Pelvic Applications of Diffusion Magnetic Resonance Images

MR Imaging of Malignancies Arising in Endometriomas and Extraovarian Endometriosis

“…For the detection of cancer arising in an endometrioma, subtraction images derived from unenhanced and contrast-enhanced T1-weighted imaging datasets offer improved conspicuity of enhancing mural nodules against the intrinsically high background signal intensity of the endometriotic cyst (10,15). In extraovarian endometriosis, diffusionweighted imaging helps characterize indeterminate masses in the female pelvis as potentially malignant (12,16). The signal intensity of myometrium, or if the uterus is absent, that of the small bowel wall, is used as an internal reference standard for the qualitative assessment of lesion signal intensity on diffusion-weighted images and apparent diffusion coefficient (ADC) maps.…”

“…These pelvic lesions characteristically enhance after the intravenous administration of a gadolinium-based contrast material and demonstrate restricted diffusion (Fig 7). A diagnosis of endometriosis-associated malignancy should be considered when such a lesion is seen in a woman with a previous diagnosis of endometriosis or when a lesion with endometriotic features and another lesion with malignant characteristics are seen concurrently on MR images (Figs 8, 9) (12,16). In contrast, malignant transformation of an endometriotic…”

Management of pregnancy in woman with suspected malignant deep infiltrating endometriosis fistulised to the uterine cervix

“…On MRI, these cancers typically manifest as solid lesions with intermediate signal intensity on T1-weighted and T2-weighted images 4. These pelvic lesions characteristically enhance after the intravenous administration of gadolinium-based contrast material and demonstrate restricted diffusion on diffusion-weighted images and ADC maps 4 9 10. In our case, we suspected malignant transformation on the solid component of the mass with intermediate-signal intensity on T2-weighted images, type 2 enhancements and restricted ADC.…”

The diagnostic utility of combined diffusion‐weighted imaging and conventional magnetic resonance imaging for detection and localization of non palpable undescended testes

“…Diffusion‐weighted imaging is based on the random motion of water molecules within the cytoplasm and is non‐specific in that any tissue with high cellular density appears bright on high b value images. Therefore, normal or reactive nodes, and bowel mucosa, may present with high signal intensity on DWI …”

“…Therefore, normal or reactive nodes, and bowel mucosa, may present with high signal intensity on DWI. 20 It was difficult in some cases to differentiate between reactive lymph nodes and testes at the inguinal region utilizing DWI alone, as both structures display high signal. However, the combined conventional and diffusion images proved to be efficient in these cases as the testes showed higher signal intensity than lymph nodes on fat-suppression T2WI.…”