Hyperintense uterine leiomyoma at T2-weighted MR imaging: differentiation with dynamic enhanced MR imaging and clinical implications.

Yamashita, Yasuyuki; Torashima, Miyuki; Takahashi, Manabu; Tanaka, Nobuyuki; Katabuchi, Hidetaka; Miyazaki, Kohji; Ito, Masaharu; Okamura, Hitoshi

doi:10.1148/radiology.189.3.8234695

Cited by 175 publications

(90 citation statements)

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“…We found that this variation in the treatment efficacy could be partly predicted by fibroid SI as seen on pretreatment T2-weighted MR images: Low fibroid SI was predictive of a good response to MR-guided focused ultrasound surgery. It has previously been established that low or hypointense SI on T2-weighted MR images reflects low cellularity and/or vascularity (18), while high SI represents vascularization, fluid-rich tissues, or degeneration (19). In hyperintense fibroids, it is difficult to obtain adequate temperature elevation with sonication because high perfusion decreases heat accumulation through the vascular cooling effect (20).…”

Section: Discussionmentioning

confidence: 99%

Uterine Leiomyomas: MR Imaging–guided Focused Ultrasound Surgery—Imaging Predictors of Success

Lénárd¹,

McDannold²,

Fennessy³

et al. 2008

Radiology

156

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Purpose:To retrospectively assess the magnetic resonance (MR) imaging predictors of success at reducing uterine leiomyoma volume and achieving patient symptom relief 12 months after MR imaging-guided focused ultrasound surgery. Materials and Methods:This single-center retrospective analysis of 71 symptomatic fibroids in 66 women was approved by the institutional review board and was HIPAA-compliant. Patients were treated with MR imaging-guided focused ultrasound surgery. The volume of treated fibroid and nonperfused volume (NPV) were calculated with software, while symptom outcome was assessed with a symptom severity score (SSS). Fibroids were classified as hyperintense or hypointense relative to skeletal muscle on pretreatment T2-weighted MR images. Results:Baseline volume of treated fibroids was 255.5 cm 3 Ϯ 201.7 (standard deviation), and baseline SSS was 61.5 Ϯ 14.9. Both pretreatment fibroid signal intensity (SI) and posttreatment NPV predicted 12-month volume reduction independently: Fibroids with an NPV of at least 20% or with low SI both showed significantly larger volume reduction (17.0% Ϯ 13.0 and 17.2% Ϯ 20.1, respectively) than fibroids with an NPV less than 20% or with high SI (10.7% Ϯ 18.2 and no significant change, respectively). Patients whose fibroids demonstrated an NPV of at least 20% also experienced a larger decrease in SSS than did patients with fibroids with an NPV less than 20% (50.1% Ϯ 19.8 vs 32.6% Ϯ 29.9). Conclusion:Fibroids with low SI on pretreatment T2-weighted MR images were more likely to shrink than were ones with high SI. The larger the NPV immediately after treatment, the greater the volume reduction and symptom relief were. These findings may help both in selecting appropriate patients for MR-guided focused ultrasound surgery and in predicting patient outcome.

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Section: Discussionmentioning

confidence: 99%

Uterine Leiomyomas: MR Imaging–guided Focused Ultrasound Surgery—Imaging Predictors of Success

Lénárd¹,

McDannold²,

Fennessy³

et al. 2008

Radiology

156

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“…However, this finding is typically not seen in the menstrual and first part of the cycle. Furthermore, in women at postmenopausal age where such an enhancement pattern is reported as typical, its visualization may be impaired by the low spatial resolution of dynamic contrastenhanced imaging [17,18]. Slice section of 2 mm with enough spatial resolution is only possible in 3D gradient echo sequences, which may be preferable to standard enhanced 2D sequences.…”

Section: Technical Consideration With Agreementmentioning

confidence: 99%

Staging of endometrial cancer with MRI: Guidelines of the European Society of Urogenital Imaging

