Background: It is crucial to rule out any cancer in an ovarian mass. Following initial diagnosis, it is the most essential issue and has a significant impact on how the patient will be managed. Therefore, an accurate way to distinguish between a benign and malignant ovarian mass would allow for the best clinical evaluation and could perhaps lessen the number of unneeded laparotomies performed on benign lesions disease.
Aim of the Work: This work aims to investigate the quantitative and qualitative characteristics of proton MR spectroscopy [1 H-MRS] and to assess the effectiveness of 1H-MRS for distinguishing benign from malignant ovarian/adnexal tumors.
Patients and Methods: Forty patients with spotted adnexal/ovarian masses on primary pelvic ultrasound check referred to radio-diagnosis department at Al-Azhar university Hospital and National Cancer Institute. Twenty cases were benign, two were doubtful, and 18 were malignant.
Results: Standard MRI exhibited an accuracy of 70.6%, a sensitivity of 81.2%, a specificity of 61.1%, a positive predictive value of 65%, and a negative predictive value of 78.6%. We found that concurrent occurrence of both Cho and lactate peaks [the noise level was twice as loud as usual] increases the statistical accuracy in distinguishing benign from malignant ovarian masses from 85.3% with Choline alone and from 50 % with Lactate alone, to 93 % if both of them are found together. In combination of conventional MRI and proton MRS, we found increasing whole diagnostic accuracy of MRI in description of ovarian neoplasms, with sensitivity 96.5%, specificity 92.7%, positive predictive value 90.5%, negative predictive value 89% and accuracy 90.6%.
Conclusion: In vivo H¹ MRS is a non-invasive MR method that has creditable advantage in diagnosis of ovarian lesions with high specificity and positive predictive value. Combined analysis of conventional MRI and MR spectroscopy can achieve excellent results.