Ovarian Carcinoma in Patients with Endometriosis
MR Imaging Findings
Yumiko Oishi Tanaka1,
Takeshi Yoshizako1,2,
Masato Nishida3,
Masayuki Yamaguchi1,
Kazuro Sugimura2 and
Yuji Itai1
1
Department of Radiology, Institute of Clinical Medicine, University of
Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan.
2
Department of Radiology, Shimane Medical University, 89-1 Enya, Izumo, Shimane
693-8501, Japan.
3
Department of Obstetrics and Gynecology, Institute of Clinical Medicine,
University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan.
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Fig. 1A. —43-year-old woman with clear cell adenocarcinoma that
developed from endometrial cyst of right ovary. Patient had history of
administration of danazol to control endometriosis. Axial spin-echo
T1-weighted MR image (TR/TE, 500/15) shows multilocular cystic mass (M) that
includes hyperintense fluid behind uterus (U). Bilateral cysts and uterus have
adhered to one another as shown by absence of fat between them.
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Fig. 1B. —43-year-old woman with clear cell adenocarcinoma that
developed from endometrial cyst of right ovary. Patient had history of
administration of danazol to control endometriosis. Axial fast spin-echo
T2-weighted MR image (4000/88) shows extensive shading on left cyst (L). Note
signal loss on right cyst is limited to small area.
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Fig. 1C. —43-year-old woman with clear cell adenocarcinoma that
developed from endometrial cyst of right ovary. Patient had history of
administration of danazol to control endometriosis. Axial spin-echo
T1-weighted MR image (500/15) slightly cranial to A and B
reveals small hypointense mural nodule (arrow) on wall of right cyst.
Left endometrial cyst cannot be seen at this level. Most of mural nodule shows
higher signal intensity than outer myometrium of uterus as seen on
B.
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Fig. 1D. —43-year-old woman with clear cell adenocarcinoma that
developed from endometrial cyst of right ovary. Patient had history of
administration of danazol to control endometriosis. Contrast-enhanced axial
spin-echo T1-weighted MR image (500/15) shows weakly enhanced mural nodule. It
is difficult to evaluate contrast enhancement because of hyperintense fluid
surrounding mural nodule.
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Fig. 2A. —42-year-old woman with clear cell adenocarcinoma that
developed in endometrial cyst of left ovary. Axial spin-echo T1-weighted MR
image (TR/TE, 442/14) reveals large multilocular hyperintense cystic mass with
mural nodule (arrow) behind uterus. Note smaller right ovarian
endometrial cyst (R) is also seen between uterus and larger endometrial
cyst.
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Fig. 2B. —42-year-old woman with clear cell adenocarcinoma that
developed in endometrial cyst of left ovary. Axial fast spin-echo T2-weighted
MR image (1836/110) shows signal loss of smaller endometrial cyst (R);
however, larger cyst remains hyperintense. Mural nodule shows slight
hyperintensity compared with signal of outer myometrium of uterus (U).
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Fig. 2C. —42-year-old woman with clear cell adenocarcinoma that
developed in endometrial cyst of left ovary. Unenhanced MR image (fast
gradient echo; 12/5.1; flip angle, 40°) of dynamic sequence shows mural
nodule on anterior endometrial cyst wall.
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Fig. 2D. —42-year-old woman with clear cell adenocarcinoma that
developed in endometrial cyst of left ovary. Axial dynamic contrast-enhanced
MR image (fast gradient echo; 12/5.1; flip angle, 40°) obtained 92 sec
after administration of contrast material shows enhancement of uterus;
however, enhancement of mural nodule is harder to recognize
(arrow).
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Fig. 2E. —42-year-old woman with clear cell adenocarcinoma that
developed in endometrial cyst of left ovary. Unenhanced dynamic subtraction MR
image synthesized from C reveals no abnormal pelvic structures or
masses with mural nodules.
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Fig. 2F. —42-year-old woman with clear cell adenocarcinoma that
developed in endometrial cyst of left ovary. Axial dynamic substraction MR
image synthesized from D shows enhancement of root of mural nodule
(arrow).
