Abstract
Purpose
To compare in vivo ^1^H magnetic resonance (MR) spectra of preinvasive and invasive cervical lesions with ex vivo magic angle spinning (MAS) spectra of intact biopsies from the same subjects and to establish the effects of tumor load in the tissue sampled on the findings.
Materials and Methods
A total of 51 subjects (nine with normal cervix, 10 with cervical intraepithelial neoplasia [CIN], and 32 with cervical cancer) underwent endovaginal MR at 1.5 T. Single‐voxel (3.4 cm^3^) ^1^H MR spectra were acquired and voxel tumor load was calculated (tumor volume within voxel as a percentage of voxel volume). Resonances from triglycerides –CH~2~ and –CH~3~ and choline‐containing compounds (Cho) were correlated with voxel tumor load. Biopsies analyzed by ^1^H MAS‐MR spectroscopy (MRS) had metabolite levels correlated with tumor load in the sample at histology.
Results
In vivo studies detected Cho in normal, CIN, and cancer patients with no significant differences in levels (P = 0.93); levels were independent of voxel tumor load. Triglyceride –CH~2~ and –CH~3~ signals in‐phase with Cho were present in 77% and 29%, respectively, of cancer subjects (but not in normal women or those with CIN), but did not correlate with voxel tumor load. Ex vivo cancer biopsies showed levels of triglycerides –CH~2~ and –CH~3~ and of Cho that were significantly greater than in normal or CIN biopsies (P < 0.05); levels were independent of the tumor load in the sample. The presence of –CH~2~ in vivo predicted the presence of cancer with a sensitivity and specificity of 77.4% and 93.8% respectively, positive (PPV) and negative (NPV) predictive values were 96% and 68.2%; for –CH~2~ ex vivo, sensitivity was 100%; specificity, 69%; PPV, 82%; and NPV, 100%.
Conclusion
Elevated lipid levels are detected by MRS in vivo and ex vivo in cervical cancer and are independent of tumor load in the volume of tissue sampled. J. Magn. Reson. Imaging 2004;19:356–364. © 2004 Wiley‐Liss, Inc.