Top

Published in:

01-03-2009 | Urogenital

Role of diffusion-weighted imaging in the diagnosis of gynecological diseases

Authors: Tomohiro Namimoto, Kazuo Awai, Takeshi Nakaura, Yumi Yanaga, Toshinori Hirai, Yasuyuki Yamashita

Published in: European Radiology | Issue 3/2009

Abstract

Recent technical advances in diffusion-weighted imaging (DWI) greatly enhanced the clinical value of magnetic resonance imaging (MRI) of the body. DWI can provide excellent tissue contrast based on molecular diffusion and may be able to demonstrate malignant tumors. Quantitative measurement of the apparent diffusion coefficient (ADC) may be valuable in distinguishing between malignant and benign lesions. We reviewed DWI and conventional MRI of the female pelvis to study the utility of DWI in patients with gynecological diseases. Although the ADC can help to differentiate between normal and cancerous tissue in the uterine cervix and endometrium, its utility may be limited by the large overlap of the uterine myometrium and ovaries. On the other hand, the ADC may be useful for monitoring the therapeutic outcome after uterine arterial embolizati (UAE), chemotherapy and/or radiation therapy. In patients with ovarian cancer, DWI demonstrates high intensity not only at the primary cancer site but also in disseminated peritoneal implants. When added to conventional MRI findings, DWI and ADC values provide additional information and DWI may play an important role in the diagnosis of patients with gynecological diseases.

Le Bihan D, Breton E, Lallemand D, Grenier P, Cabanis E, Laval-Jeantet M (1986) MR imaging of intravoxel incoherent motions: application to diffusion and perfusion in neurologic disorders. Radiology 161:401–407PubMed

Li TQ, Takahashi AM, Hindmarsh T, Moseley ME (1999) ADC mapping by means of a single-shot spiral MRI technique with application in acute cerebral ischemia. Magn Reson Med 41:143–147CrossRefPubMed

Schaefer PW, Grant PE, Gonzalez RG (2000) Diffusion-weighted MR imaging of the brain. Radiology 217:331–345

Kurihara Y, Yakushiji YK, Tani I, Nakajima Y, Van Cauteren M (2002) Coil sensitivity encoding in MR imaging: advantages and disadvantages in clinical practice. AJR Am J Roentgenol 178:1087–1091PubMed

Namimoto T, Yamashita Y, Sumi S, Tang Y, Takahashi M (1997) Focal liver masses: characterization with diffusion-weighted echo-planar MR imaging. Radiology 204:739–744PubMed

Ichikawa T, Haradome H, Hachiya J, Nitatori T, Araki T (1998) Diffusion weighted MR imaging with a singleshot echoplanar sequence: detection and characterization of focal hepatic lesions. AJR Am J Roentgenol 170:397–402PubMed

Sato C, Naganawa S, Nakamura T et al (2005) Differentiation of noncancerous tissue and cancer lesions by apparent diffusion coefficient values in transition and peripheral zones of the prostate. J Magn Reson Imaging 21:258–262CrossRefPubMed

Charles-Edwards EM, deSouza NM (2006) Diffusion-weighted magnetic resonance imaging and its application to cancer. Cancer Imaging 6:135–143CrossRefPubMed

Hosseinzadeh K, Schwarz SD (2004) Endorectal diffusion-weighted imaging in prostate cancer to differentiate malignant and benign peripheral zone tissue. J Magn Reson Imaging. 20:654–661CrossRefPubMed

10.

Matoba M, Tonami H, Kondou T, Yokota H, Higashi K, Toga H, Sakuma T (2007) Lung carcinoma: diffusion-weighted MR imaging-preliminary evaluation with apparent diffusion coefficient. Radiology 243:570–577CrossRefPubMed

11.

Theilmann RJ, Borders R, Trouard TP, Xia G, Outwater E, Ranger-Moore J, Gillies RJ, Stopeck A (2004) Changes in water mobility measured by diffusion MRI predict response of metastatic breast cancer to chemotherapy. Neoplasia 6:831–837CrossRefPubMed

12.

Naganawa S, Sato C, Kumada H, Ishigaki T, Miura S, Takizawa O (2005) Apparent diffusion coefficient in cervical cancer of the uterus: comparison with the normal uterine cervix. Eur Radiol 15:71–78CrossRefPubMed

13.

McVeigh PZ, Syed AM, Milosevic M, Fyles A, Haider MA (2008) Diffusion-weighted MRI in cervical cancer. Eur Radiol 18:1058–1064CrossRefPubMed

14.

Tamai K, Koyama T, Saga T, Umeoka S, Mikami Y, Fujii S, Togashi K (2007) Diffusion-weighted MR imaging of uterine endometrial cancer. J Magn Reson Imaging 26:682–687CrossRefPubMed

15.

