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Diffusion-Weighted Single-Shot Echo-Planar Imaging with Parallel Technique in Assessment of Endometrial Cancer

Shu-Huei Shen1, Yi-You Chiou1, Jia-Hwia Wang1, Ming-Shyen Yen2, Rheun-Chuan Lee1, Chiung-Ru Lai3 and Cheng-Yen Chang1

1 Department of Radiology, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, 201, Sect II, Shih-Pai Rd., Taipei, 112, Taiwan, Province of China.
2 Department of Obstetric and Gynecology, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan.
3 Department of Laboratory and Pathology, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan.


Figure 1
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  		Fig. 1A —83-year-old woman with benign endometrial polyp. T2-weighted fast spin-echo sagittal (A) and axial (B) images show polypoid tumor (star, A; arrows, B) protruding from endometrial cavity.

 

Figure 2
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  		Fig. 1B —83-year-old woman with benign endometrial polyp. T2-weighted fast spin-echo sagittal (A) and axial (B) images show polypoid tumor (star, A; arrows, B) protruding from endometrial cavity.

 

Figure 3
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  		Fig. 1C —83-year-old woman with benign endometrial polyp. Sagittal (C and D) and axial (E and F) diffusion-weighted images at same level as A and B show tumor (arrows) barely visible on dark background with high b value (b = 1,000) (D and F). Metallic prosthesis in right hip joint causes severe susceptibility artifact and obscures caudal part of lesion. C and E, b = 0.

 

Figure 4
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  		Fig. 1D —83-year-old woman with benign endometrial polyp. Sagittal (C and D) and axial (E and F) diffusion-weighted images at same level as A and B show tumor (arrows) barely visible on dark background with high b value (b = 1,000) (D and F). Metallic prosthesis in right hip joint causes severe susceptibility artifact and obscures caudal part of lesion. C and E, b = 0.

 

Figure 5
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  		Fig. 1E —83-year-old woman with benign endometrial polyp. Sagittal (C and D) and axial (E and F) diffusion-weighted images at same level as A and B show tumor (arrows) barely visible on dark background with high b value (b = 1,000) (D and F). Metallic prosthesis in right hip joint causes severe susceptibility artifact and obscures caudal part of lesion. C and E, b = 0.

 

Figure 6
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  		Fig. 1F —83-year-old woman with benign endometrial polyp. Sagittal (C and D) and axial (E and F) diffusion-weighted images at same level as A and B show tumor (arrows) barely visible on dark background with high b value (b = 1,000) (D and F). Metallic prosthesis in right hip joint causes severe susceptibility artifact and obscures caudal part of lesion. C and E, b = 0.

 

Figure 7
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  		Fig. 2A —41-year-old woman with endometrial adenocarcinoma. T2-weighted turbo spin-echo sagittal image shows polypoid lesion with stalk (star) at endometrial cavity.

 

Figure 8
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  		Fig. 2B —41-year-old woman with endometrial adenocarcinoma. Contrast-enhanced T1-weighted 3D fat-suppressed spoiled gradient-recalled echo sagittal image shows lesion has minimal enhancement compared with normal myometrium. Star indicates polypoid lesion with stalk.

 

Figure 9
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  		Fig. 2C —41-year-old woman with endometrial adenocarcinoma. Sagittal T2-weighted echo-planar image (b = 0) shows tissue contrast enhancement is strong and zonal anatomy of uterus is enhanced. Junctional zone (arrows) is clear.

 

Figure 10
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  		Fig. 2D —41-year-old woman with endometrial adenocarcinoma. Sagittal diffusion-weighted image (b = 1,000) shows tumor as area of high signal intensity with dark background. Pathologic examination disclosed endometrial cancer with superficial myometrial invasion.

 

Figure 11
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  		Fig. 3A —71-year-old woman with endometrial adenocarcinoma. T2-weighted turbo spin-echo sagittal image shows tumor (arrows) of intermediate signal intensity at uterine fundus.

 

Figure 12
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  		Fig. 3B —71-year-old woman with endometrial adenocarcinoma. Contrast-enhanced T1-weighted 3D fat-suppressed spoiled gradient-recalled echo sagittal image shows myometrial invasion (arrows).

 

Figure 13
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  		Fig. 3C —71-year-old woman with endometrial adenocarcinoma. Sagittal diffusion-weighted images with b values of 0 (C) and 1,000 (D) show tumor has high signal intensity (star, D). Boundary is evident.

 

Figure 14
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  		Fig. 3D —71-year-old woman with endometrial adenocarcinoma. Sagittal diffusion-weighted images with b values of 0 (C) and 1,000 (D) show tumor has high signal intensity (star, D). Boundary is evident.

 

Figure 15
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  		Fig. 4A —82-year-old woman with endometrial adenocarcinoma. T2-weighted turbo spin-echo sagittal image shows endometrial thickening at uterine fundus and endocervical canal (arrows). Both are suspected tumor focuses.

 

Figure 16
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  		Fig. 4B —82-year-old woman with endometrial adenocarcinoma. Contrast-enhanced T1-weighted 3D fat-suppressed spoiled gradient-recalled echo sagittal images do not exclude possibility of tumor growth for both lesions.

