European Radiology

, Volume 18, Issue 4, pp 723–730 | Cite as

The utility of diffusion-weighted MR imaging for differentiating uterine sarcomas from benign leiomyomas

  • Ken Tamai
  • Takashi KoyamaEmail author
  • Tsuneo Saga
  • Nobuko Morisawa
  • Koji Fujimoto
  • Yoshiki Mikami
  • Kaori Togashi


The usefulness of diffusion-weighted (DW) magnetic resonance (MR) imaging for the diagnosis of uterine sarcomas was investigated, as well as whether DW images and quantitative measurement of apparent diffusion coefficient (ADC) values can facilitate differentiating uterine sarcomas from benign leiomyomas. MR images including DW images were obtained in 43 surgically treated patients with 58 myometrial tumors, including seven uterine sarcomas (five leiomyosarcomas and two endometrial stromal sarcomas) and 51 benign leiomyomas (43 ordinary leiomyomas, two cellular leiomyomas and six degenerated leiomyomas). Qualitative analysis of non-enhanced and postcontrast MR images and DW images and quantitative measurement of ADC values were performed for each myometrial tumor. Both uterine sarcomas and cellular leiomyomas exhibited high signal intensity on DW images, whereas ordinary leiomyomas and most degenerated leiomyomas showed low signal intensity. The mean ADC value (10−3 mm2/s) of sarcomas was 1.17 ± 0.15, which was lower than those of the normal myometrium (1.62 ± 0.11) and degenerated leiomyomas (1.70 ± 0.11) without any overlap; however, they were overlapped with those of ordinary leiomyomas and cellular leiomyomas. In addition to morphological features on nonenhanced and postcontrast MR sequences, DW imaging and ADC measurement may have a potential ability to differentiate uterine sarcomas from benign leiomyomas.


