Endometrial Carcinoma in Adenomyosis: Assessment of Myometrial Invasion on T2-Weighted Spin-Echo and Gadolinium-Enhanced T1-Weighted Images

Daisuke Utsunomiya, Shiho Notsute, Notsute S, Hayashida Y, Yoshiko Hayashida, Lwakatare F, Flora Lwakatare, Lwakatare Flora, Hidetaka Katabuchi, Katabuchi H, Hitoshi Okamura, Okamura H, Kazuo Awai, Awai K, Yasuyuki Yamashita, Yamashita Y
AJR. American journal of roentgenology · 2004 · vol. 182(2) , pp. 399–404 · doi:10.2214/ajr.182.2.1820399 · PMID:14736670 · W2049435761
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Contrast-enhanced dynamic T1-weighted MRI significantly improves the accuracy of staging myometrial invasion by endometrial carcinoma in the presence of adenomyosis compared to T2-weighted imaging.

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Abstract

OBJECTIVE: The aim of our study was to compare T2-weighted and contrast-enhanced dynamic T1-weighted images with histologic findings in assessing the depth of myometrial invasion by endometrial carcinoma in adenomyosis. MATERIALS AND METHODS: We retrospectively reviewed the MRIs of 11 patients who had a total of 12 lesions of endometrial carcinoma within adenomyosis. T2-weighted and contrast-enhanced dynamic T1-weighted images were compared with the histologic findings separately. We assessed the extent of myometrial invasion by endometrial carcinomas. The depth of myometrial invasion seen on MRI was classified as stage S (superficial invasion), stage D (deep invasion), or undetectable. The staging accuracies of each sequence were assessed. The tumor-myometrium contrast-to-noise ratios were calculated for each sequence. RESULTS: The histologic specimens revealed that myometrial invasion was deep in seven of 12 lesions and superficial in five. On T2-weighted images the depth of invasion was underestimated in two lesions and impossible to determine in five lesions. On dynamic T1-weighted images the depth of invasion was overestimated in one lesion and underestimated in one lesion. The staging accuracy on dynamic T1-weighted images (83%) was significantly higher than that on T2-weighted images (42%). The contrast-to-noise ratio was significantly higher on dynamic T1-weighted studies during the early phase (mean +/- SD, 2.68 +/- 0.94) than it was on T2-weighted studies (1.74 +/- 1.05) and during the delayed phase (2.01 +/- 0.86). CONCLUSION: When adenomyosis coexists with endometrial cancer at the same site on T2-weighted images, contrast-enhanced dynamic T1-weighted imaging improves the accuracy of staging.

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Condition tags

endometriosisadenomyosis

MeSH descriptors

Endometrial Neoplasms Endometriosis Magnetic Resonance Imaging Myometrium Adult Aged Contrast Media Endometrial Neoplasms Endometrial Neoplasms Endometriosis Endometriosis Female Gadolinium DTPA Humans Image Enhancement Image Enhancement Magnetic Resonance Imaging Middle Aged Myometrium Neoplasm Invasiveness

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