRPV6阳性表达率为71.8%,显著低于未绝经患者(89.5%);(3)在子宫内膜癌组织中,宫颈受累者TRPV6阳性率显著高于宫颈未受累者(89.3%vs 67.7%,P=0.039)。结论:TRPV6在子宫内膜癌组织的表达低于正常子宫内膜组织,TRPV6阳性表达者较多发生子宫内膜癌宫颈受侵,表明钙通道蛋白TRPV6与子宫内膜癌有一定的关系,为探讨子宫内膜癌发病分子机制提供了研究资料。     

The role of MRI in the conservative management of endometrial cancer

BACKGROUND: Young patients with endometrial cancer who desire to preserve their fertility often decline hysterectomy in favor of conservative progestin therapy. Proper candidates should have disease confined to the uterus and a well-differentiated tumor. One of the evolving techniques to evaluate the extent of the disease and myometrial or cervical invasion is magnetic resonance imaging (MRI). CASE: A young patient with early-stage endometrial cancer initially declined surgery and was treated with megestrol. MRI suggested myoinvasion, and the patient consented to surgical staging. The final pathology revealed no residual carcinoma. CONCLUSIONS: The accuracy of MRI in detecting myoinvasion is limited, and as such results should be interpreted with caution when this information is used in counseling a young patient regarding surgical staging for endometrial cancer.     

31P magnetic resonance spectroscopy of the liver in HELLP syndrome.

OBJECTIVES: Using magnetic resonance spectroscopy (MRS) to measure phosphorus-containing metabolites in the liver, this study aimed to investigate non-invasively whether or not women with haemolysis, elevated liver enzymes and low platelets (HELLP) have detectable abnormalities of hepatic energetics. SETTING: John Radcliffe Hospital, Oxford. DESIGN: Prospective study. METHODS: After giving informed consent, patients with HELLP syndrome (n = 7) and controls with severe pre-eclampsia (n = 3), were studied by 31P MRS of the liver as soon as possible after delivery (range 2-4 days) and compared with normal nonpregnant controls (n = 6). Haematological and biochemical tests were performed serially and on the day of the MRS in all pregnant patients. RESULTS: The severity of HELLP varied as follows: peak aspartate aminotransferase (range 129-2574), peak gamma glutamyl transferase (range 28-96), peak lactate dehydrogenase (range 305-2820), nadir platelets (range 25-114), peak international normalised ratio for prothrombin time (before fresh frozen plasma) (range 0.9-1.9). One pregnancy was terminated but all others resulted in live births and all mothers made uneventful, rapid recoveries. MRS-determined relative hepatic concentrations of phosphorus-containing metabolites and absolute concentrations of adenosine triphosphate did not differ significantly between groups. One patient with the most clinically severe HELLP syndrome (by laboratory criteria) exhibited magnetic resonance spectra which showed a relative increase in phosphomonoester and an absolute decrease in hepatic adenosine triphosphate (to 62% of control). CONCLUSIONS: Enthusiasm for the conservative management of HELLP syndrome that develops remote from term has been tempered by the inability to identify patients at risk for progression to hepatic necrosis. We found that most patients with HELLP syndrome had normal liver metabolism as assessed by MRS. However, clinically severe HELLP syndrome can be associated with disturbed hepatic metabolism consistent with that seen in hepatic ischaemia and/or granulocytic infiltration of the liver.     

Magnetic resonance imaging in stage I endometrial carcinoma

A prospective study was conducted on 50 consecutive patients with stage I endometrial cancer who had primary surgical treatment. The purpose of the study was to assess the value of magnetic resonance imaging (MRI) for accurate staging of early disease and determination of myometrial invasion. Features identified by MRI were correlated with surgical pathology. Preliminary MRI results provided additional valuable information. All but one of 18 patients with histologically proven deep myometrial invasion were predicted preoperatively by MRI. Of 17 patients with detached fragments of malignant tissue in the endocervical curettage (ECC) but with results inconclusive for actual cervical invasion, MRI revealed all three patients with true cervical tissue involvement. Magnetic resonance imaging detected all six patients with gross extrauterine spread and also precisely measured uterine enlargement by myomata. The extent and location of tumor growth in the uterus could be mapped out in the majority of cases. Based on these findings, a pretreatment MRI scan of the pelvis in presumably stage I endometrial carcinoma resulted in an advance in staging in 18% of the patients, and accurately predicted deep myometrial invasion in 94% of the cases. Inclusion of MRI in the routine work-up in stage I endometrial carcinoma should be considered for proper clinical staging, particularly in patients with a positive but nondiagnostic ECC, uterine papillary serous carcinoma, or grade 3 tumor.     

Application of 1.5 T magnetic resonance imaging in endometrial cancer

Objective  

To determine the diagnostic accuracy, sensitivity and specificity of magnetic resonance imaging (MRI) in detecting myometrial invasion, cervical involvement and disease stage in endometrial cancer.     

Gynecologic masses: value of magnetic resonance imaging

Forty-two women with gynecologic abnormalities were studied with the use of magnetic resonance imaging. Magnetic resonance imaging correctly assessed the origin of the pelvic mass in all patients. In the evaluation of leiomyoma, magnetic resonance imaging accurately depicted the number, size, and location of the lesion. In the evaluation of endometrial carcinoma, magnetic resonance imaging depicted the location of the lesion, the presence of cervical extension, and the depth of myometrial penetration in the majority of the cases. In the analysis of adnexal cysts, magnetic resonance imaging was sensitive in localizing the lesion and was able to distinguish serous from hemorrhagic fluid. This preliminary report indicates that magnetic resonance imaging may become a valuable imaging modality in the diagnosis of gynecologic abnormalities.