The paired Mullerian or paramesonephric ducts fuse between 6 and 11 weeks of gestation to form uterus, cervix and upper two-thirds of vagina. Mullerian duct anomalies (MDA) result from disruption in any of the three stages of uterine development, i.e. organogenesis, fusion or septal resorption. 1 Ovaries develop from primordial germ cells, while lower one-third of vagina develops from sinovaginal bulb. Owing to the different embryological origins, ovaries and lower third of vagina are not involved in MDA. 2 The prevalence of MDA is reported to be 1-5%. 2 American Fertility Society (AFS), has classified MDA into seven basic types, from Type I to Type VII. 3 Out of these seven types, Type I MDA also called as Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome, which reportedly accounts for nearly 15% of total case load. 2 MRKH syndrome is characterized by complete/partial agenesis of uterus and upper two-thirds of vagina, with normal bilateral ovaries,
Background
The aim of our study was to determine the value of single-voxel proton MR spectroscopy (1HMRS) in distinguishing benign from malignant focal bone lesions in the peripheral skeleton. MRI and 1HMRS was performed in 50 focal lesions (> 1 cm size) detected on radiographs of peripheral skeleton.1HMRS was performed at 1.5 T with TE of 144 ms with automatic shimming and water suppression. Qualitative analysis for a discrete choline peak at 3.2 ppm was done. Significance of the presence of choline peak on 1HMRS in distinguishing benign from malignant lesions was calculated using histopathology as a gold standard. Chi-square test was used and p value < 0.05 was considered significant.
Results
Forty-one benign and 9 malignant lesions were confirmed by histopathological results. Amongst malignant lesions, choline peak was positive in all but 1 case of low-grade lymphoma. MR spectra of 11 benign lesions showed the presence of choline peak. All 7 benign giant cell tumors (GCT) were positive for choline peak. The sensitivity, specificity, PPV, NPV of proton MR spectroscopy in differentiating benign from malignant lesions were 87.5%,71%,38.8%, and 96.4% respectively. p value was significant (< 0.05).
Conclusion
1HMRS in focal bone lesions can help in the differentiation of malignant from benign musculoskeletal tumors. Although some benign lesions may show false-positive result, absence of choline peak is a reliable reassurance against malignancy. GCT is an exception amongst benign bone tumors as it consistently shows the presence of choline peak on 1HMRS.
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