In vivo proton (H1) magnetic resonance spectroscopy for cervical carcinoma

Proton magnetic resonance spectroscopy (MRS) may be a useful tool in both t he initial diagnosis of cervical carcinoma and the subsequent surveillance after radiation therapy, particularly when other standard diagnostic method s are inconclusive. Single voxel magnetic resonance (MR) spectral data were acquired from 8 normal volunteers, 16 patients with cervical cancer before radiation therapy, and 18 patients with cervical cancer after radiation th erapy using an external pelvic coil at a 1.5-T on a Signa system. The prese nce or absence of various resonances within each spectrum was evaluated for similarities within each patient group and for spectral differences betwee n groups. Resonances corresponding to lipid and creatine dominated the spec trum for the eight normal volunteers without detection of a choline resonan ce. Spectra from 16 pretreatment patients with biopsy-proven cervical cance r revealed strong resonances at a chemical shift of 3.25 ppm corresponding to choline. Data acquired from the 18 posttreatment setting studies was var iable, but often correlated well with the clinical findings. Biopsy confirm ation was obtained in seven patients. H I MRS of the cervix using a noninva sive pelvic coil consistently demonstrates reproducible spectral difference s between normal and neoplastic cervical tissue in vivo. However, signal is still poor for minimal disease recurrence. Further study is needed at inte rvals before, during, and after definitive irradiation with biopsy confirma tion to validate the accuracy of MRS in distinguishing persistence or recur rence of disease from necrosis and fibrosis.