Fujii S, Matsusue E, Kigawa J, Sato S, Kanasaki Y, Nakanishi J, Sugihara S, Kaminou T, Terakawa N, Ogawa T (2008) Diagnostic accuracy of the apparent diffusion coefficient in differentiating benign from malignant uterine endometrial cavity lesions: initial results. Eur Radiol 18:384–389CrossRefPubMed

16.

Shen SH, Chiou YY, Wang JH, Yen MS, Lee RC, Lai CR, Chang CY (2008) Diffusion-weighted single-shot echo-planar imaging with parallel technique in assessment of endometrial cancer. AJR Am J Roentgenol 190:481–488CrossRefPubMed

17.

Tamai K, Koyama T, Saga T, Morisawa N, Fujimoto K, Mikami Y, Togashi K (2008) The utility of diffusion-weighted MR imaging for differentiating uterine sarcomas from benign leiomyomas. Eur Radiol 18:723–730CrossRefPubMed

18.

Jacobs MA, Herskovits EH, Kim HS (2005) Uterine fibroids: diffusion weighted MR imaging for monitoring therapy with focused ultrasound surgery-preliminary study. Radiology 236:196–203CrossRefPubMed

19.

Liapi E, Kamel IR, Bluemke DA, Jacobs MA, Kim HS (2005) Assessment of response of uterine fibroids and myometrium to embolization using diffusion-weighted echoplanar MR imaging. J Comput Assist Tomogr 29:83–86CrossRefPubMed

20.

Shimada K, Ohashi I, Kasahara I, Watanabe H, Ohta S, Miyasaka N, Itoh E, Shibuya H (2004) Differentiation between completely hyalinized uterine leiomyomas and ordinary leiomyomas: three-phase dynamic magnetic resonance imaging (MRI) vs. diffusion weighted MRI with very small b-factors. J Magn Reson Imaging 20:97–104CrossRefPubMed

21.

Moteki T, Ishizaka H (2000) Diffusion-weighted EPI of cystic ovarian lesions: evaluation of cystic contents using apparent diffusion coefficients. J Magn Reson Imaging 12:1014–1019CrossRefPubMed

22.

Katayama M, Masui T, Kobayashi S, Ito T, Sakahara H, Nozaki A, Kabasawa H (2002) Diffusion-weighted echo planar imaging of ovarian tumors: is it useful to measure apparent diffusion coefficients? J Comput Assist Tomogr 26:250–256CrossRefPubMed

23.

Nakayama T, Yoshimitsu K, Irie H, Aibe H, Tajima T, Nishie A, Asayama Y, Matake K, Kakihara D, Matsuura S, Nakano H, Honda H (2005) Diffusion-weighted echo-planar MR imaging and ADC mapping in the differential diagnosis of ovarian cystic masses: usefulness of detecting keratinoid substances in mature cystic teratomas. J Magn Reson Imaging 22:271–278CrossRefPubMed

24.

Koyama T, Togashi K (2007) Functional MR imaging of the female pelvis. J Magn Reson Imaging 25:1101–1112CrossRefPubMed

25.

Koyama T, Tamai K, Togashi K (2006) Current status of body MR imaging: fast MR imaging and diffusion-weighted imaging. Int J Clin Oncol 11:278–285CrossRefPubMed

26.

Thoeny HC, De Keyzer F (2007) Extracranial applications of diffusion-weighted magnetic resonance imaging. Eur Radiol 17:1385–1393CrossRefPubMed

27.

Provenzale JM, Engelter ST, Petrella JR, Smith JS, MacFall JR (1999) Use of MR exponential diffusion-weighted images to eradicate T2 “shine-through” effect. AJR Am J Roentgenol 172:537–539PubMed

28.

Silvera S, Oppenheim C, Touzé E, Ducreux D, Page P, Domigo V, Mas JL, Roux FX, Frédy D, Meder JF (2005) Spontaneous intracerebral hematoma on diffusion-weighted images: influence of T2-shine-through and T2-blackout effects. AJNR Am J Neuroradiol 26:236–241PubMed

29.

Yamashita Y, Takahashi M, Sawada T, Miyazaki K, Okamura H (1992) Carcinoma of the cervix: dynamic MR imaging. Radiology 182:643–648PubMed

30.

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

31.

Yamashita Y, Harada M, Torashima M, Takahashi M, Miyazaki K, Tanaka N, Okamura H (1996) Dynamic MR imaging of recurrent postoperative cervical cancer. J Magn Reson Imaging 6:167–171CrossRefPubMed

32.

Tsuda K, Murakami T, Kurachi H, Ogawa H, Oi H, Miyake A, Narumi Y, Nakamura H (1997) MR imaging of cervical carcinoma: comparison among T2-weighted, dynamic, and postcontrast T1-weighted images with histopathological correlation. Abdom Imaging 22:103–107CrossRefPubMed

33.

