Ytre-Hauge Sigmund, Esmaeili Morteza, Sjøbakk Torill E, Grüner Renate, Woie Kathrine, Werner Henrica M, Krakstad Camilla, Bjørge Line, Salvesen Øyvind O, Stefansson Ingunn M, Trovik Jone, Bathen Tone F, Haldorsen Ingfrid S
1 Department of Radiology, Haukeland University Hospital, Bergen, Norway.
2 Section for Radiology, Department of Clinical Medicine, University of Bergen, Bergen, Norway.
Acta Radiol. 2018 Apr;59(4):497-505. doi: 10.1177/0284185117733297. Epub 2017 Sep 19.
Background In vivo magnetic resonance spectroscopy (MRS) enables non-invasive measurements of tumor metabolites. Choline-containing metabolites play a key role in tumor metabolism. Purpose To explore whether preoperative MRS-derived tumor choline levels are associated with clinical and histological features in endometrial carcinomas. Material and Methods Preoperative pelvic magnetic resonance imaging (MRI) (1.5T), including structural and diffusion-weighted imaging and localized multivoxel proton MR (1H-MR) spectroscopy, was performed in 77 prospectively included patients with histologically confirmed endometrial carcinomas. Relative levels of total choline-containing metabolites (tCho) in tumor and myometrium were measured using the ratios: tCho/Creatine; tCho/Water; and tCho/Noise. MRS parameters were analyzed in relation to histological subtype and grade, surgicopathological staging parameters, MRI-measured tumor volume, and tumor apparent diffusion coefficient (ADC) value and clinical outcome. Results Tumor tissue had significantly higher ratios for tCho/Creatine, tCho/Water, and tCho/Noise than normal myometrial tissue ( P < 0.001 for all). High tumor tCho/Water ratio was significantly associated with high tumor grade in endometrioid tumors ( P = 0.02). Tumor tCho/Creatine ratio was positively correlated to MRI-measured tumor volume (r = 0.25; P = 0.03). Conclusion High choline levels in tumor are associated with high-risk features. In vivo MRS may potentially aid in the preoperative risk stratification in endometrial cancer.
背景 活体磁共振波谱成像（MRS）能够对肿瘤代谢物进行非侵入性测量。含胆碱的代谢物在肿瘤代谢中起关键作用。目的 探讨术前MRS得出的肿瘤胆碱水平是否与子宫内膜癌的临床和组织学特征相关。材料与方法 对77例经组织学确诊为子宫内膜癌的前瞻性纳入患者进行术前盆腔磁共振成像（MRI）（1.5T）检查，包括结构成像、扩散加权成像以及局部多体素质子磁共振（1H-MR）波谱成像。使用以下比值测量肿瘤和肌层中总含胆碱代谢物（tCho）的相对水平：tCho/肌酸；tCho/水；以及tCho/噪声。分析MRS参数与组织学亚型和分级、手术病理分期参数、MRI测量的肿瘤体积、肿瘤表观扩散系数（ADC）值以及临床结局的关系。结果 肿瘤组织的tCho/肌酸、tCho/水和tCho/噪声比值显著高于正常肌层组织（所有P均<0.001）。在子宫内膜样肿瘤中，高肿瘤tCho/水比值与高肿瘤分级显著相关（P = 0.02）。肿瘤tCho/肌酸比值与MRI测量的肿瘤体积呈正相关（r = 0.25；P = 0.03）。结论 肿瘤中高胆碱水平与高危特征相关。活体MRS可能有助于子宫内膜癌的术前风险分层。
