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Triple-Phase Dynamic MRI of Intratumoral Vessel Density and Hyalinization Grade in Uterine Leiomyomas

¹ Department of Radiology, Toride Kyodo General Hospital, 2-1-1 Hongo, Toride-shi, Ibaraki 302-0022, Japan.
² Department of Radiology, School of Medicine, Tokyo Medical and Dental University, Tokyo 113-8549, Japan.
³ Department of Human Pathology, Graduate School, Tokyo Medical and Dental University, Tokyo 113-8549, Japan.
⁴ Department of Pathology, Tokyo Metropolitan Geriatric Medical Center, Tokyo 173-0015, Japan.
⁵ Department of Obstetrics and Gynecology, School of Medicine, Tokyo Medical and Dental University, Tokyo 113-8549, Japan.

Abstract

OBJECTIVE. Our purpose was to clarify the relationship between the tissue vascularity shown on triple-phase dynamic MRI and the number of intratumoral vessels and degree of hyalinization, which are two histopathologic changes in leiomyoma.

SUBJECTS AND METHODS. The subjects were 10 premenopausal patients with 20 leiomyomas who had undergone surgery without preoperative gonadotropin-releasing hormone analogue treatment. Intratumoral vessel density was determined by the mean number of intratumoral vessels with at least one smooth-muscle layer in the optic fields magnified 100 times. Hyalinization grade was determined by the severity of hyalinization, histopathologically classified in three grades. The enhancement index (EI) of the leiomyoma was calculated using the formula EI(t) = [S(t) – S(0)] / S(0), where S(0) is the signal intensity on enhanced T1-weighted images and S(t) is the signal intensity on each dynamic phase image (t = 20, 60, and 180 sec). The histopathologic parameters of intratumoral vessel density and hyalinization grade were compared with the enhancement indexes obtained from the triple-phase dynamic MRI.

RESULTS. We found positive correlations between intratumoral vessel density and EI₆₀ and between intratumoral vessel density and EI₁₈₀ (in both cases, p = 0.0028 and r = 0.69). We found significant differences among the mean enhancement indexes for each hyalinization grade at all dynamic phases (p < 0.01). The leiomyomas with lower intratumoral vessel densities tended to show greater hyalinization.

CONCLUSION. Our results showed that leiomyomas with only slight hyalinization or with abundant vessels were well enhanced, but the leiomyomas with severe hyalinization enhanced poorly.

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