Role of diffusion-weighted imaging in the diagnosis of gynecological diseases

Abstract

Recent technical advances in diffusion-weighted imaging (DWI) greatly enhanced the clinical value of magnetic resonance imaging (MRI) of the body. DWI can provide excellent tissue contrast based on molecular diffusion and may be able to demonstrate malignant tumors. Quantitative measurement of the apparent diffusion coefficient (ADC) may be valuable in distinguishing between malignant and benign lesions. We reviewed DWI and conventional MRI of the female pelvis to study the utility of DWI in patients with gynecological diseases. Although the ADC can help to differentiate between normal and cancerous tissue in the uterine cervix and endometrium, its utility may be limited by the large overlap of the uterine myometrium and ovaries. On the other hand, the ADC may be useful for monitoring the therapeutic outcome after uterine arterial embolizati (UAE), chemotherapy and/or radiation therapy. In patients with ovarian cancer, DWI demonstrates high intensity not only at the primary cancer site but also in disseminated peritoneal implants. When added to conventional MRI findings, DWI and ADC values provide additional information and DWI may play an important role in the diagnosis of patients with gynecological diseases.

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.…”