Uterine Tumours
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David Sutton Radiology Textbook Reading, Radiology Resident of Gajah Mada University
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Uterine Tumours
- 1. TEXTBOOK READING OF SUTTON Textbook of Radiology and Imaging 7th Edition, Volume 2, page 1095-1097 CHAPTER 34: GYNECOLOGICAL IMAGING Presented by: Yessi Oktiari Consultant: dr. Yana Supriatna, Ph.D, Sp.Rad(K)RI
- 2. CHAPTER 34: GYNECOLOGICAL IMAGING Ultrasound Plain Film Radiology Contrast Studies Computed Tomography Interventional Radiology Magnetic Resonance Imaging Uterus, Cervix and Vagina Congenital Uterine Abnormalities Uterine Tumours Cervical Carcinoma Ovaries
- 3. UTERUS ANATOMY Source: Atlas of Human Anatomy 6th Ed Source: Diagnostic Imaging 7th Ed
- 4. LEIOMYOMA (UTERINE FIBROID) Most common solid uterine tumour Composed of smooth muscle, varying amount of fibrous tissue Single or multiple Estrogen dependent Location Submucosal Intramural Subserosal Source: mayoclinic.org
- 5. LEIOMYOMA MRI Accurate assesment of the site, number, size as small as 3 mm diameter IV gadolinium-chelate does not improve the detection
- 6. LEIOMYOMA Non degenerating T1: uniform signal intensity T2: low signal intensity Degenerating T1: intermediate-high signal intensity T2: high signal intensity Source: Diagnostic Imaging 7th Ed Sagittal T2-weighted MRI demonstrating several uterine fibroids (white arrows), which are of low signal intensity. The endometrial cavity is normal (black arrow). B, bladder; C, cervix
- 7. LEIOMYOMA USG • Useful in demonstrating subserosal and submucosal lesion on pedicle • Precludes the use of uterine artery ablation MRI • Limited in the presence of retroverted displaced uterus • Difficult in discriminating a uterine & adnexal mass • False negative up to 20%
- 8. ADENOMYOSIS http://www.emedicinehealth.com/adenomyosis-health/article_em.htm The presence of endometrial glandular cells and cells of the chorion more than 2.5 mm from the endometrium-myometrium interface Risk factor: 1. Prior endouterine surgery 2. Multiparity 3. Women between 40-50 tahun Signs and symptoms: 1. Menorrhagia 2. Dysmenorrhea 3. Recent onset of menstrual cramping that is gradually getting worse MRI Characteristics of the Uterine Junctional Zone: From Normal to the Diagnosis of Adenomyosis, Novellas et al., 2011
- 9. ADENOMYOSIS Can’t be distinguished from leiomyomas on clinical findings or by ultrasound Similar pelvic pain & menorraghia with uterine enlargement Different treatment Adenomyosis vs leiomyoma on MRI MRI findings Adenomyoma Leiomyoma 1. Diffuse or focal thickening of junctional zone Yes No 2. Ill-defined margin Yes No 3. Signal intensity Low Low but often high 4. Periphery large vessels No Yes
- 10. JUNCTIONAL ZONE MRI is the first imaging technique to reveal this structure Innermost layer of myometrium A distinct low signal on T2-weighted sequences separating the endometrium in high signal intensity from the outer myometrium in intermediate signal Looser extracellular matrix, lower water content The upper limit of normal for the junctional zone thickness: up to 5–8 mm (midsagital image through the long axis of uterus) MRI Characteristics of the Uterine Junctional Zone: From Normal to the Diagnosis of Adenomyosis, Novellas et al., 2011
- 11. JUNCTIONAL ZONE MRI Characteristics of the Uterine Junctional Zone: From Normal to the Diagnosis of Adenomyosis, Novellas et al., 2011
- 12. ADENOMYOSIS ON MRI Direct sign Indirect sign 1. Microcysts 2. Adenomyoma Thickness of the junctional zone exceeding 12 mm Diagnostic accuracy 85% and spesificity of 96% Advantages Limitation • Less interoperator variability • More specific diagnosis • Only 50% cases detecting mycrocysts • From 20% to 30% of patients will not have a measurable junctional zone during their reproductive cycle, 50% in postmenopausal women MRI Characteristics of the Uterine Junctional Zone: From Normal to the Diagnosis of Adenomyosis, Novellas et al., 2011 Sensitivity: 70% to 86% and a specificity of 86–93% These numbers are similar to ultrasound
- 13. ADENOMYOSIS Source: Diagnostic Imaging 7th Ed
- 14. RESUME Uterus anatomy Leiomyoma Pathology MRI Adenomyoma Definition Junctional Zone MRI
- 15. QUIZ What is the most likely diagnosis on the following MRI: a. Endometriomas b. Adenomyosis c. Leiomyosarcoma d. Uterine fibroids e. Cervical carcinoma