Hypointensity on Postcontrast MR Imaging from Compression of the Sacral Promontory in Enlarged Uterus with Huge Leiomyoma and Adenomyosis

Uotani K, Kensuke Uotani, Monzawa S, Shuichi Monzawa, Adachi S, Shuji Adachi, Takemori M, Masayuki Takemori, Yasushi Kaji, Kaji Y, Kazuro Sugimura, Sugimura K
Magnetic resonance in medical sciences : MRMS : an official journal of Japan Society of Magnetic Resonance in Medicine · 2007 · vol. 6(2) , pp. 61–66 · doi:10.2463/mrms.6.61 · PMID:17690535 · W2006628245
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Enlarged uteri with huge leiomyomas or adenomyosis showed hypointense areas on postcontrast MR imaging, likely due to decreased blood flow from compression of the sacral promontory.

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This paper evaluated a rare postcontrast MRI finding—dorsal uterine hypointensity near the sacral promontory—in patients with huge leiomyomas and two cases with huge adenomyotic lesions, with all enlarged uteri extending beyond the sacral promontory. MR hypointensity patterns were described (flare-shaped in 10 leiomyoma patients and nodular-shaped in 2 adenomyosis patients), and in a subset undergoing hysterectomy, the corresponding regions were correlated with histopathology, alongside the explicit limitation that precontrast T1- and T2-weighted images showed no abnormalities in the hypointense areas. The study found no specific pathological changes in the sampled regions in 7 hysterectomy patients, and concluded the hypointensity may reflect functional changes such as decreased localized blood flow from compression of the sacral promontory. This paper is centrally about endometriosis and/or adenomyosis — adenomyosis is directly included as patients with huge adenomyotic lesions showing nodular postcontrast hypointensity near the sacral promontory with histopathology correlation.

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Abstract

PURPOSE: In patients with huge leiomyoma and with adenomyosis of the uterus, a peculiar area of hypointensity was occasionally observed on postcontrast magnetic resonance (MR) imaging in the dorsal portion of the enlarged uterus near the sacral promontory. We describe the imaging characteristics of these MR findings and correlate them with histopathological findings to examine whether the areas represent specific pathological changes. METHODS: Ten patients with huge leiomyomas and two with huge adenomyotic lesions whose imaging revealed the hypointensity were enrolled. All had enlarged uteri that extended beyond the sacral promontory. MR findings of the hypointense areas were evaluated and correlated with histopathological findings in 5 patients with leiomyoma and two with adenomyosis who had hysterectomy. RESULTS: The ten patients with leiomyoma showed flare-shaped hypointensity arising from the dorsal surface of the uterine body that extended deep into the tumor. The base of the hypointense areas was narrow in 5 patients with intramural leiomyoma and broad in five with subserosal leiomyoma. Two patients with adenomyosis showed nodular-shaped areas of hypointensity in front of the sacral promontory. Precontrast T(1)- and T(2)-weighted MR images showed no signal abnormalities in the portions corresponding to the hypointensity in any of the 12 patients. Pathological examinations showed no specific findings in the portions corresponding to the hypointensity in the 7 patients who had hysterectomy. CONCLUSION: The areas of hypointensity may represent functional changes, such as decreased localized blood flow caused by compression of the sacral promontory.
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Abstract

Purpose: In patients with huge leiomyoma and with adenomyosis of the uterus, a peculiar area of hypointensity was occasionally observed on postcontrast magnetic resonance (MR) imaging in the dorsal portion of the enlarged uterus near the sacral promontory. We describe the imaging characteristics of these MR findings and correlate them with histopathological findings to examine whether the areas represent specific pathological changes.

Methods

Ten patients with huge leiomyomas and two with huge adenomyotic lesions whose imaging revealed the hypointensity were enrolled. All had enlarged uteri that extended beyond the sacral promontory. MR findings of the hypointense areas were evaluated and correlated with histopathological findings in 5 patients with leiomyoma and two with adenomyosis who had hysterectomy.

Results

The ten patients with leiomyoma showed flare-shaped hypointensity arising from the dorsal surface of the uterine body that extended deep into the tumor. The base of the hypointense areas was narrow in 5 patients with intramural leiomyoma and broad in five with subserosal leiomyoma. Two patients with adenomyosis showed nodular-shaped areas of hypointensity in front of the sacral promontory. Precontrast T1- and T2-weighted MR images showed no signal abnormalities in the portions corresponding to the hypointensity in any of the 12 patients. Pathological examinations showed no specific findings in the portions corresponding to the hypointensity in the 7 patients who had hysterectomy.

Conclusion

The areas of hypointensity may represent functional changes, such as decreased localized blood flow caused by compression of the sacral promontory.

Methods

Ten patients with huge leiomyomas and two with huge adenomyotic lesions whose imaging revealed the hypointensity were enrolled. All had enlarged uteri that extended beyond the sacral promontory. MR findings of the hypointense areas were evaluated and correlated with histopathological findings in 5 patients with leiomyoma and two with adenomyosis who had hysterectomy.

Results

The ten patients with leiomyoma showed flare-shaped hypointensity arising from the dorsal surface of the uterine body that extended deep into the tumor. The base of the hypointense areas was narrow in 5 patients with intramural leiomyoma and broad in five with subserosal leiomyoma. Two patients with adenomyosis showed nodular-shaped areas of hypointensity in front of the sacral promontory. Precontrast T1- and T2-weighted MR images showed no signal abnormalities in the portions corresponding to the hypointensity in any of the 12 patients. Pathological examinations showed no specific findings in the portions corresponding to the hypointensity in the 7 patients who had hysterectomy.

Conclusion

The areas of hypointensity may represent functional changes, such as decreased localized blood flow caused by compression of the sacral promontory. © 2007 by Japanese Society for Magnetic Resonance in Medicine Favorites & Alerts Recently viewed articles

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Condition tags

endometriosisadenomyosis

MeSH descriptors

Endometriosis Gadolinium DTPA Leiomyoma Magnetic Resonance Imaging Sacrum Uterine Neoplasms Uterus Adult Contrast Media Contrast Media Endometriosis Endometriosis Female Humans Image Enhancement Image Enhancement Leiomyoma Leiomyoma Leiomyoma Magnetic Resonance Imaging

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