title: Diffusion weighted imaging of the uterus: regional ADC variation with oral contraceptive usage and comparison with cervical cancer.
abstract: BACKGROUND
  There is growing interest in diffusion weighted magnetic resonance imaging (MRI) of cervical carcinoma but normal uterine appearances and effects of the oral contraceptive pill (OCP) have not been described.
  
  
  OBJECTIVE
  To establish apparent diffusion coefficient (ADC) values for normal regions of uterus, determine the effect of the OCP on these values, and compare them with ADCs from cervical cancer.
  
  
  METHODS
  Twenty-seven premenopausal women (19 taking the OCP) with cervical intraepithelial neoplasia (CIN) were studied with T2W and diffusion weighted MRI (DW-MRI). Regions of interest were drawn on ADC maps by visual matching with T2W images on different zones of the uterus and values compared between women not taking and taking the OCP. A further group of 25 women with clinically obvious tumors of the cervix were also studied with T2W and DW-MRI and ADC values of tumor were compared with ADC values of cervical epithelium and stroma.
  
  
  RESULTS
  The ADC values of adjacent zones of the uterus and cervix were significantly different from one another (P<0.001). The junctional zone was seen as a band of restricted diffusion between endometrium and outer myometrium. The ADC value of the junctional zone of the uterus was significantly greater (P<0.001) in patients taking the OCP than those patients not taking the OCP. There was no significant affect of the OCP on the ADC values of other uterine zones.
  
  
  CONCLUSIONS
  The zonal anatomy of the uterus is well demonstrated by DW-MRI with hormonal effects secondary to the OCP affecting junctional zone alone. ADC of cervical tumor is significantly different to cervical epithelium and stroma indicating a role in cervical cancer detection and local staging.
authors.affiliation: Cancer Research UK Clinical Magnetic Resonance Research Group, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Downs Road, Surrey, UK.
authors.forename: Christina
authors.initials: C
authors.lastname: Messiou
authors.forename: Veronica A
authors.initials: VA
authors.lastname: Morgan
authors.forename: Sonali S
authors.initials: SS
authors.lastname: De Silva
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Ind
authors.forename: Nandita M
authors.initials: NM
authors.lastname: deSouza
mesh_terms: D000328:Adult; D003276:Contraceptives, Oral / Q000008:administration & dosage*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D011446:Prospective Studies; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D014599:Uterus / Q000187:drug effects / Q000473:pathology*; D055815:Young Adult
chemical_list: D003276:Contraceptives, Oral