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Fujii S, Gonda T, Yunaga H. Clinical Utility of Diffusion-Weighted Imaging in Gynecological Imaging: Revisited. Invest Radiol 2024; 59:78-91. [PMID: 37493356 DOI: 10.1097/rli.0000000000001004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
ABSTRACT Diffusion-weighted imaging (DWI) is an increasingly valuable sequence in daily clinical practice, providing both functional and morphological information. The use of DWI can help quantify diffusion using the apparent diffusion coefficient, which reflects the physiological features of the tissue and tumor microcirculation. This knowledge is crucial for understanding and interpreting gynecological imaging. This article reviews the clinical utility of DWI for gynecological imaging, highlighting its ability to aid in the detection of endometrial and cervical cancers, as well as tumor extension and metastasis. In addition, DWI can easily detect the solid components of ovarian cancer (including dissemination), assist in the diagnosis of adnexal torsion, and potentially show bone marrow status. Apparent diffusion coefficient measurement is useful for differentiating between endometrial lesions, uterine leiomyomas, and sarcomas, and may provide important information for predicting the prognosis of gynecological cancers.
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Affiliation(s)
- Shinya Fujii
- From the Division of Radiology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Japan
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Wang S, Duan H. The role of the junctional zone in the management of adenomyosis with infertility. Front Endocrinol (Lausanne) 2023; 14:1246819. [PMID: 37886646 PMCID: PMC10598341 DOI: 10.3389/fendo.2023.1246819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
The junctional zone (JZ) is an important structure in the myometrium that maintains uterine fertility. Changes in the junctional zone are closely related to infertility and adenomyosis (ADS). As an increasing number of young women are affected by ADS, the disease is no longer considered typical of women over 40. With these changes, an increasing number of patients refuse hysterectomy and desire fertility preservation treatment. At the same time, ADS is a crucial factor causing female infertility. Therefore, the treatment of ADS-related infertility and preservation of reproductive function is one of the other major challenges facing clinicians. For these young patients, preserving fertility and even promoting reproduction has become a new challenge. Therefore, we searched and summarized these studies on PubMed and Google Scholar using keywords such as "adenomyosis", "junctional zone", and "infertility" to explore infertility causes, diagnosis, and treatment of ADS patients who wish to preserve their uterus or fertility and become pregnant, focusing on the junctional zone, to obtain a full appreciation of the new perspective on this disease.
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Affiliation(s)
| | - Hua Duan
- Department of Minimally Invasive Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
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Zhang Z, Liu J, Wang W, Zhang Y, Qu F, Hilbert T, Kober T, Cheng J, Li S, Zhu J. Feasibility of accelerated T2 mapping for the preoperative assessment of endometrial carcinoma. Front Oncol 2023; 13:1117148. [PMID: 37564932 PMCID: PMC10411727 DOI: 10.3389/fonc.2023.1117148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 07/07/2023] [Indexed: 08/12/2023] Open
Abstract
Objective The application value of T2 mapping in evaluating endometrial carcinoma (EMC) features remains unclear. The aim of the study was to determine the quantitative T2 values in EMC using a novel accelerated T2 mapping, and evaluate them for detection, classification,and grading of EMC. Materials and methods Fifty-six patients with pathologically confirmed EMC and 17 healthy volunteers were prospectively enrolled in this study. All participants underwent pelvic magnetic resonance imaging, including DWI and accelerated T2 mapping, before treatment. The T2 and apparent diffusion coefficient (ADC) values of different pathologic EMC features were extracted and compared. Receiver operating characteristic (ROC) curve analysis was performed to analyze the diagnostic efficacy of the T2 and ADC values in distinguishing different pathological features of EMC. Results The T2 values and ADC values were significantly lower in EMC than in normal endometrium (bothl p < 0.05). The T2 and ADC values were significantly different between endometrioid adenocarcinoma (EA) and non-EA (both p < 0.05) and EMC tumor grades (all p < 0.05) but not for EMC clinical types (both p > 0.05) and depth of myometrial invasion (both p > 0.05). The area under the ROC curve (AUC) was higher for T2 values than for ADC values in predicting grade 3 EA (0.939 vs. 0.764, p = 0.048). When combined T2 and ADC values, the AUC for predicting grade 3 EA showed a significant increase to 0.947 (p = 0.03) compared with those of ADC values. The T2 and ADC values were negatively correlated with the tumor grades (r = -0.706 and r = -0.537, respectively). Conclusion Quantitative T2 values demonstrate potential suitability in discriminating between EMC and normal endometrium, EA and non-EA, grade 3 EA and grade 1/2 EA. Combining T2 and ADC values performs better in predicting the histological grades of EA in comparison with ADC values alone.
