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Combined use of T2-weighted and diffusion-weighted 3-T MR imaging for differentiating uterine sarcomas from benign leiomyomas

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Abstract

The objective of our study was to compare diffusion-weighted imaging (DWI) alone and DWI combined with T2-weighted MRI for the differentiation of uterine sarcomas from benign leiomyomas. T2-weighted imaging and DWI were performed in 103 patients with 103 myometrial tumours, including 8 uterine sarcomas and 95 benign leiomyomas on 3-T MR imaging. The signal intensity (SI) of the tumour on T2-weighted images was quantified as the tumour–myometrium contrast ratio (TCR) by using the following formula: (SItumour − SImyometrium)/SImyometrium. The TCR or apparent diffusion coefficient (ADC) value alone and then the ADC value combined with T2-weighted imaging were evaluated for differentiation between sarcomas and leiomyomas. The mean ADC value of sarcomas was 0.86 ± 0.11 × 10−3 m2/s, which was significantly lower than that of leiomyomas 1.18 ± 0.24 × 10−3 m2/s; however, there was a substantial overlap. The mean TCR of sarcomas was 0.66 ± 0.71, which was significantly higher than that of the leiomyomas, –0.37 ± 0.34; however, again, there was a considerable overlap. When ADC was less than 1.05 × 10−3 mm2/s and TCR was greater than 0 this condition was considered to confirm a sarcoma; a combination of ADC and TCR achieved a significant improvement without any overlap between sarcomas and leiomyomas (sensitivity 100%, specificity 100%). Our preliminary results indicate that combined DWI and T2-weighted MR imaging is better than DWI alone in the differentiation of uterine sarcomas from benign leiomyomas.

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References

  1. 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 189:721–725

    CAS  PubMed  Google Scholar 

  2. Spies JB, Roth AR, Jha RC, Gomez-Jorge J, Levy EB, Chang TC, Ascher SA (2002) Leiomyomata treated with uterine artery embolization: factors associated with successful symptom and imaging outcome. Radiology 222:45–52

    Article  PubMed  Google Scholar 

  3. 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 592:163–167

    Article  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  5. 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 12:354–361

    Article  CAS  PubMed  Google Scholar 

  6. Tanaka Y, 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 20:998–1007

    Article  PubMed  Google Scholar 

  7. 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 173:767–772

    CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  9. 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 11:28–33

    Article  CAS  PubMed  Google Scholar 

  10. 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 171:531–534

    CAS  PubMed  Google Scholar 

  11. Hricak H, Tscholakoff D, Heinrichs L, Fisher MR, Dooms GC, Reinhold C, Jaffe RB (1986) Uterine leiomyomas: correlation of MR, histopathologic findings, and symptoms. Radiology 158:385–391

    CAS  PubMed  Google Scholar 

  12. 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–S145

    PubMed  Google Scholar 

  13. 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 161:401–407

    PubMed  Google Scholar 

  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 41:143–147

    Article  CAS  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  16. 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 178:1087–1091

    PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  18. Yamashita Y, Tang Y, Takahashi M (1998) Ultrafast MR imaging of the abdomen: echo planar imaging and diffusion-weighted imaging. J Magn Reson Imaging 8:367–374

    Article  CAS  PubMed  Google Scholar 

  19. 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 21:258–262

    Article  PubMed  Google Scholar 

  20. Charles-Edwards EM, deSouza NM (2006) Diffusion-weighted magnetic resonance imaging and its application to cancer. Cancer Imaging 13; 6:135–143

    Article  Google Scholar 

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

    Article  PubMed  Google Scholar 

  22. Szafer A, Zhong J, Gore JC (1995) Theoretical model for water diffusion in tissues. Magn Reson Med 33:697–712

    Article  CAS  PubMed  Google Scholar 

  23. Liu KF, Li F, Tatlisumak T, Garcia JH, Sotak CH, Fisher M, Fenstermacher JD (2001) Regional variations in the apparent diffusion coefficient and the intracellular distribution of water in rat brain during acute focal ischemia. Stroke 32:1897–1905

    CAS  PubMed  Google Scholar 

  24. Knight RA, Ordidge R, Helpern J, Chopp M, Rodolosi L, Peck D (1991) Temporal evolution of ischemic damage in rat brain measured by proton nuclear magnetic resonance imaging. Stroke 22:802–808

    CAS  PubMed  Google Scholar 

  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 243:570–577

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  27. 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 22:271–278

    Article  PubMed  Google Scholar 

  28. 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 15:71–78

    Article  PubMed  Google Scholar 

  29. 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 26:682–687

    Article  PubMed  Google Scholar 

  30. 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

    Article  PubMed  Google Scholar 

  31. 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 29:83–86

    Article  PubMed  Google Scholar 

  32. 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 20:97–104

    Google Scholar 

  33. 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 18:723–730

    Article  PubMed  Google Scholar 

  34. 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 22:112–118

    CAS  PubMed  Google Scholar 

  35. 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 26:236–241

    PubMed  Google Scholar 

  36. Lee VS, Hecht EM, Taouli B, Chen Q, Prince K, Oesingmann N (2007) Body and cardiovascular MR imaging at 3.0 T. Radiology 244:692–705

    Article  PubMed  Google Scholar 

  37. Morakkabati-Spitz N, Schild HH, Kuhl CK, Lutterbey G, von Falkenhausen M, Träber F, Gieseke J (2006) Female pelvis: MR imaging at 3.0 T with sensitivity encoding and flip-angle sweep technique. Radiology 241:538–545

    Article  PubMed  Google Scholar 

  38. Kataoka M, Kido A, Koyama T, Isoda H, Umeoka S, Tamai K, Nakamoto Y, Maetani Y, Morisawa N, Saga T, Togashi K (2007) MRI of the female pelvis at 3T compared to 1.5T: evaluation on high-resolution T2-weighted and HASTE images. J Magn Reson Imaging 25:527–534

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1–1–1, Honjo, Kumamoto, 860–8556, Japan

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

  2. Radiation Oncology, Graduate School of Medical Sciences, Kumamoto University, 1–1–1, Honjo, Kumamoto, 860–8556, Japan

    Tetsuo Saito

  3. Obstetrics and Gynecology, Graduate School of Medical Sciences, Kumamoto University, 1–1–1, Honjo, Kumamoto, 860–8556, Japan

    Hidetaka Katabuchi

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  1. Tomohiro Namimoto
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  2. Yasuyuki Yamashita
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Correspondence to Tomohiro Namimoto.

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Namimoto, T., Yamashita, Y., Awai, K. et al. Combined use of T2-weighted and diffusion-weighted 3-T MR imaging for differentiating uterine sarcomas from benign leiomyomas. Eur Radiol 19, 2756–2764 (2009). https://doi.org/10.1007/s00330-009-1471-x

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