Endometrial carcinoma in adenomyosis: assessment of myometrial invasion on T2-weighted spin-echo and gadolinium-enhanced T1-weighted images.
OBJECTIVE
The aim of our study was to compare T2-weighted and contrast-enhanced dynamic T1-weighted images with histologic findings in assessing the depth of myometrial invasion by endometrial carcinoma in adenomyosis.


METHODS
We retrospectively reviewed the MRIs of 11 patients who had a total of 12 lesions of endometrial carcinoma within adenomyosis. T2-weighted and contrast-enhanced dynamic T1-weighted images were compared with the histologic findings separately. We assessed the extent of myometrial invasion by endometrial carcinomas. The depth of myometrial invasion seen on MRI was classified as stage S (superficial invasion), stage D (deep invasion), or undetectable. The staging accuracies of each sequence were assessed. The tumor-myometrium contrast-to-noise ratios were calculated for each sequence.


RESULTS
The histologic specimens revealed that myometrial invasion was deep in seven of 12 lesions and superficial in five. On T2-weighted images the depth of invasion was underestimated in two lesions and impossible to determine in five lesions. On dynamic T1-weighted images the depth of invasion was overestimated in one lesion and underestimated in one lesion. The staging accuracy on dynamic T1-weighted images (83%) was significantly higher than that on T2-weighted images (42%). The contrast-to-noise ratio was significantly higher on dynamic T1-weighted studies during the early phase (mean +/- SD, 2.68 +/- 0.94) than it was on T2-weighted studies (1.74 +/- 1.05) and during the delayed phase (2.01 +/- 0.86).


CONCLUSIONS
When adenomyosis coexists with endometrial cancer at the same site on T2-weighted images, contrast-enhanced dynamic T1-weighted imaging improves the accuracy of staging.
Utsunomiya
Daisuke
D
Department of Radiology, Kumamoto University School of Medicine, 1-1-1, Honjo, Kumamoto, Kumamoto 860-8556, Japan. d.t-utsu@d8.dion.ne.jp
Notsute
Shiho
S
Hayashida
Yoshiko
Y
Lwakatare
Flora
F
Katabuchi
Hidetaka
H
Okamura
Hitoshi
H
Awai
Kazuo
K
Yamashita
Yasuyuki
Y
D000328:Adult; D000368:Aged; D003287:Contrast Media; D016889:Endometrial Neoplasms / Q000150:complications / Q000473:pathology*; D004715:Endometriosis / Q000150:complications / Q000473:pathology*; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D009215:Myometrium / Q000473:pathology*; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D015203:Reproducibility of Results; D012189:Retrospective Studies
D003287:Contrast Media; D019786:Gadolinium DTPA