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Affiliation(s)
- Zanxia Zhang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jie Liu
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Weijian Wang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yong Zhang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Feifei Qu
- Magnetic Resonance Collaboration, Siemens Healthcare Ltd., Beijing, China
| | - Tom Hilbert
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland
- Signal Processing Lab 5 (LTS5), Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Tobias Kober
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland
- Signal Processing Lab 5 (LTS5), Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jingliang Cheng
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shujian Li
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jinxia Zhu
- Magnetic Resonance Collaboration, Siemens Healthcare Ltd., Beijing, China
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Liubing C, Ting S, Xi P, Yonglu C, Yi L, Jun YY, Liuqing C. Magnetic resonance imaging thicknesses and apparent diffusion coefficient values of the endometrium and junction zone in women of reproductive age. Acta Radiol 2023; 64:1263-1271. [PMID: 35950223 DOI: 10.1177/02841851221117559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The endometrium and uterine junction zone often change throughout the menstrual cycle. Some pathological conditions may appear normal in uterine imaging, which will lead to missed diagnosis and misdiagnosis. PURPOSE To evaluate the changes in the thickness and apparent diffusion coefficient (ADC) values of the endometrium and uterine junction zone throughout the menstrual cycle in magnetic resonance imaging (MRI) of women of reproductive age. MATERIAL AND METHODS Data were collected from 40 healthy women of reproductive age with regular menstrual cycles from January 2017 to April 2018. They underwent four total MRI sessions during the menstrual, proliferation, and early and late secretive phases. The main MRI sequences were T2-weighted (T2W) volume isotropic turbo spin echo acquisition (VISTA) spectral attenuated inversion recovery (SPAIR) and diffusion-weighted imaging (b = 0, 600, 800, 1000 s/mm2), which were used to measure the thicknesses and ADC values of endometrium and uterine junction zone. RESULTS First, the endometrium was thinnest during the menstrual phase and thickest in the late secretive phase. Second, the uterine junction zone was thinnest in the late secretive phase and thickest in the menstrual phase. Third, the ADC values of the endometrium were lowest in the menstrual phase and peaked in the early secretive phase. Finally, the ADC values of the uterine junction zone were lowest in the menstrual phase and peaked in the late secretive phase. CONCLUSION The endometrium and uterine junction zone showed cyclic changes. Radiologists should consider these changes in the thickness and ADC values when analyzing MRI images of the uterus.
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Affiliation(s)
- Chen Liubing
- Department of Radiology, 74714GuangZhou Red Cross Hospital, Jinan University, Guangdong Province, Guangzhou, PR China
| | - Song Ting
- Department of Radiology, 117980The Third Affiliated Hospital of Guangzhou Medical University, Guangdong Province, Guangzhou, PR China
| | - Peng Xi
- Department of Radiology, 117980The Third Affiliated Hospital of Guangzhou Medical University, Guangdong Province, Guangzhou, PR China
| | - Chen Yonglu
- Department of Radiology, 117980The Third Affiliated Hospital of Guangzhou Medical University, Guangdong Province, Guangzhou, PR China
| | - Liu Yi
- Department of Radiology, 117980The Third Affiliated Hospital of Guangzhou Medical University, Guangdong Province, Guangzhou, PR China
| | - Yang Yong Jun
- Department of Radiology, 533631Guangzhou United Family Hospital, Guangdong Province, Guangzhou, PR China
| | - Chen Liuqing
- Personnel Department, Shantou Chenghai District Chronic Disease Prevention and Treatment Station, Guangdong Province, Shantou, PR China
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Handayani AFSD, Sitepu M, Effendi IH, Asroel EM, Halim B, Rivany R, Ardiansyah E. Correlation between Blood Glucose Levels on Niche Incidence after Cesarean Section. Open Access Maced J Med Sci 2023. [DOI: 10.3889/oamjms.2023.11029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND: Long-term sequelae of cesarean section (CS) is formation of niche in CS surgical scar. Blood glucose involved in wound healing process after CS.
AIM: This study was to find correlation of blood glucose level with niche in CS patients.
