Hypointensity on postcontrast MR imaging from compression of the sacral promontory in enlarged uterus with huge leiomyoma and adenomyosis.
OBJECTIVE
In patients with huge leiomyoma and with adenomyosis of the uterus, a peculiar area of hypointensity was occasionally observed on postcontrast magnetic resonance (MR) imaging in the dorsal portion of the enlarged uterus near the sacral promontory. We describe the imaging characteristics of these MR findings and correlate them with histopathological findings to examine whether the areas represent specific pathological changes.


METHODS
Ten patients with huge leiomyomas and two with huge adenomyotic lesions whose imaging revealed the hypointensity were enrolled. All had enlarged uteri that extended beyond the sacral promontory. MR findings of the hypointense areas were evaluated and correlated with histopathological findings in 5 patients with leiomyoma and two with adenomyosis who had hysterectomy.


RESULTS
The ten patients with leiomyoma showed flare-shaped hypointensity arising from the dorsal surface of the uterine body that extended deep into the tumor. The base of the hypointense areas was narrow in 5 patients with intramural leiomyoma and broad in five with subserosal leiomyoma. Two patients with adenomyosis showed nodular-shaped areas of hypointensity in front of the sacral promontory. Precontrast T(1)- and T(2)-weighted MR images showed no signal abnormalities in the portions corresponding to the hypointensity in any of the 12 patients. Pathological examinations showed no specific findings in the portions corresponding to the hypointensity in the 7 patients who had hysterectomy.


CONCLUSIONS
The areas of hypointensity may represent functional changes, such as decreased localized blood flow caused by compression of the sacral promontory.
Uotani
Kensuke
K
Department of Radiology, Hyogo Medical Center for Adults, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan. uota2@med.kobe-u.ac.jp
Monzawa
Shuichi
S
Adachi
Shuji
S
Takemori
Masayuki
M
Kaji
Yasushi
Y
Sugimura
Kazuro
K
D000328:Adult; D003287:Contrast Media / Q000008:administration & dosage; D004715:Endometriosis / Q000150:complications / Q000473:pathology*; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007889:Leiomyoma / Q000098:blood supply / Q000150:complications / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D015588:Observer Variation; D011312:Pressure; D012039:Regional Blood Flow; D012447:Sacrum / Q000473:pathology*; D014594:Uterine Neoplasms / Q000098:blood supply / Q000150:complications / Q000473:pathology*; D014599:Uterus / Q000098:blood supply / Q000473:pathology*
D003287:Contrast Media; D019786:Gadolinium DTPA