1H-magnetic resonance spectroscopy: a new technique to discriminate benign from malignant ovarian tumors

BACKGROUND

Currently used techniques such as ultrasound, computed tomography, and magnetic resonance imaging are not fully capable of differentiating benign from malignant ovarian tumors. Magnetic resonance spectroscopy (MRS) may help solve this clinical problem by analyzing the composition of fluid from ovarian cysts.

METHODS

The authors studied fluid samples from 28 different ovarian cysts. Nine patients were found to have a malignant ovarian tumor whereas 19 patients had benign cysts. Single pulse 1H-Nuclear Magnetic Resonance spectra were obtained in all fluid samples.

RESULTS

Compared with the group of benign epithelial cysts (n = 17) the 8 malignant epithelial ovarian cysts had significantly higher levels of lactate, isoleucine, valine, 3-hydroxybutyric acid, methionine, and alanine (P < 0.05). In two benign cysts (endometrioma and mature teratoma) surprisingly high levels were found for a large number of compounds. Values were as high as 100-fold the values in fluid from benign cysts.

CONCLUSIONS

1H-NMR spectroscopy demonstrates significant differences in metabolite concentration between benign and malignant ovarian cysts. This ultimately may lead to the noninvasive differential diagnosis of ovarian tumors by in vivo MRS.

Staging urinary bladder cancer after transurethral biopsy: value of fast dynamic contrast-enhanced MR imaging

PURPOSE

To evaluate contrast enhancement patterns of urinary bladder cancer and surrounding structures and to evaluate a fast dynamic first-pass magnetic resonance (MR) imaging technique in tumor and node staging and in differentiation of urinary bladder cancer from postbiopsy effects.

MATERIALS AND METHODS

Sixty-one consecutive patients with histologically proved urinary bladder cancer were referred to undergo unenhanced and dynamic MR imaging 1-4 weeks after transurethral resection or biopsy. Subtraction and time (to beginning of enhancement) images were acquired.

RESULTS

Results with unenhanced T1- and T2-weighted images were compared with those obtained with the unenhanced images plus dynamic contrast material-enhanced single-section turbo fast low-angle shot (FLASH) images. Urinary bladder cancer started to enhance 6.5 seconds +/- 3.5 (standard deviation) after the beginning of arterial enhancement, which was 4 seconds earlier than most other structures (postbiopsy tissue, 13.6 seconds +/- 4.2). In differentiation of postbiopsy tissue from malignancy on the basis of the beginning of enhancement depicted on time and subtracted images, accuracy improved from 79% to 90% (P < .02) and specificity improved from 33% to 92% (not significant). Overall, tumor staging accuracy improved significantly from 67% to 84% (P < .01) by adding the turbo FLASH images.

CONCLUSION

Fast dynamic first-pass MR imaging, with at least one image acquired every 2 seconds, improved delineation of urinary bladder cancer, tumor staging, and detection of metastases.

Mandibulofacial dysostosis: CT findings of the temporal bones

Six patients of two families with clinically suspected and genetically proven Treacher Collins syndrome and hearing loss were studied by CT of the temporal bone. The objective of this study was to detect the abnormalities and to show the variation of expression of abnormalities. We found a high incidence of asymmetry in the different ear malformations and a slightly lower incidence of some other classical features, probably due to our patient selection.

The role of yearly chest radiography in the early detection of lung cancer following oral cancer

In a study of 213 patients with oral cancer, we investigated the incidence and prognosis of lung malignancies in patients offered a yearly chest radiography in the follow-up. Three conclusions can be drawn. (1) Metastatic or primary lung cancer was diagnosed in 22 (10.3%) patients. The 2-year actuarial incidence rate of lung cancer following cancer of the oral cavity is 13%. No new lung cancers were detected after 2 years follow-up. This suggests that after this period, yearly chest radiography may be superfluous for the early detection of lung cancer. (2) The survival rate of patients with a lung malignancy following cancer of the oral cavity is poor (1-year = 25%). The survival rate of patients detected by the yearly chest radiography without symptoms is higher than for patients detected after symptoms (p = 0.006). It is not clear to what extent this different survival rate is biased by lead-time and selection of patients with a favourable prognosis. A randomized study would be required to assess whether patients with oral cancer do benefit from the yearly chest radiography compared with no regular chest radiography. (3) Of 22 patients with lung cancer, 13 (59%) were detected by chest radiography without symptoms. In the first year following oral cancer, 11 patients were diagnosed with lung cancer. Only 4 of these 11 patients (36%) were detected by chest radiography in an asymptomatic stage. The detection of patients with lung cancer in an asymptomatic stage may be increased by more frequent chest radiography examinations in the 1st year following oral cancer.