METHODS: This research was an observational and analytic study with case series design conducted at Department of Obstetrics and Gynecology, Universitas Sumatera Utara, RSUP H Adam Malik Medan, and Sundari Hospital Medan Starting from July to August 2022. To assess correlation between variables, eta test was used to assess the correlation of blood glucose with incidence of niche. The analysis results were said to be significant if p < 0.05, with 95% CI.
RESULTS: Mean of patients were in 21–29 years (70%), multiparity with 12 patients (40%), aterm gestational age with 30 patients (100%), 16 patients (53.3%) with anteflexion uterus, previous CS 2 times were the majority with 9 patients (30%), and 17 patients (56.7%) were elective CS. Incidence of niche was 63.3%. Triangular were the most found niche with 11 patients (36.7%). Mean of total myometrial thickness, depth of niche, and residual myometrial thickness were 5.23 ± 11.2 mm, 2.44 ± 2.75 mm, and 5.23 ± 11.22 mm, respectively. Mean blood sugar level was 103.3 ± 17.4 mg/dl. From eta analysis, there was no correlation between blood glucose levels post-CS patients using eta test with p = 0.872.
CONCLUSION: There was no significant correlation between blood glucose levels on niche incidence in post-CS patients.
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Effect of changes in the menstrual cycle and age on the signal intensity of amide proton transfer imaging in the normal uterus: a preliminary study. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:4219-4226. [PMID: 36100756 DOI: 10.1007/s00261-022-03674-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 07/15/2022] [Accepted: 08/31/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE To analyze the effect of changes in the menstrual cycle and age on the signal intensity of amide proton transfer (APT) imaging in normal uterine structures. METHODS Thirty-one healthy females (age: 21-50 years old) underwent regular pelvic MRI and APT sequences during their menstrual cycle. The APT values of the endometrium, myometrium, and junctional zone were measured. One-way and multi-way analyses of variance were used to analyze the data. Intraindividual difference and Pearson's correlation analyses were also conducted. RESULTS The APT values of the uterine structures during the menstrual, proliferative, and secretory phases were 3.413 ± 0.682%, 4.776 ± 0.829%, and 5.218 ± 0.772% for the endometrium; 2.966 ± 0.533%, 3.597 ± 0.380%, and 4.324 ± 0.583% for the myometrium; and 1.703 ± 0.393%, 2.362 ± 0.486%, and 2.779 ± 0.528% for the junctional zone. The individual variation in the APT values of the normal uterus during the three menstrual phases was 1.1-1.7%.There were no significant differences in APT values of uterine structures with age. The APT values of the endometrium were greater than those of other structures (P < 0.05).The Pearson correlation coefficients between APT values of uterine structures and menstrual cycle were 0.686, 0.743, and 0.684, respectively. CONCLUSION The menstrual cycle had a significant effect on the APT signal intensities of the uterine structures, whereas premenopausal age had no significant effect. Changes in the uterine structures during the menstrual cycle should be considered when using APT to diagnose suspected uterine lesions.
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Bandry KW, Abou-Taleb H, Seifeldein GS, Taha MG, Qenawy OK. Prediction of the relationship of cesarean section scar niche and postmenstrual spotting: is there any relation? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00699-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Postmenstrual spotting has recently been related to a discontinuation of the myometrium at the site of a previous cesarean section called "CS scar niche". There was no consensus regarding the gold standard method for the assessment of the niche. Recently, Magnetic resonance imaging (MRI) has shown promise in the evaluation of the niche. Our study aims to assess the role of MRI in the evaluation of the CS scar niche characters and its association with post-menstrual spotting.
Results
A total of 65 patients with CS niche were prospectively included in this study and subdivided into two groups, according to presence or absence of postmenstrual spotting (Group A; 34 patients with postmenstrual spotting and Group B; 31 patients without spotting). All patients were examined using a 1.5 T MRI unit. CS scar niche volume was significantly higher among women with post-menstrual spotting (0.57 ± 0.07 vs. 0.07 ± 0.05 (cm3); P < 0.001). Also, women with post-menstrual spotting have significantly higher scar length (9.38 ± 3.06 vs. 5.02 ± 2.10 (mm); P < 0.001), scar depth (6.95 ± 3.16 vs. 3.23 ± 0.99 (mm); P < 0.001), scar width (15.78 ± 3.94 vs. 9.87 ± 1.84 (mm); P < 0.001) in comparison to those without post-menstrual spotting.
