Top

Published in:

01-08-2003 | Urogenital

A thickened or indistinct junctional zone on T2-weighted MR images in patients with endometrial carcinoma: pathologic consideration based on microcirculation

Authors: Yumiko Oishi Tanaka, Masato Nishida, Hajime Tsunoda, Yoshihito Ichikawa, Yukihisa Saida, Yuji Itai

Published in: European Radiology | Issue 8/2003

Abstract.

Thickened or indistinct junctional zone (JZ) is a problematic finding in staging endometrial carcinoma. We studied the incidence, pathological cause of this condition correlated to microcirculation, and the utility of dynamic contrast MRI for differential diagnosis. T2-weighted images were analyzed in 119 cases with endometrial carcinoma. The enhancement of the JZ during the dynamic contrast MRI, histopathological causes, and the density of arterioles in the JZ were retrospectively analyzed in cases with thickened or indistinct JZ. The MRI histopathological correlation of all 31 patients with a thickened or indistinct JZ were analyzed, in which it was corresponded to myometrial cancer invasion only in 22%. The sensitivity of a poor early enhancement pattern on dynamic study for detecting myometrial invasion was 71.4%, the specificity was 100%, and the overall accuracy was 92.5%. Although only weak relationship between the contrast enhancement and the arteriole density was revealed, the arteriole density within the JZ with cancer invasion was significantly decreased. Poor enhancement of JZ in early dynamic phase was correlated with the decreased density of arterioles within the myometrium which was invaded by endometrial carcinoma. Dynamic contrast study should be performed in staging endometrial carcinoma especially when JZ was thickened or indistinct.

Lurain JR(1996) Uterine cancer. In:Berek JS, Adashi EY, Hillard PA (eds) Novak's gynecology. Williams and Wilkins, Baltimore, pp1057–1110

Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB (1987) Surgical pathologic spread patterns of endometrial cancer. A Gynecologic Oncology Group Study. Cancer 60:2035–2041PubMed

Hricak H, Stern JL, Fisher MR, Shapeero LG, Winkler ML, Lacey CG (1987) Endometrial carcinoma staging by MR imaging. Radiology 162:297–305PubMed

Sironi S, Taccagni G, Garancini P, Belloni C, DelMaschio A (1992) Myometrial invasion by endometrial carcinoma: assessment by MR imaging. AJR 158:565–569

DelMaschio A, Vanzulli A, Sironi S, Spagnolo D, Belloni C, Garancini P, Taccagni GL (1993) Estimating the depth of myometrial involvement by endometrial carcinoma: efficacy of transvaginal sonography vs MR imaging. AJR 160:533–538

Takahashi S, Murakami T, Narumi Y, Kurachi H, Tsuda K, Kim T, Enomoto T, Tomoda K, Miyake A, Murata Y, Nakamura H (1998) Preoperative staging of endometrial carcinoma: diagnostic effect of T2-weighted fast spin-echo MR imaging. Radiology 206:539–547PubMed

Scoutt LM, McCarthy SM, Flynn SD, Lange RC, Long F, Smith RC, Chambers SK, Kohorn E, Schwartz P, Chambers JT (1995) Clinical stage I endometrial carcinoma: pitfalls in preoperative assessment with MR imaging. Work in progress. Radiology194:567–572

Mark AS, Hricak H, Heinrichs LW, Hendrickson MR, Winkler ML, Bachica JA, Stickler JE (1987) Adenomyosis and leiomyoma: differential diagnosis with MR imaging. Radiology 163:527–529PubMed

Togashi K, Nishimura K, Itoh K, Fujisawa I, Noma S, Kanaoka M, Nakano Y, Itoh H, Ozasa H, Fujii S et al. (1988) Adenomyosis: diagnosis with MR imaging. Radiology 166:111–114PubMed

10.

Hirano Y, Kubo K, Hirai Y, Okada S, Yamada K, Sawano S, Yamashita T, Hiramatsu Y (1992) Preliminary experience with gadolinium-enhanced dynamic MR imaging for uterine neoplasms. Radiographics 12:243–256PubMed

11.

