Diffusion-weighted imaging (DWI) of adenomyosis and fibroids of the uterus

Purpose Although magnetic resonance imaging is often able to distinguish between adenomyosis and fibroids, occasionally the imaging features of focal adenomyosis and fibroids overlap. Diffusion-weighted imaging (DWI) may provide useful information in differentiating pathologies. Therefore, the purpose of our study was to evaluate differences, if any, in the apparent diffusion coefficient (ADC) values of fibroids and adenomyosis.

Patients (n = 50) with uterine fibroids and adenomyosis (n = 43), who underwent pelvic MR imaging including DWI, were included in this IRB approved HIPPA compliant retrospective study. DWI was performed with b factors of 50, 400, and 800 s/mm using a 1.5 T scanner. ADC ROI measurements were placed over a fibroid, an area of adenomyosis, unaffected normal myometrium, skeletal muscle, and urine. Histogram analysis of ADC maps in 20 cases each of adenomyosis and fibroids was evaluated to assess the degree of tissue heterogeneity.

The ADC values of adenomyosis and fibroids were compared using Student’s t test. The mean and the standard deviation of the ADC values of the control group were as follows: fibroid 0.64 ± 0.29, adenomyosis 0.86 ± 0.30, myometrium 1.39 ± 0.36, and urine 3.01 ± 0.2 × 10−3 mm2/s. There was a statistically significant difference among the ADC values of normal myometrium and fibroids (p < 0.0001), normal myometrium and adenomyosis (p < 0.0001), and fibroids and adenomyosis (p < 0.001). Histogram analysis demonstrates less heterogeneity of adenomyosis as compared to fibroids.

The present study shows that ADC measurements have the potential to quantitatively differentiate between fibroids and adenomyosis. Similar content being viewed by others

