J Gynecol Oncol.  2011 Dec;22(4):275-287. 10.3802/jgo.2011.22.4.275.

Diffusion-weighted MR imaging in gynecologic cancers

• Motoshima
• Irie H
• Nakazono T
• Kamura T
• Kudo S

• KMID: 2173630
• DOI: http://doi.org/10.3802/jgo.2011.22.4.275

Abstract

Diffusion-weighted imaging (DWI) reflects changes in proton mobility caused by pathological alterations of tissue cellularity, cellular membrane integrity, extracellular space perfusion, and fluid viscosity. Functional imaging is becoming increasingly important in the evaluation of cancer patients because of the limitations of morphologic imaging. DWI is being applied to the detection and characterization of tumors and the evaluation of treatment response in patients with cancer. The advantages of DWI include its cost-effectiveness and brevity of execution, its complete noninvasiveness, its lack of ionizing radiation, and the fact that it does not require injection of contrast material, thus enabling its use in patients with renal dysfunction. In this article, we describe the clinical application of DWI to gynecological disorders and its diagnostic efficacy therein.

Keyword

Diagnosis; Diffusion magnetic resonance imaging; Gynecology; Magnetic resonance imaging; Neoplasms

MeSH Terms

Diffusion Magnetic Resonance Imaging
Extracellular Space
Gynecology
Humans
Magnetic Resonance Imaging
Membranes
Perfusion
Protons
Radiation, Ionizing
Viscosity
Protons

Figure

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  Fig. 1 Stage IC endometrioid adenocarcinoma grade 1 (G1) of the endometrium in a 30-year-old woman. The tumor (arrowheads) shows slightly high signal intensity on sagittal and axial T2-weighted imaging (A, B) and high signal intensity on axial diffusion-weighted imaging (C). Axial apparent diffusion coefficient (ADC) map (D) demonstrated low ADC values (0.75×10-3 mm2/sec). Arrow, right hydrosalpinx.

• 

  Fig. 2 Postoperative vaginal cuff recurrence of stage IVB endometrial carcinoma in a 66-year-old woman. Axial T2-weighted imaging shows a slightly high-signal lesion (arrowhead) on the right side of vaginal cuff (A). Axial diffusion-weighted imaging clearly depicts the lesion (B) and the apparent diffusion coefficient (ADC) map (not shown) demonstrated low ADC values (0.91×10-3 mm2/sec). The lesion is difficult to distinguish on contrast-enhanced-computed tomography (C).

• 

  Fig. 3 Uterine leiomyosarcoma and leiomyoma in a 72-year-old woman. Sagittal T2-weighted imaging shows an enlarged uterus with two solid lesions (arrowheads) (A). The upper lesion (arrowheads) shows low signal intensity on axial diffusion-weighted imaging (DWI) (B) and the apparent diffusion coefficient (ADC) map (C) demonstrated high ADC values (2.13×10-3 mm2/sec). The lower lesion (arrowheads) shows high signal intensity on axial DWI (D) and the ADC map (E) demonstrated low ADC values (0.67×10-3 mm2/sec). Pathological examination revealed leiomyoma in the upper lesion and leiomyosarcoma in the lower lesion.

• 

  Fig. 4 Stage IV serous papillary adenocarcinoma of right ovary in a 60-year-old-woman. MR images show huge lobulated, solid lesion (arrowheads) dorsal to the uterus. The lesion shows slightly low signal intensity on axial T2-weighted imaging (A) and very high signal intensity on axial (original) diffusion-weighted imaging (B). Apparent diffusion coefficient map (not shown) demonstrated low ADC values (0.75×10-3 mm2/sec).

• 

  Fig. 5 Right ovarian fibroma in a 37-year-old woman. MR images show lobulated, solid lesion (arrowhead) in the right adnexal region. The lesion shows low signal on axial T2-weighted imaging (A) and diffusion-weighted imaging (B). Apparent diffusion coefficient map (C) shows low values (0.96×10-3 mm2/sec), which is representing T2 blackout effect. U, uterus; arrow, right paraovarian cyst.

• 

  Fig. 6 Stage IIA squamous cell carcinoma of the cervix in a 54-year-old woman. Posterior lip of the cervix (arrowheads) shows high signal intensity on sagittal and axial T2-weighted imaging (T2WI) (A, B) and axial diffusion-weighted imaging (DWI) (C). The apparent diffusion coefficient (ADC) map (not shown) demonstrated low ADC values (0.72×10-3 mm2/sec). The lesion (arrowheads) was reduced and difficult to identify after radiation therapy on sagittal and axial T2WI (D, E) and signal intensity was decreased on axial DWI (F). ADC values increased to 1.34 ×10-3 mm2/sec (not shown).

• 

  Fig. 7 Left common iliac lymph node metastasis posttreatment (operation and subsequent chemotherapy) of stage IC endometrial carcinoma in a 70-year-old woman. Left common iliac lymph node region (arrowhead) shows high signal intensity on inverted grayscale of diffusion-weighted imaging (A). Positron emission tomography also shows abnormal uptake in the left common iliac lymph node region (arrowhead) (B).

• 

  Fig. 8 Right ovarian teratoma with paucity of fat in a 77-year-old woman. The cystic lesion (arrowheads) shows high signal intensity on axial T2-weighted imaging (A) and axial diffusion-weighted imaging (C) in the right adnexal region. The apparent diffusion coefficient (ADC) map (not shown) demonstrated low ADC values (0.67×10-3 mm2/sec). A small fraction of the cystic lesion shows high signal intensity (arrows) on axial T1-weighted (B), and chemical shift imaging (not shown) suggested fat. H&E stain (not shown) indicated hyperkeratoic epidermis cells. u, uterus.

• 

  Fig. 9 Right salpingo-oophoritis in a 50-year-old woman. Axial T2-weighted imaging show solid lesion (arrowheads) in the right adnexal region (A). Fat saturated contrast enhanced (FS-CE) T1-weighted (not shown) was homogeneously enhanced. The solid lesion shows high signal intensity on axial diffusion-weighted imaging (B) and the apparent diffusion coefficient (ADC) map (not shown) demonstrated low ADC values (0.84×10-3 mm2/sec). Pathological diagnosis was a right salpingo-oophoritis. u, uterus.

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