Nicolet V, Carignan L, Bourdon F, Prosmanne O (2000) MR imaging of cervical carcinoma: a practical staging approach. Radiographics 20:1539–1549PubMed

34.

Kinkel K (2006) Pitfalls in staging uterine neoplasm with imaging: a review. Abdom Imaging 31:164–173CrossRefPubMed

35.

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

36.

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

37.

Manfredi R, Gui B, Maresca G, Fanfani F, Bonomo L (2005) Endometrial cancer: magnetic resonance imaging. Abdom Imaging 30:626–636CrossRefPubMed

38.

Sahdev A, Sohaib SA, Jacobs I, Shepherd JH, Oram DH, Reznek RH (2001) MR imaging of uterine sarcomas. AJR Am J Roentgenol 177:1307–1311PubMed

39.

Goto A, Takeuchi S, Sugimura K, Maruo T (2002) Usefulness of Gd-DTPA contrast-enhanced dynamic MRI and serum determination of LDH and its isozymes in the differential diagnosis of leiomyosarcoma from degenerated leiomyoma of the uterus. Int J Gynecol Cancer 12:354–361CrossRefPubMed

40.

Tanaka YO, Nishida M, Tsunoda H, Okamoto Y, Yoshikawa H (2004) Smooth muscle tumors of uncertain malignant potential and leiomyosarcomas of the uterus: MR findings. J Magn Reson Imaging 20:998–1007CrossRefPubMed

41.

Koyama T, Togashi K, Konishi I, Kobayashi H, Ueda H, Kataoka ML, Itoh T, Higuchi T, Fujii S, Konishi J (1999) MR imaging of endometrial stromal sarcoma: correlation with pathologic findings. AJR Am J Roentgenol 173:767–772PubMed

42.

Ueda M, Otsuka M, Hatakenaka M, Torii Y (2000) Uterine endometrial stromal sarcoma located in uterine myometrium: MRI appearance. Eur Radiol 10:780–782CrossRefPubMed

43.

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 11:28–33CrossRefPubMed

44.

Hricak H, Tscholakoff D, Heinrichs L et al (1986) Uterine leiomyomas: correlation of MR, histopathologic findings, and symptoms. Radiology 158:385–391PubMed

45.

Ueda H, Togashi K, Konishi I, Kataoka ML, Koyama T, Fujiwara T, Kobayashi H, Fujii S, Konishi J (1999) Unusual appearances of uterine leiomyomas: MR imaging findings and their histopathologic backgrounds. Radiographics 19:S131–S145PubMed

46.

Yamashita Y, Torashima M, Takahashi M, Tanaka N, Katabuchi H, Miyazaki K, Ito M, Okamura H (1993) Hyperintense uterine leiomyoma at T2-weighted MR imaging: differentiation with dynamic enhanced MR imaging and clinical implications. Radiology 189:721–725PubMed

47.

Spies JB, Roth AR, Jha RC et al (2002) Leiomyoma treated with uterine artery embolization: factors associated with successful symptom and imaging outcome. Radiology 222:45–52CrossRefPubMed

48.

Smart OC, Hindley JT, Regan L, Gedroyc WM (2006) Magnetic resonance guided focused ultrasound surgery of uterine fibroids-the tissue effects of GnRH agonist pre-treatment. Eur J Radiol 592:163–167CrossRef

49.

Maldjian JA, Listerud J, Moonis G, Siddiqi F (2001) Computing diffusion rates in T2-dark hematomas and areas of low T2 signal. AJNR Am J Neuroradiol 22:112–118PubMed

50.

Chen S, Ikawa F, Kurisu K, l, Arita K, Takaba J, Kanou Y (2001) Quantitative MR evaluation of intracranial epidermoid tumors by fast fluid-attenuated inversion recovery imaging and echo-planar diffusion-weighted imaging. AJNR Am J Neuroradiol 22:1089–1096PubMed

51.

Kurtz AB, Tsimikas JV, Tempany CM, Hamper UM, Arger PH, Bree RL, Wechsler RJ, Francis IR, Kuhlman JE, Siegelman ES, Mitchell DG, Silverman SG, Brown DL, Sheth S, Coleman BG, Ellis JH, Kurman RJ, Caudry DJ, McNeil BJ (1999) Diagnosis and staging of ovarian cancer: comparative values of Doppler and conventional US, CT, and MR imaging correlated with surgery and histopathologic: report of the Radiology Diagnostic Oncology Group. Radiology 212:19–27PubMed

52.

Tempany CM, Zou KH, Silverman SG, Brown DL, Kurtz AB, McNeil BJ (2000) Staging of advanced ovarian cancer: comparison of imaging modalities-report from the Radiological Diagnostic Oncology Group. Radiology 215:761–767PubMed

53.