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Fig. 3A. —51-year-old woman with clear cell adenocarcinoma in
endometrial cyst of right ovary. Sagittal spin-echo T1-weighted MR image
(TR/TE, 500/15) obtained before diagnosis of ovarian cancer reveals unilocular
hyperintense cystic mass with mural nodule (arrow). Note smaller
endometrial cyst in left ovary on other slice level.
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Fig. 3B. —51-year-old woman with clear cell adenocarcinoma in
endometrial cyst of right ovary. Contrast-enhanced sagittal spin-echo
T1-weighted MR image (500/15) reveals slight enhancement of mural nodule
(arrow). We could not conclude whether the nodule was benign or
malignant.
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Fig. 3C. —51-year-old woman with clear cell adenocarcinoma in
endometrial cyst of right ovary. Sagittal spin-echo T1-weighted MR image
(408/15) obtained 18 months after A and B reveals enlarged
tumor, mural nodule, and another mural nodule (arrow) visible on
anterior wall of endometrial cyst, despite hormone therapy for
endometriosis.
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Fig. 3D. —51-year-old woman with clear cell adenocarcinoma in
endometrial cyst of right ovary. Sagittal fast spin-echo T2-weighted MR image
(2076/130) does not show signal loss of endometrial cyst. Mural nodules show
lower intensity compared with signal of myometrium.
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Fig. 3E. —51-year-old woman with clear cell adenocarcinoma in
endometrial cyst of right ovary. Sagittal unenhanced MR image (fast gradient
echo; 11/5.6; flip angle, 25°) of dynamic sequenceshows two hypointense
mural nodules on endometrial cyst wall.
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Fig. 3F. —51-year-old woman with clear cell adenocarcinoma in
endometrial cyst of right ovary. Sagittal dynamic contrast-enhanced MR image
(fast gradient echo; 11/5.6; flip angle, 25°) obtained 99 sec after
administration of contrast material shows enhancement of mural nodule on
anterior wall of endometrioma. Enhancement of mural nodule on superior wall is
harder to recognize.
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Fig. 4A. —46-year-old woman with ovarian endometrioma and mural nodule
on sonography. Sagittal spin-echo T1-weighted MR image (TR/TE, 442/14) reveals
multilocular hyperintense mass with slightly more hyperintense area
(arrow) on posteroinferior wall. This area corresponds to mural
nodule on sonography (not shown).
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Fig. 4B. —46-year-old woman with ovarian endometrioma and mural nodule
on sonography. Sagittal fast spin-echo T2-weighted MR image (1836/110) shows
hyperintense mass with hypointense mural nodule (arrow).
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Fig. 4C. —46-year-old woman with ovarian endometrioma and mural nodule
on sonography. Sagittal unenhanced MR image (fast gradient echo; 12/5.1; flip
angle, 40°) of dynamic sequence shows high signal intenisty similar to
that in A.
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Fig. 4D. —46-year-old woman with ovarian endometrioma and mural nodule
on sonography. Sagittal dynamic contrast-enhanced MR image (fast gradient
echo; 12/5.1; flip angle, 40°) obtained 117 sec after administration of
contrast material does not reveal enhancement of mural nodule
(arrowhead).
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Fig. 4E. —46-year-old woman with ovarian endometrioma and mural nodule
on sonography. Unenhanced dynamic subtraction MR image synthesized from
C shows no abnormal pelvic structures or masses with mural nodules.
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Fig. 4F. —46-year-old woman with ovarian endometrioma and mural nodule
on sonography. Sagittal dynamic subtraction MR image synthesized from D
confirms nonenhancement of mural nodule (arrow).
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Fig. 5. —Bar chart shows difficulty in evaluation of contrast
enhancement of mural nodules with various imaging sequences. We can easily
evaluate contrast enhancement of mural nodules on five dynamic subtraction
images. Conversely, we can evaluate enhancement in only one of 12 conventional
T1-weighted images. Dynamic subtraction imaging is best for evaluating
contrast enhancement of mural nodules in endometrial cysts.
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