MR imaging of uterine morphology and dynamic changes during lactation.

PURPOSE: To investigate the influence of lactation and ovarian hormones on uterine morphology and function by comparing uteruses of lactating women with nulliparous women on MRI. MATERIALS AND METHODS: Sagittal T2WI and cine MR images were obtained with 1.5 Tesla (T) and 3T scanner from 22 lactating women and 16 nulliparous women as a control group. The lactating group was further divided into amenorrhea and menorrhea subgroups. Uterine area, endometrial thickness, junctional zone (JZ) thickness, relative signal intensity (rSI) of the JZ, and of the outer myometrium (OM), were measured on T2-weighted fast spin echo images as static image parameters. Frequency of peristalsis (/3min), degree of endometrial transformation, subendometrial conduction, outer myometrial (OM) conduction, and sporadic myometrial contraction were evaluated using cine MR images. The above image parameters were compared between the lactating group and the control group, and between the lactational amenorrhea group and the lactational menorrhea group as a sub-analysis. RESULTS: A significant difference was observed in all the static image parameters and in three of the five cine image parameters between the lactating group and the control group (P < 0.01). In sub-analysis, a statistical significance was found between the lactational amenorrhea group and lactational menorrhea group in area of the uterus and both endometrial and JZ thickness (P < 0.05), but not in cine image parameters (P = 0.682, P = 0.096, P = 0.191, P = 0.939, P = 0.289, respectively). CONCLUSION: Uterine appearance and peristalsis were different between lactating and nulliparous women. The morphological differences were pronounced between lactating amenorrhea and menorrhea women. LEVEL OF EVIDENCE: 2 J. Magn. Reson. Imaging 2017;45:617-623.

Assessment of the early predictive power of quantitative magnetic resonance imaging parameters during neoadjuvant chemotherapy for uterine cervical cancer.

OBJECTIVES: The purpose of this study was to quantitatively evaluate 3 types of magnetic resonance imaging (MRI) parameters in parallel for the early prediction of neoadjuvant chemotherapy (NACT) effectiveness in cervical cancer-tumor volume parameters, diffusion parameters, and perfusion parameters. MATERIALS AND METHODS: We prospectively evaluated 13 patients with International Federation of Gynecology and Obstetrics stage IB to IIB cervical squamous cell carcinoma who underwent 3 serial MRI studies, that is, pretreatment, post-first course NACT, and post-second course NACT followed by radical hysterectomy. We obtained tumor volume parameters, diffusion parameters, and dynamic contrast material-enhanced perfusion parameters quantitatively from pretreatment MRI and post-first course MRI. The correlation of these parameters and the eventual tumor volume regression rate (TVRR) obtained from pretreatment MRI and post-second course MRI before surgery were investigated, statistically based on the Pearson correlation coefficient. RESULTS: Thirteen patients had a total of 39 scans. Early TVRR (r = 0.844; P < 0.001), the fractional volume of the tissue extracellular extravascular space (Ve, r = 0.648; P < 0.05), and the change of Ve during the first course of NACT (r = -0.638; P < 0.05) correlated with eventual TVRR. CONCLUSIONS: Early TVRR, Ve, and the change of Ve could be useful predictors for the treatment effectiveness of NACT. These parameters could help to modify strategy in the early stage of NACT and to choose individualized treatment to avoid the delay of radical treatment, even when NACT is ineffective.

Anticholinergic agents result in weaker and shorter suppression of uterine contractility compared with intestinal motion: time course observation with cine MRI.

PURPOSE: To evaluate the time course effects of anticholinergic agents on uterine contractility and intestinal motion with cine magnetic resonance imaging (MRI). MATERIALS AND METHODS: Using a 1.5 T MRI scanner, 60 T2-weighted half-Fourier rapid acquisitions with relaxation enhancement images of the uterus were serially acquired over 3 minutes in 25 healthy women in the periovulatory phase, at four instances, prior to and 2-5, 5-8, and 10-13 minutes after intravenous injection of 20 mg of hyoscine butylbromide. Uterine peristalsis frequency (waves / 3 min) and degrees of endometrial transformation, subendometrial conduction, outer myometrial conduction, sporadic myometrial contraction, and intestinal movement were independently evaluated by three readers. RESULTS: Uterine peristalsis frequency of 6.14 ± 2.34 decreased the most at 2-5 minutes (P < 0.001) by 1.41 (95% confidential interval [CI] = 0.59-2.22), or 23.0% ([6.14-4.73]/6.14) and remained reduced at 5-8 minutes (P = 0.013) by 0.97 (95% CI = 0.15-1.78), or 15.8% ([6.14-5.17]/6.14) after injection. The degree of intestinal movement was 3.32 ± 0.54 and was prominently reduced at every phase (P < 0.001 for all) and maximally decreased to 0.67 ± 0.65 at 5-8 min. It increased to 1.36 ± 0.72 at 10-13 minutes compared with the degrees of motion at 2-5 minutes (P = 0.04) and 5-8 minutes (P = 0.004). CONCLUSION: Suppression of uterine peristalsis was weaker and shorter compared with the stronger and longer suppression of intestinal movement by the intravenous administration of anticholinergic agents.