Yamashita Y, Harada M, Sawada T, Takahashi M, Miyazaki K, Okamura H (1993) Normal uterus and FIGO stage I endometrial carcinoma: dynamic gadolinium-enhanced MR imaging. Radiology 186:495–501PubMed

12.

Yamashita Y, Mizutani H, Torashima M, Takahashi M, Miyazaki K, Okamura H, Ushijima H, Ohtake H, Tokunaga T (1993) Assessment of myometrial invasion by endometrial carcinoma: transvaginal sonography vs contrast-enhanced MR imaging. AJR 161:595–599

13.

Ito K, Matsumoto T, Nakada T, Nakanishi T, Fujita N, Yamashita H (1994) Assessing myometrial invasion by endometrial carcinoma with dynamic MRI. J Comput Assist Tomogr 18:77–86PubMed

14.

Joja I, Asakawa M, Asakawa T, Nakagawa T, Kanazawa S, Kuroda M, Togami I, Hiraki Y, Akamatsu N, Kudo T (1996) Endometrial carcinoma: dynamic MRI with turbo-FLASH technique. J Comput Assist Tomogr 20:878–887CrossRefPubMed

15.

Savci G, Ozyaman T, Tutar M, Bilgin T, Erol O, Tuncel E (1998) Assessment of depth of myometrial invasion by endometrial carcinoma: comparison of T2-weighted SE and contrast-enhanced dynamic GRE MR imaging. Eur Radiol 8:218–223CrossRef

16.

Reinhold C, McCarthy S, Bret PM, Mehio A, Atri M, Zakarian R, Glaude Y, Liang L, Seymour RJ (1996) Diffuse adenomyosis: comparison of endovaginal US and MR imaging with histopathologic correlation. Radiology199:151–158

17.

Hricak H, Alpers C, Crooks LE, S PE (1983) Magnetic resonance imaging of the female pelvis: initial experience. AJR 141:1119–1128

18.

Demas BE, Hricak H, Jaffe RB (1986) Uterine MR imaging: effects of hormonal stimulation. Radiology159:123–126

19.

McCarthy S, Tauber C, Gore J (1986) Female pelvic anatomy: MR assessment of variations during the menstrual cycle and use of oral contraceptives. Radiology160:119–123

20.

McCarthy S, Scott G, Majumdar S, Shapiro B, Thompson S, Lange R, Gore J (1989) Uterine junctional zone: MR study of water content and relaxation properties. Radiology171:241–243

21.

Brown HK, Stoll BS, Nicosia SV, Fiorica JV, Hambley PS, Clarke LP, Silbiger ML (1991) Uterine junctional zone: correlation between histologic findings and MR imaging. Radiology 179:409–413PubMed

22.

Scoutt LM, Flynn SD, Luthringer DJ, McCauley TR, McCarthy SM (1991) Junctional zone of the uterus: correlation of MR imaging and histologic examination of hysterectomy specimens. Radiology 179:403–407PubMed

23.

Togashi K, Kawakami S, Kimura I, Asato R, Takakura K, Mori T, Konishi J (1993) Sustained uterine contractions: a cause of hypointense myometrial bulging. Radiology 187:707–710

24.

Togashi K, Nakai A, Sugimura K (2001) Anatomy and physiology of the female pelvis: MR imaging revisited. J Magn Reson Imaging 13:842–849CrossRefPubMed

25.

Masui T, Katayama M, Kobayashi S, Nakayama S, Nozaki A, Kabasawa H, Ito T, Sakahara H (2001) Changes in myometrial and junctional zone thickness and signal intensity: demonstration with kinematic T2-weighted MR imaging. Radiology 221:75–85PubMed

26.

Kurman RJ, Zaino RJ, Norris HJ (1994) Endometrial carcinoma. In: Kurman RJ (ed) Blaustein's pathology of the female genital tract. Springer, Berlin Heidelberg, New York, pp 439–486

27.

Ascher SM, Arnold LL, Patt RH, Schruefer JJ, Bagley AS, Semelka RC, Zeman RK, Simon JA (1994) Adenomyosis: prospective comparison of MR imaging and transvaginal sonography. Radiology190:803–806

28.