Siegler AM, Camilien L (1994) Adenomyosis. J Reprod Med 39:841–853 Aziz R (1989) Adenomyosis: current perspectives. Obstet Gynecol Clin N Am 16:221–235 Ferenczy A (1998) Pathophysiology of adenomyosis. Hum Reprod Update 4(4):312–322 Tamai K, Togashi K, Ito T, et al. (2005) MR imaging findings of adenomyosis: correlation with histopathologic features and diagnostic pitfalls. Radiographics 25(1):21–40 (Review) Reinhold C, McCarthy S, Bret PM, et al. (1996) Diffuse adenomyosis: comparison of endovaginal US and MR imaging with histopathologic correlation. Radiology 199(1):151–158 Koh DM, Collins DJ (2007) Diffusion-weighted MRI in the body: applications and challenges in oncology. AJR Am J Roentgenol 188(6):1622–1635 Padhani AR, Guoying L, Dow M, et al. (2009) Diffusion-weighted magnetic resonance imaging as a cancer biomarker: consensus and recommendations. Neoplasia 11(2):102–125 Chenevert TL, Galban CJ, Ivancevic MK, et al. (2011) Diffusion coefficient measurement using a temperature controlled fluid for quality control in multi-center studies. J Magn Reson Imaging 34:983–987 Nishizawa S, Imai S, Okaneya T, et al. (2010) Diffusion weighted imaging in the detection of upper urinary tract urothelial tumors. Int Braz J Urol 36(1):18–28 El-Assmy A, Abou-El-Ghar ME, Refaie HF, et al. (2008) Diffusion-weighted MR imaging in diagnosis of superficial and invasive urinary bladder carcinoma: a preliminary prospective study. Sci World J 8:364–370 Damasio MB, Tagliafico A, Capaccio E, et al. (2008) Diffusion-weighted MRI sequences (DW-MRI) of the kidney: normal findings, influence of hydration state and repeatability of results. Radiol Med 113(2):214–224 Matsuki M, Inada Y, Tatsugami F, et al. (2007) Diffusion-weighted MR imaging for urinary bladder carcinoma: initial results. Eur Radiol 17(1):201–204 Guo Y, Cai YQ, Cai ZL, et al. (2002) Differentiation of clinically benign and malignant breast lesions using diffusion-weighted imaging. J Magn Reson Imaging 16:172–178 Gauvain KM, McKinstry RC, Mukherjee P, et al. (2001) Evaluating pediatric brain tumor cellularity with diffusion-tensor imaging. AJR Am J Roentgenol 177:449–454 Sugahara T, Korogi Y, Kochi M, et al. (1999) Usefulness of diffusion-weighted MRI with echo-planar technique in the evaluation of cellularity in gliomas. J Magn Reson Imaging 9:53–60 Lang P, Wendland MF, Saeed M, et al. (1998) Osteogenic sarcoma: noninvasive in vivo assessment of tumor necrosis with diffusion-weighted MR imaging. Radiology 206:227–235 Nasu K, Kuroki Y, Nawano S, et al. (2006) Hepatic metastases: diffusion-weighted sensitivity-encoding versus SPIO-enhanced MR imaging. Radiology 239:122–130 Provenzale JM, Mukundan S, Barboriak DP (2006) Diffusion-weighted and perfusion MR imaging for brain tumor characterization and assessment of treatment response. Radiology 239:632–649 Chan JH, Tsui EY, Luk SH, et al. (2001) Diffusion weighted MR imaging of the liver: distinguishing hepatic abscess from cystic or necrotic tumor. Abdom Imaging 26:161–165 Cova M, Squillaci E, Stacul F, et al. (2004) Diffusion weighted MRI in the evaluation of renal lesions: preliminary results. Br J Radiol 77:851–857 Chen CY, Li CW, Kuo YT, et al. (2006) Early response of hepatocellular carcinoma to transcatheter arterial chemoembolization: choline levels and MR diffusion constants-initial experience. Radiology 239:448–456 Jacobs MA, Herskovits EH, Kim HS (2005) Uterine fibroids: diffusion-weighted MR imaging for monitoring therapy with focused ultrasound surgery *preliminary study. Radiology 236:196–203 Scoutt LM, Flynn SD, Luthringer DJ, et al. (1991) Junctional zone of the uterus: correlation of MR imaging and histologic examination of hysterectomy specimens. Radiology 179(2):403–407 McCarthy S, Scott G, Majumdar S, et al. (1989) Uterine junctional zone: MR study of water content and relaxation properties. Radiology 171(1):241–243 Brown HK, Stoll BS, Nicosia SV, et al. (1991) Uterine junctional zone: correlation between histologic findings and MR imaging. Radiology 179(2):409–413 Farrer-Brown G, Beilby JO, Tarbit MH (1970) The blood supply of the uterus. 1. Arterial vasculature. J Obstet Gynaecol Br Commonw 77:673 Koyama T, Togashi K (2007) Functional MR imaging of the female pelvis. J Magn Reson Imaging 25:1101–1112 Ascher SM, Jha RC, Reinhold C (2003) Benign myometrial conditions: leiomyomas and adenomyosis. Top Magn Reson Imaging 14(4):281–304 Hever A, Roth RB, Hevezi PA, et al. (2006) Molecular characterization of human adenomyosis. Mol Hum Reprod 12(12):737–748 Kilickesmez O, Bayramoglu S, Inci E, et al. (2009) Quantitative diffusion-weighted magnetic resonance imaging of normal and diseased uterine zones. Acta Radiol 50(3):340–347 Liapi E, Kamel IR, Bluemke DA, et al. (2005) Assessment of response of uterine fibroids and myometrium to embolization using diffusion-weighted echoplanar MR imaging. J Comput Assist Tomogr 29(1):83–86 Erdem G, Celik O, Karakas HM, et al. (2009) Microstructural changes in uterine leiomyomas and myometrium: a diffusion-weighted magnetic resonance imaging study. Gynecol Obstet Investig 67(4):217–222 (Epub 2009) Taouli B, Vilgrain V, Dumont E, et al. (2003) Evaluation of liver diffusion isotropy and characterization of focal hepatic lesions with two single-shot echo-planar MR imaging sequences: prospective study in 66 patients. Radiology 226:71–78 Koh DM, Scurr E, Collins DJ, et al. (2006) Colorectal hepatic metastases: quantitative measurements using single-shot echo-planar diffusion-weighted MR imaging. Eur Radiol 16:1898–1905 Hricak H, Tscholakoff D, Heinrichs L, et al. (1986) Uterine leiomyomas: correlation of MR, histopathologic findings, and symptoms. Radiology 158:385–391 Disclosure The authors have nothing to disclose Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Jha, R.C., Zanello, P.A., Ascher, S.M. et al. Diffusion-weighted imaging (DWI) of adenomyosis and fibroids of the uterus. Abdom Imaging 39, 562–569 (2014). https://doi.org/10.1007/s00261-014-0095-z Published: Issue date: DOI: https://doi.org/10.1007/s00261-014-0095-z