Diffusion-weighted MR Imaging of Female Pelvic Tumors: A Pictorial Review

Abstract

Functional imaging is becoming increasingly important in the evaluation of cancer patients because of the limitations of morphologic imaging, particularly in the assessment of response to therapy. Diffusion-weighted magnetic resonance (MR) imaging has been established as a useful functional imaging tool in neurologic applications for a number of years, but recent technical advances now allow its use in abdominal and pelvic applications. Diffusion-weighted MR imaging studies of female pelvic tumors have shown reduced apparent diffusion coefficient (ADC) values within cervical and endometrial tumors. In addition, this unique noninvasive modality has demonstrated the capacity to help discriminate between benign and malignant uterine lesions and to help assess the extent of peritoneal spread from gynecologic malignancies. Potential pitfalls can be avoided by reviewing diffusion-weighted MR imaging findings in conjunction with anatomic imaging findings. Increasing familiarity with ADC calculation and manipulation software will allow radiologists to provide new information for the care of patients with known or suspected gynecologic malignancies.

Diffusion-weighted MR imaging of normal and abnormal scrotum: preliminary results

“…The use of these sequences may produce image distortion caused by susceptibility artifacts, due to the presence of air and chemical shift artifacts from fatty tissue. [10][11][12][13][14][15][16][17][18][19][20][21][22][23] These artifacts were not seen in the present study, probably because of the lack of neighboring organs in the scrotal area. A relatively low signal to noise ratio and spatial resolution has also been reported with these images.…”

“…Another advantage of echo planar sequences is rapid image acquisition, reducing motion artifacts. [10][11][12][13][14][15][16][17][18][19][20][21][22][23] There were some limitations in this study. First, it was a retrospective review of a small number of patients with a narrow range of scrotal abnormalities.…”

“…[3][4][5][6][7][8][9] The technique due to its wide field of view, multiplanar capabilities, high contrast and spatial resolution has proved satisfactory in the localization of a scrotal mass, in the differentiation of paratesticular masses with respect to tumor morphology and tissue characteristics, in the distinction between benign from malignant intratesticular lesions and in the evaluation of the local extent of the disease in cases of testicular carcinomas. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] The technique is mainly recommended when sonographic findings are inconclusive or inconsistent with clinical findings. 5,6 In accordance with previous reports, this study demonstrated high accuracy of conventional MR sequences in characterizing both paratesticular and intratesticular mass lesions.…”

“…In agreement with previous study, this study reported reduced ADC values for malignancies. [12][13][14][15][16][17][18][19][20][21][22][23] The decrease of ADC values in testicular neoplasms is related to the histopathological characteristics of neoplastic tissue, that is, increased tissue cellularity, densely packed malignant cells, enlargement of the nuclei, and angulation of the nuclear contour, all causing reduced motility of water molecules.…”

“…The ADC values of malignancies are reported lower than those of benign lesions or normal tissues. [10][11][12][13][14][15][16][17][18][19][20][21][22][23] Published series reported the usefulness of DW MR imaging in the early detection of ischemia in the testis of Wistar rats and in the detection of nonpalpable testes in children. 24,25 To the author's knowledge, there are no reports in the English-language literature, regarding the normal ADC values of the scrotal contents, that is the testis and the epididymis and the ADC values of scrotal pathology.…”