Uterus Magnetic resonance Neoplasm Apparent diffusion coefficient Myometrium 


  1. 1.
    Kahanpaa KV, Wahlstrom T, Grohn P, Heinonen E, Nieminen U, Widholm O (1986) Sarcomas of the uterus: a clinicopathologic study of 119 patients. Obstet Gynecol 67:417–424PubMedGoogle Scholar
  2. 2.
    Zoloudek C, Norris H (2002) Mesenchymal tumors of the uterus. In: Kurman RJ (ed) Blaustein’s Pathology of the female genital tract, 5th edn. Springer, Berlin Heidelberg New YorkGoogle Scholar
  3. 3.
    Sahdev A, Sohaib SA, Jacobs I, Shepherd JH, Oram DH, Reznek RH (2001) MR imaging of uterine sarcomas. AJR Am J Roentgenol 177:1307–1311PubMedGoogle Scholar
  4. 4.
    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 12:354–361PubMedCrossRefGoogle Scholar
  5. 5.
    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 20:998–1007PubMedCrossRefGoogle Scholar
  6. 6.
    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 173:767–772PubMedGoogle Scholar
  7. 7.
    Ueda M, Otsuka M, Hatakenaka M, Torii Y (2000) Uterine endometrial stromal sarcoma located in uterine myometrium: MRI appearance. Eur Radiol 10:780–782PubMedCrossRefGoogle Scholar
  8. 8.
    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 11:28–33PubMedCrossRefGoogle Scholar
  9. 9.
    Togashi K, Ozasa H, Konishi I, Itoh H, Nishimura K, Fujisawa I, Noma S, Sagoh T, Minami S, Yamashita K et al (1989) Enlarged uterus: differentiation between adenomyosis and leiomyoma with MR imaging. Radiology 171:531–534PubMedGoogle Scholar
  10. 10.
    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(Spec No):S131–S145PubMedGoogle Scholar
  11. 11.
    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 189:721–725PubMedGoogle Scholar
  12. 12.
    Le Bihan D, Turner R, Douek P, Patronas N (1992) Diffusion MR imaging: clinical applications. AJR Am J Roentgenol 159:591–599PubMedGoogle Scholar
  13. 13.
    Bahn MM, Oser AB, Cross DT 3rd (1996) CT and MRI of stroke. J Magn Reson Imaging 6:833–845PubMedCrossRefGoogle Scholar
  14. 14.
    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 41:143–147PubMedCrossRefGoogle Scholar
  15. 15.
    Thoeny HC, De Keyzer F (2007) Extracranial applications of diffusion-weighted magnetic resonance imaging. Eur Radiol 17:1385–1393PubMedCrossRefGoogle Scholar
  16. 16.
    Ichikawa T, Haradome H, Hachiya J, Nitatori T, Araki T (1998) Diffusion-weighted MR imaging with a single-shot echoplanar sequence: detection and characterization of focal hepatic lesions. AJR Am J Roentgenol 170:397–402PubMedGoogle Scholar
  17. 17.
    Takahara T, Imai Y, Yamashita T, Yasuda S, Nasu S, Van Cauteren M (2004) Diffusion weighted whole body imaging with background body signal suppression (DWIBS): technical improvement using free breathing, STIR and high resolution 3D display. Radiat Med 22:275–282PubMedGoogle Scholar
  18. 18.
    Marini C, Iacconi C, Giannelli M, Cilotti A, Moretti M, Bartolozzi C (2007) Quantitative diffusion-weighted MR imaging in the differential diagnosis of breast lesion. Eur Radiol 17:2646–2655PubMedCrossRefGoogle Scholar
  19. 19.
    Lyng H, Haraldseth O, Rofstad EK (2000) Measurement of cell density and necrotic fraction in human melanoma xenografts by diffusion weighted magnetic resonance imaging. Magn Reson Med 43:828–836PubMedCrossRefGoogle Scholar
  20. 20.
    Nonomura Y, Yasumoto M, Yoshimura R, Haraguchi K, Ito S, Akashi T, Ohashi I (2001) Relationship between bone marrow cellularity and apparent diffusion coefficient. J Magn Reson Imaging 13:757–760PubMedCrossRefGoogle Scholar
  21. 21.
    Szafer A, Zhong J, Gore JC (1995) Theoretical model for water diffusion in tissues. Magn Reson Med 33:697–712PubMedCrossRefGoogle Scholar
  22. 22.
    Koyama T, Tamai K, Togashi K (2006) Current status of body MR imaging: fast MR imaging and diffusion-weighted imaging. Int J Clin Oncol 11:278–285PubMedCrossRefGoogle Scholar
  23. 23.
    Abdel Razek AA, Soliman NY, Elkhamary S, Alsharaway MK, Tawfik A (2006) Role of diffusion-weighted MR imaging in cervical lymphadenopathy. Eur Radiol 16:1468–1477PubMedCrossRefGoogle Scholar
  24. 24.
    Sumi M, Ichikawa Y, Nakamura T (2007) Diagnostic ability of apparent diffusion coefficients for lymphomas and carcinomas in the pharynx. Eur Radiol 17:2631–2637PubMedCrossRefGoogle Scholar
  25. 25.
    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 243:570–577PubMedCrossRefGoogle Scholar
  26. 26.
    Nasu K, Kuroki Y, Kuroki S, Murakami K, Nawano S, Moriyama N (2004) Diffusion-weighted single shot echo planar imaging of colorectal cancer using a sensitivity-encoding technique. Jpn J Clin Oncol 34:620–626PubMedCrossRefGoogle Scholar
  27. 27.
    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 15:71–78PubMedCrossRefGoogle Scholar
  28. 28.
    Sato C, Naganawa S, Nakamura T, Kumada H, Miura S, Takizawa O, Ishigaki T (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 21:258–262PubMedCrossRefGoogle Scholar
  29. 29.
    Nasu K, Kuroki Y, Nawano S, Kuroki S, Tsukamoto T, Yamamoto S, Motoori K, Ueda T (2006) Hepatic metastases: diffusion-weighted sensitivity-encoding versus SPIO-enhanced MR imaging. Radiology 239:122–130PubMedCrossRefGoogle Scholar
  30. 30.
    Taouli B, Vilgrain V, Dumont E, Daire JL, Fan B, Menu Y (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 226:71–78PubMedCrossRefGoogle Scholar
  31. 31.
    Matsuki M, Inada Y, Tatsugami F, Tanikake M, Narabayashi I, Katsuoka Y (2007) Diffusion-weighted MR imaging for urinary bladder carcinoma: initial results. Eur Radiol 17:201–204PubMedCrossRefGoogle Scholar
  32. 32.
    Matsuki M, Inada Y, Nakai G, Tatsugami F, Tanikake M, Narabayashi I, Masuda D, Arisaka Y, Takaori K, Tanigawa N (2007) Diffusion-weighed MR imaging of pancreatic carcinoma. Abdom Imaging 32(4):481–483PubMedCrossRefGoogle Scholar
  33. 33.
    Jacobs MA, Herskovits EH, Kim HS (2005) Uterine fibroids: diffusion-weighted MR imaging for monitoring therapy with focused ultrasound surgery-preliminary study. Radiology 236:196–203PubMedCrossRefGoogle Scholar
  34. 34.
    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 29:83–86PubMedCrossRefGoogle Scholar
  35. 35.
    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 20:97–104PubMedCrossRefGoogle Scholar
  36. 36.
    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 22:112–118PubMedGoogle Scholar
  37. 37.
    Hiwatashi A, Kinoshita T, Moritani T, Wang HZ, Shrier DA, Numaguchi Y, Ekholm SE, Westesson PL (2003) Hypointensity on diffusion-weighted MRI of the brain related to T2 shortening and susceptibility effects. AJR Am J Roentgenol 181:1705–1709PubMedGoogle Scholar

Copyright information

© European Society of Radiology 2007

Authors and Affiliations

  • Ken Tamai
    • 1
  • Takashi Koyama
    • 2
    Email author
  • Tsuneo Saga
    • 1
  • Nobuko Morisawa
    • 1
  • Koji Fujimoto
    • 1
  • Yoshiki Mikami
    • 3
  • Kaori Togashi
    • 1
  1. 1.Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of MedicineKyoto UniversityKyotoJapan
  2. 2.Department of RadiologyKyoto University HospitalKyotoJapan
  3. 3.Laboratory of Anatomic PathologyKyoto University HospitalKyotoJapan

Personalised recommendations