Coakley FV, Choi PH, Gougoutas CA, Pothuri B, Venkatraman E, Chi D, Bergman A, Hricak H (2002) Peritoneal metastases: detection with spiral CT in patients with ovarian cancer. Radiology 223:495–499CrossRefPubMed

54.

Ricke J, Sehouli J, Hach C, Hanninen EL, Lichtenegger W, Felix R (2003) Prospective evaluation of contrastenhanced MRI in the depiction of peritoneal spread in primary or recurrent ovarian cancer. Eur Radiol 13:943–949CrossRefPubMed

55.

Pannu HK, Horton KM, Fishman EK (2003) Thin section dual-phase multidetector-row computed tomography detection of peritoneal metastases in gynecologic cancers. J Comput Assist Tomogr 27:333–340CrossRefPubMed

56.

Pannu HK, Bristow RE, Montz FJ, Fishman EK (2003) Multidetector CT of peritoneal carcinomatosis from ovarian cancer. Radiographics 23:687–701CrossRefPubMed

57.

Fujii S, Matsusue E, Kanasaki Y, Kanamori Y, Nakanishi J, Sugihara S, Kigawa J, Terakawa N, Ogawa T (2008) Detection of peritoneal dissemination in gynecological malignancy: evaluation by diffusion-weighted MR imaging. Eur Radiol 18:18–23CrossRefPubMed

58.

Lutman CV, Havrilesky LJ, Cragun JM, Secord AA, Calingaert B, Berchuck A, Clarke-Pearson DL, Soper JT (2006) Pelvic lymph node count is an important prognostic variable for FIGO stage I and II endometrial carcinoma with high-risk histology. Gynecol Oncol 102:92–97CrossRefPubMed

59.

Yu KK, Hricak H, Subak LL, Zaloudek CJ, Powell CB (1998) Preoperative staging of cervical carcinoma: phased array coil fast spin-echo versus body coil spin-echo T2-weighted MR imaging. AJR Am J Roentgenol 171:707–711PubMed

60.

Reinhardt MJ, Ehritt-Braun C, Vogelgesang D, Ihling C, Högerle S, Mix M, Moser E, Krause TM (2001) Metastatic lymph nodes in patients with cervical cancer: detection with MR imaging and FDG PET. Radiology 218:776–782PubMed

61.

Rockall AG, Sohaib SA, Harisinghani MG, Babar SA, Singh N, Jeyarajah AR, Oram DH, Jacobs IJ, Shepherd JH, Reznek RH (2005) Diagnostic performance of nanoparticle-enhanced magnetic resonance imaging in the diagnosis of lymph node metastases in patients with endometrial and cervical cancer. J Clin Oncol 23:2813–2821CrossRefPubMed

62.

Lin G, Ho KC, Wang JJ, Ng KK, Wai YY, Chen YT, Chang CJ, Ng SH, Lai CH, Yen TC (2008) Detection of lymph node metastasis in cervical and uterine cancers by diffusion-weighted magnetic resonance imaging at 3T. J Magn Reson Imaging 28:128–135CrossRefPubMed

63.

Castillo M, Arbelaez A, Smith JK, Fisher LL (2000) Diffusion-weighted MR imaging offers no advantage over routine noncontrast MR imaging in the detection of vertebral metastases. AJNR Am J Neuroradiol 21:948–953PubMed

64.

Nakanishi K, Kobayashi M, Nakaguchi K, Kyakuno M, Hashimoto N, Onishi H, Maeda N, Nakata S, Kuwabara M, Murakami T, Nakamura H (2007) Whole-body MRI for detecting metastatic bone tumor: diagnostic value of diffusion-weighted images. Magn Reson Med Sci 6:147–155CrossRefPubMed

Title: Role of diffusion-weighted imaging in the diagnosis of gynecological diseases
Authors: Tomohiro Namimoto
Kazuo Awai
Takeshi Nakaura
Yumi Yanaga
Toshinori Hirai
Yasuyuki Yamashita
Publication date: 01-03-2009
Publisher: Springer-Verlag
Published in: European Radiology / Issue 3/2009
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-008-1185-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Role of diffusion-weighted imaging in the diagnosis of gynecological diseases

Abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 3/2009

Acknowledgement

Infant with chronic bilateral retroauricular tumefaction (2009: 3a)

Reliability of tumor volume estimation from MR images in patients with malignant glioma. Results from the American College of Radiology Imaging Network (ACRIN) 6662 Trial

Morphological MRI criteria improve the detection of lymph node metastases in head and neck squamous cell carcinoma: multivariate logistic regression analysis of MRI features of cervical lymph nodes

CT, MR, US, 18F-FDG PET/CT, and their combined use for the assessment of cervical lymph node metastases in squamous cell carcinoma of the head and neck

Combined FDG-PET/CT for the detection of unknown primary tumors: systematic review and meta-analysis