et al. 2009

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The purpose of this study was to define guidelines for endometrial cancer staging with MRI. The technique included critical review and expert consensus of MRI protocols by the female imaging subcommittee of the European Society of Urogenital Radiology, from ten European institutions, and published literature between 1999 and 2008. The results indicated that high field MRI should include at least two T2-weighted sequences in sagittal, axial oblique or coronal oblique orientation (short and long axis of the uterine body) of the pelvic content. High-resolution postcontrast images acquired at 2 min ± 30 s after intravenous contrast injection are suggested to be optimal for the diagnosis of myometrial invasion. If cervical invasion is suspected, additional slice orientation perpendicular to the axis of the endocervical channel is recommended. Due to the limited sensitivity of MRI to detect lymph node metastasis without lymph nodespecific contrast agents, retroperitoneal lymph node screening with pre-contrast sequences up to the level of the kidneys is optional. The likelihood of lymph node invasion and the need for staging lymphadenectomy are also indicated by high-grade histology at endometrial tissue sampling and by deep myometrial or cervical invasion detected by MRI. In conclusion, expert consensus and literature review lead to an optimized MRI protocol to stage endometrial cancer.

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“…The contradicting results of previous studies may be explained by the differences in blood supply among the three Dynamic contrast-enhanced MRI serves as a predictor of HIFU treatment outcome for uterine fibroids with hyperintensity in T2-weighted images (12) observed that degenerated and cellular uterine fibroids manifested as hyperintense under T2-weighted MRI. There was considerable overlap, and dynamic contrast-enhanced MRI was able to reflect the blood flow of uterine fibroids and distinguish between them.…”

Section: Introductionmentioning

confidence: 65%

“…Dynamic contrast-enhanced MRI is performed using a T1-weighted gradient-echo sequence after pump injection of 0.1 mmol/kg gadolinium, and is able to indicate the perfusion and permeability of a tumor and is used to distinguish malignant lesions from benign lesions, in addition to distinguishing degenerative lesions from 'ordinary̓ lesions. According to a number of studies (12,17,18), dynamic contrast-enhanced MRI may be used to distinguish between degenerative fibroids and cellular fibroids, which both manifest as hyperintense under T2-weighted MRI. Cellular fibroids are copiously supplied by vessels and manifest with regular enhancement on dynamic contrast-enhanced MRI scans.…”

Section: Discussionmentioning

confidence: 99%

Dynamic contrast-enhanced MRI serves as a predictor of HIFU treatment outcome for uterine fibroids with hyperintensity in T2-weighted images

Zhao

Chen

2015

Experimental and Therapeutic Medicine

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Abstract. The aim of the present study was to investigate the efficacy of dynamic contrast-enhanced magnetic resonance imaging (MRI) in predicting the outcome of using ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation for the treatment of uterine fibroids with T2 hyperintensity under MRI. A total of 131 uterine fibroids from 131 patients that appeared hyperintense under T2-weighted MRI were analyzed. The uterine fibroids were subjectively categorized into slight, irregular or regular enhancement groups, according to pretreatment dynamic contrast-enhanced MRI in the arterial phase within 60 sec after the injection of gadolinium. The non-perfused volume (NPV), which is indicative of successful ablation, was represented as the non-perfused area inside the uterine fibroids on enhanced MRI scans following treatment. Additionally, the treatment duration, treatment efficiency, sonication duration, energy efficiency ratio and any adverse events were recorded. The results indicated that the average NPV ratio for all the treated fibroids was 68.5%, while the average NPV ratios for fibroids with slight, irregular or regular enhancement were 84.7, 70.6 and 57.1%, respectively. Fibroids with regular enhancement were associated with the lowest NPV ratio and the lowest treatment efficiency, but exhibited the highest energy effect ratio and an elevated risk of severe adverse effects. The results of the present study indicate that hyperintense uterine fibroids with slight and irregular enhancement in the arterial phase of dynamic contrast-enhanced MRI are suitable for USgHIFU treatment. By contrast, uterine fibroids with regular enhancement were associated with the lowest treatment efficacy and safety.

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Hyperintense uterine leiomyoma at T2-weighted MR imaging: differentiation with dynamic enhanced MR imaging and clinical implications.

Abstract: Evaluation of signal intensity at T2-weighted imaging and degree of contrast enhancement at dynamic enhanced MR imaging provide useful information on the nature of leiomyomas.

Cited by 175 publications

References 0 publications

Uterine Leiomyomas: MR Imaging–guided Focused Ultrasound Surgery—Imaging Predictors of Success

Uterine Leiomyomas: MR Imaging–guided Focused Ultrasound Surgery—Imaging Predictors of Success

Staging of endometrial cancer with MRI: Guidelines of the European Society of Urogenital Imaging

Dynamic contrast-enhanced MRI serves as a predictor of HIFU treatment outcome for uterine fibroids with hyperintensity in T2-weighted images

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