Amide proton transfer imaging for differentiating benign ovarian cystic lesions: Potential of first time right

Purpose: To investigate whether amide proton transfer (APT) imaging is useful to differentiate benign ovarian cystic lesions. Materials and methods: This prospective study enrolled a total of 19 lesions in 18 patients with benign ovarian cystic lesion: serous cystadenoma (SCA), n = 4; mucinous cystadenoma (MCA), n = 9; or functional cyst (FC), n = 6. APT imaging was performed with three different presaturation pulse durations: 0.5, 1.0 and 2.0 s. APT signal was defined as magnetization transfer ratio asymmetry at 3.5 ppm. The SI ratios of cyst to muscle calculated on T1- and T2-weighted images were defined as T1- and T2-ratios. Apparent diffusion coefficient (ADC) maps were also generated. We compared the three cystic lesion groups’ APT signals, T1-ratio, T2-ratio, and ADC. Results: When using 2.0 s of presaturation, the APT signals were 1.41 ± 0.71% in SCA, 5.15 ± 1.92% in MCA and 8.52 ± 1.17% in FC. Significant differences were observed between SCA and MCA (p <.01) and MCA and FC (p <.05), as well as between SCA and FC (P <.0001). When 1.0 s presaturation pulse was used, similar results were obtained. On the other hand, ADC value shows significance only between SCA (2.91±0.03×10⁻³ mm²/s) and MCA (2.59 ± 0.49 × 10⁻³ mm²/s, p <.05). Further, there was no significant difference in the T1-ratio, T2-ratio among the three groups. Conclusions: APT imaging might be useful for the non-invasive diagnosis of benign ovarian cystic lesions. With the use of the longer presaturation pulse as possible, APT imaging may provide an early and correct diagnosis of ovarian cystic lesions without additional follow-up studies.