Reinhold C, Tafazoli F, Mehio A, Wang L, Atri M, Siegelman ES, Rohoman L (1999) Uterine adenomyosis: endovaginal US and MR imaging features with histopathologic correlation. Radiographics 19:S147–S160PubMed

29.

Hricak H, Hamm B, Semelka RC, Cann CE, Nauert T, Secaf E, Stern JL, Wolf KJ (1991) Carcinoma of the uterus: use of gadopentetate dimeglumine in MR imaging. Radiology 181:95–106PubMed

30.

Kinkel K, Kaji Y, Yu KK, Segal MR, Lu Y, Powell CB, Hricak H (1999) Radiologic staging in patients with endometrial cancer: a meta-analysis. Radiology 212:711–718PubMed

31.

Frei KA, Kinkel K, Bonel HM, Lu Y, Zaloudek C, Hricak H (2000) Prediction of deep myometrial invasion in patients with endometrial cancer: clinical utility of contrast-enhanced MR imaging: a meta-analysis and Bayesian analysis. Radiology 216:444–449PubMed

32.

Saez F, Urresola A, Larena JA, Martin Ji, Pijuan Ji, Schneider J, Ibanez E (2000) Endometrial carcinoma: assessment of myometrial invasion with plain and gadolinium-enhanced MR imaging. J Magn Reson Imaging 12:460–466CrossRefPubMed

33.

Lee EJ, Byun JY, Kim BS, Koong SE, Shinn KS (1999) Staging of early endometrial carcinoma: assessment with T2-weighted and gadolinium-enhanced T1-weighted MR imaging. Radiographics19:937–946

34.

Frei KA, Kinkel K (2001) Staging endometrial cancer: role of magnetic resonance imaging. J Magn Reson Imaging 13:850–855CrossRefPubMed

35.

Ueda M, Otsuka M, Hatakenaka M, Sakai S, Ono M, Yoshimitsu K, Honda H, Torii Y (2001) MR imaging findings of uterine endometrial stromal sarcoma: differentiation from endometrial carcinoma. Eur Radiol 11:28–33PubMed

36.

Abulafia O, Triest WE, Sherer DM (1999) Angiogenesis in malignancies of the female genital tract. Gynecol Oncol 72:220–231CrossRefPubMed

37.

Healy DL, Rogers PA, Hii L, Wingfield M (1998) Angiogenesis: a new theory for endometriosis. Hum Reprod Update 4:736–740PubMed

38.

Ota H, Igarashi S, Tanaka T (1998) Morphometric evaluation of stromal vascularization in the endometrium in adenomyosis. Hum Reprod 13:715–719CrossRefPubMed

Title: A thickened or indistinct junctional zone on T2-weighted MR images in patients with endometrial carcinoma: pathologic consideration based on microcirculation
Authors: Yumiko Oishi Tanaka
Masato Nishida
Hajime Tsunoda
Yoshihito Ichikawa
Yukihisa Saida
Yuji Itai
Publication date: 01-08-2003
Publisher: Springer-Verlag
Published in: European Radiology / Issue 8/2003
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-002-1799-y

At a glance: The STEP trials

Springer Medicine

A thickened or indistinct junctional zone on T2-weighted MR images in patients with endometrial carcinoma: pathologic consideration based on microcirculation

Abstract.

At a glance: The STEP trials

Springer Medicine

Abstract.

Please log in to get access to this content

Other articles of this Issue 8/2003

Intracranial tuberculoma: is diffusion-weighted imaging useful in the diagnosis?

Schwannoma of the brachial plexus: cross-sectional imaging diagnosis using CT, sonography, and MR imaging

Combined spinal subdural tuberculous empyema and intramedullary tuberculoma in an HIV-positive patient

Imaging features of musculoskeletal tuberculosis

Renal venous thrombosis in an infant with predisposing thrombotic factors: color Doppler ultrasound and MR evaluation

Hyperdynamic hemangioma with proximal arterioportal shunting: a rare manifestation