Scar depth (> 7.4 mm) had 81% sensitivity and 97% specificity for prediction of post-menstrual spotting with overall accuracy was 88.7%. While scar width (> 12.8 mm) had 71% sensitivity and 97% specificity for prediction of post-menstrual spotting with overall accuracy was 83.3%. Scar volume (> 0.15 cm3) had 97% sensitivity and 100% specificity for prediction of post-menstrual spotting with overall accuracy was 98.4%.
Conclusion
MRI measures (CS scar volume, depth, and width) are predictors for postmenstrual spotting in patients with CS scar niche, and scar volume is the most powerful predictor.
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Harmsen MJ, Trommelen LM, de Leeuw RA, Tellum T, Juffermans LJM, Griffioen AW, Thomassin-Naggara I, Van den Bosch T, Huirne JAF. Uterine junctional zone and adenomyosis: comparison of MRI, transvaginal ultrasound and histology. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022. [PMID: 36370446 DOI: 10.1002/uog.26117] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 09/27/2022] [Accepted: 10/21/2022] [Indexed: 06/02/2023]
Abstract
The uterine junctional zone is the subendometrial area in the myometrium that contributes to peristalsis and aids in spermatozoa and blastocyst transport. Alterations in the appearance of the junctional zone on transvaginal sonography (TVS) or magnetic resonance imaging (MRI) are associated with adenomyosis. The lack of standardization of description of its appearance and ill-defined boundaries on both histology and imaging hamper understanding of the junctional zone and limit its role in the diagnosis of adenomyosis. The objectives of this review were to investigate the accordance in definition of the junctional zone across different diagnostic approaches and to examine how imaging findings can be linked to histological findings in the context of diagnosis of adenomyosis. A comprehensive literature review was conducted of articles describing the appearance on imaging and the histological structure of the uterine junctional zone. Our review suggests that the junctional zone is distinguished from the middle and outer myometrium by gradual changes in smooth-muscle cell density, extracellular space, connective tissue, water content and vascular properties. However, while the signal intensity from the junctional zone to the middle myometrium changes abruptly on MRI, the histopathological changes are gradual and its border may be difficult or impossible to distinguish on two-dimensional TVS. Moreover, the thickness of the junctional zone measured on MRI is larger than that measured on TVS. Thus, these two imaging modalities reflect this zone differently. Although a thickened junctional zone is often used to diagnose adenomyosis on MRI, the presence of adenomyosis can be described more accurately as interruptions of the junctional zone by endometrial tissue, which leads to direct signs on imaging such as subendometrial lines and buds on two- and three-dimensional TVS or bright foci on MRI. The histopathological criteria for diagnosis are based on enlargement of the uterus with severe adenomyosis, and might not reflect its early stages. Clinicians should be aware that findings on MRI cannot be extrapolated readily to ultrasound. An understanding of this is necessary when investigating the uterine junctional zone as a functional unit and the association between visualization of direct features of adenomyosis in the junctional zone and clinical symptoms. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M J Harmsen
- Department of Obstetrics & Gynaecology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - L M Trommelen
- Department of Obstetrics & Gynaecology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - R A de Leeuw
- Department of Obstetrics & Gynaecology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - T Tellum
- Department of Gynecology, Oslo University Hospital, Oslo, Norway
| | - L J M Juffermans
- Department of Obstetrics & Gynaecology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - A W Griffioen
- Angiogenesis Laboratory, Department of Medical Oncology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - I Thomassin-Naggara
- Department of Diagnostic and Interventional Imaging (IRIS), Sorbonne Université, Assistance Publique Hopitaux de Paris, Paris, France
| | - T Van den Bosch
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium
| | - J A F Huirne
- Department of Obstetrics & Gynaecology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
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He YL, Ding N, Qi YF, Li Y, Xiang Y, Qian TY, Liu H, Lin CY, Yuan L, Zhou HL, Jin ZY, Xue HD. Visualising the boundary sharpness of uterine zonal structures using high-resolution T2-weighted images during the menstrual cycle. Clin Radiol 2019; 74:81.e19-81.e24. [DOI: 10.1016/j.crad.2018.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 09/24/2018] [Indexed: 11/28/2022]
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Weston MJ. Gynaecology virtual special issue. Clin Radiol 2018; 73:837-838. [PMID: 30057331 DOI: 10.1016/j.crad.2018.07.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 07/02/2018] [Indexed: 11/18/2022]
Affiliation(s)
- M J Weston
- Department of Radiology, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK.
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