title: Carcinosarcoma of the uterus: MRI findings including diffusion-weighted imaging and MR spectroscopy.
abstract: BACKGROUND
  Recently carcinosarcoma has become regarded as a subset of endometrial carcinoma. Because the clinical course of carcinosarcoma is aggressive with poor prognosis, it should be differentiated from endometrial carcinomas for the appropriate surgical management and adjuvant therapy.
  
  
  OBJECTIVE
  To clarify the magnetic resonance imaging (MRI) characteristics of uterine carcinosarcoma including diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) measurement and MR spectroscopy (MRS) with quantitative metabolite evaluation.
  
  
  METHODS
  MRI findings of 12 pathologically diagnosed uterine carcinosarcomas obtained on 3T MRI were retrospectively evaluated. The mean and minimum ADCs, and the lipid and choline concentration levels were compared with those of pathologically diagnosed 38 endometrial carcinomas.
  
  
  RESULTS
  The mean and minimum ADCs in carcinosarcomas and endometrial carcinomas were not significantly different. The mean ADC of carcinosarcomas was significantly higher than that of higher grade (G2 and G3) endometrial carcinomas. The choline concentration in carcinosarcomas was significantly lower than that in endometrial carcinomas. High lipid peak was observed in 91% of carcinosarcomas and in 24% of endometrial carcinomas.
  
  
  CONCLUSIONS
  Large, exophytic heterogeneous endometrial mass containing strongly enhanced areas, which may exhibit "tumor delivery", is a suggestive of carcinosarcoma. Relatively high mean ADC and low choline concentration considering its highly malignant nature due to intra-tumoral heterogeneity with necrosis and epithelial cystic components, and the presence of necrosis-associated high lipid peak may be compatible with carcinosarcoma.
authors.affiliation: Department of Radiology, University of Tokushima, Tokushima, Japan mayumi@tokushima-u.ac.jp.
authors.forename: Mayumi
authors.initials: M
authors.lastname: Takeuchi
authors.affiliation: Department of Radiology, University of Tokushima, Tokushima, Japan Department of Radiological Technology, Tokushima Bunri University, Kagawa, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Matsuzaki
authors.affiliation: Department of Radiology, University of Tokushima, Tokushima, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Harada
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002296:Carcinosarcoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D009682:Magnetic Resonance Spectroscopy; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D014594:Uterine Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy
chemical_list: D003287:Contrast Media
keywords: Genital/reproductive; MR diffusion/perfusion; MR spectroscopy; magnetic resonance imaging (MRI); neoplasms – primary; uterus