 

Figure 17
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  		Fig. 4C —82-year-old woman with endometrial adenocarcinoma. Contrast-enhanced T1-weighted 3D fat-suppressed spoiled gradient-recalled echo sagittal images do not exclude possibility of tumor growth for both lesions.

 

Figure 18
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  		Fig. 4D —82-year-old woman with endometrial adenocarcinoma. Sagittal diffusion-weighted image with b values of 0 (D–F) and 1,000 (G–I) show only lesion (arrow, G) at fundus has high signal intensity. Lesion was pathologically confirmed only tumor focus.

 

Figure 19
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  		Fig. 4E —82-year-old woman with endometrial adenocarcinoma. Sagittal diffusion-weighted image with b values of 0 (D–F) and 1,000 (G–I) show only lesion (arrow, G) at fundus has high signal intensity. Lesion was pathologically confirmed only tumor focus.

 

Figure 20
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  		Fig. 4F —82-year-old woman with endometrial adenocarcinoma. Sagittal diffusion-weighted image with b values of 0 (D–F) and 1,000 (G–I) show only lesion (arrow, G) at fundus has high signal intensity. Lesion was pathologically confirmed only tumor focus.

 

Figure 21
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  		Fig. 4G —82-year-old woman with endometrial adenocarcinoma. Sagittal diffusion-weighted image with b values of 0 (D–F) and 1,000 (G–I) show only lesion (arrow, G) at fundus has high signal intensity. Lesion was pathologically confirmed only tumor focus.

 

Figure 22
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  		Fig. 4H —82-year-old woman with endometrial adenocarcinoma. Sagittal diffusion-weighted image with b values of 0 (D–F) and 1,000 (G–I) show only lesion (arrow, G) at fundus has high signal intensity. Lesion was pathologically confirmed only tumor focus.

 

Figure 23
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  		Fig. 4I —82-year-old woman with endometrial adenocarcinoma. Sagittal diffusion-weighted image with b values of 0 (D–F) and 1,000 (G–I) show only lesion (arrow, G) at fundus has high signal intensity. Lesion was pathologically confirmed only tumor focus.

 

Figure 24
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  		Fig. 5A —58-year-old woman with endometrial adenocarcinoma. Several tumor foci were present at endocervical canal (not shown) and fundus with hydrometra. Axial diffusion-weighted images with b values of 0 (A–D) and 1,000 (E–H) show images with high b value depict lesion (arrow, E) with high signal intensity in left pelvic cavity.

 

Figure 25
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  		Fig. 5B —58-year-old woman with endometrial adenocarcinoma. Several tumor foci were present at endocervical canal (not shown) and fundus with hydrometra. Axial diffusion-weighted images with b values of 0 (A–D) and 1,000 (E–H) show images with high b value depict lesion (arrow, E) with high signal intensity in left pelvic cavity.

 

Figure 26
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  		Fig. 5C —58-year-old woman with endometrial adenocarcinoma. Several tumor foci were present at endocervical canal (not shown) and fundus with hydrometra. Axial diffusion-weighted images with b values of 0 (A–D) and 1,000 (E–H) show images with high b value depict lesion (arrow, E) with high signal intensity in left pelvic cavity.

 

Figure 27
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  		Fig. 5D —58-year-old woman with endometrial adenocarcinoma. Several tumor foci were present at endocervical canal (not shown) and fundus with hydrometra. Axial diffusion-weighted images with b values of 0 (A–D) and 1,000 (E–H) show images with high b value depict lesion (arrow, E) with high signal intensity in left pelvic cavity.

 

Figure 28
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  		Fig. 5E —58-year-old woman with endometrial adenocarcinoma. Several tumor foci were present at endocervical canal (not shown) and fundus with hydrometra. Axial diffusion-weighted images with b values of 0 (A–D) and 1,000 (E–H) show images with high b value depict lesion (arrow, E) with high signal intensity in left pelvic cavity.

 

Figure 29
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  		Fig. 5F —58-year-old woman with endometrial adenocarcinoma. Several tumor foci were present at endocervical canal (not shown) and fundus with hydrometra. Axial diffusion-weighted images with b values of 0 (A–D) and 1,000 (E–H) show images with high b value depict lesion (arrow, E) with high signal intensity in left pelvic cavity.

 

Figure 30
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  		Fig. 5G —58-year-old woman with endometrial adenocarcinoma. Several tumor foci were present at endocervical canal (not shown) and fundus with hydrometra. Axial diffusion-weighted images with b values of 0 (A–D) and 1,000 (E–H) show images with high b value depict lesion (arrow, E) with high signal intensity in left pelvic cavity.

 

Figure 31
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  		Fig. 5H —58-year-old woman with endometrial adenocarcinoma. Several tumor foci were present at endocervical canal (not shown) and fundus with hydrometra. Axial diffusion-weighted images with b values of 0 (A–D) and 1,000 (E–H) show images with high b value depict lesion (arrow, E) with high signal intensity in left pelvic cavity.

 

Figure 32
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  		Fig. 5I —58-year-old woman with endometrial adenocarcinoma. Several tumor foci were present at endocervical canal (not shown) and fundus with hydrometra. T2-weighted turbo spin-echo axial image shows enlarged left fallopian tube (arrows), which has intermediate signal intensity and might have been easily overlooked.

 

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