Objective:

To investigate the ability of proton magnetic resonance spectroscopy (

1

H-MRS) in differentiating benign from borderline cystic epithelial ovarian tumors (EOTs).

Methods:

Sixty-four patients with surgically and histologically proven cystic EOT (33 benign and 31 border

line) underwent 1H-MRS. Single voxel spectroscopy (SVS) or multi-voxel 2D-chemical shift imaging (CSI) was performed using point-resolved echo spin spectroscopy (PRESS). Resonance peak integrals of choline (Cho)

N

-acetyl aspartate (NAA)

creatine (Cr)

lactate (Lac)

and lipid (Lip) were analyzed and the Cho/Cr

NAA/Cr

Lac/Cr and Lip/Crratios were compared between the two groups using Mann-Whitney U test. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic performance of

1

H-MRS in differentiating benign from borderline EOTs.

Results:

The mean Cho/Cr ratios of benign and borderline EOTs were 1.390.90 and 3.311.60

respectively

with a statistically significant difference between the two groups (

P

0.001). The mean NAA/Cr ratios of benign and borderline EOTs were 2.542.20 and 9.435.20

respectively

with a statistically significant difference between the two groups (

P

0.001). Area under the curves of Cho/Cr and NAA/Cr ratios was 0.901 and 0.907 for differentiating benign from borderline EOTs.

Conclusion:

The

1

H-MRS patterns of benign and borderline cystic EOTs are different. The Cho/Cr and NAA/Cr ratios are higher in borderline EOT than benign cystic EOT and are perfect differential biomarkers.