Effect of hyoscine butylbromide (HBB) on the uterine corpus: quantitative assessment with T2-weighted (T2W) MRI in healthy volunteers.

PURPOSE: To investigate effects of hyoscine butylbromide (HBB) on the appearance of three zonal anatomy of the uterine corpus on T2-weighted images (T2WI). MATERIALS AND METHODS: Sagittal T2WI of the pelvis were acquired before and after intramuscular administration of HBB with interval of 10 minutes in 22 healthy volunteers. By drawing polygonal regions of interest (ROIs), the uterine corpus was delineated into outer myometrium (OM), junctional zone (JZ), and endometrium (EM) in 20 subjects. Areas (mm(2)) and relative signal intensity (rSI) of each layer were compared between pre-HBB and post-HBB administration images by using paired t-tests. Histogram analysis was conducted for the uterine layers and changes were visualized. RESULTS: Areas of OM were significantly increased (P = 0.014) and mean rSI of JZ and OM were significantly increased (P = 0.007 and 0.001, respectively) after administration of HBB. Histogram showed an increase in the number of pixels with higher rSI in the OM, which was considered to be caused by an increase in interstitial fluid and vascular dilatation. EM did not show significant changes. CONCLUSION: Layer-wise ROI analyses demonstrated changes in the area and rSI in T2WI of the uterus after HBB administration. Histogram analysis contributed to the investigation of signal changes.

Neuroendocrine carcinoma of uterine cervix findings shown by MRI for staging and survival analysis - Japan multicenter study.

OBJECTIVES: To investigate neuroendocrine carcinoma (NEC) of the uterine cervix cases for MRI features and staging, as well as pathological correlations and survival. RESULTS: FIGO was I in 42, II in 14, III in 1, and IV in 5 patients. T2-weighted MRI showed homogeneous slightly high signal intensity and obvious restricted diffusion (ADC map, low intensity; DWI, high intensity) throughout the tumor in most cases, and mild enhancement in two-thirds. In 50 patients who underwent a radical hysterectomy and lymphadenectomy without neoadjuvant chemotherapy (NAC), intrapelvic T staging by MRI overall accuracy was 88.0% with reference to pathology staging, while patient-based sensitivity, specificity, and accuracy for metastatic pelvic lymph node detection was 38.5%, 100%, and 83.3%, respectively. During a mean follow-up period of 45.6 months (range 4.3-151.0 months), 28 patients (45.2%) experienced recurrence and 24 (38.7%) died. Three-year progression-free and overall survival rates for FIGO I, II, III, and IV were 64.3% and 80.9%, 50% and 64.3%, 0% and 0%, and 0% and 0%, respectively. MATERIALS AND METHODS: Sixty-two patients with histologically surgery-proven uterine cervical NEC were enrolled. Twelve received NAC. Clinical data, pathological findings, and pretreatment pelvic MRI findings were retrospectively reviewed. Thirty-two tumors were pure NEC and 30 mixed with other histotypes. The NECs were small cell type (41), large cell type (18), or a mixture of both (3). CONCLUSIONS: Homogeneous lesion texture with obvious restricted diffusion throughout the tumor are features suggestive of cervical NEC. Our findings show that MRI is reliable for T staging of cervical NEC.

Subendometrial enhancement and peritumoral enhancement for assessing endometrial cancer on dynamic contrast enhanced MR imaging.

OBJECTIVES: To evaluate the diagnostic accuracy of subendometrial enhancement (SEE) in assessing the myometrial invasion in endometrial cancer, the frequency and clinical significance of peritumoral enhancement (PTE) on dynamic contrast enhanced (DCE) imaging. MATERIALS AND METHODS: MR images of 147 patients with endometrial cancer were retrospectively analyzed for intact SEE and PTEs: Type 1, a focal early enhancement peritumorally, and Type 2, an irregular thin-layered early intense enhancement peritumorally. Two radiologists independently assessed intact SEE and PTEs on DCE imaging and compared the lesions by the presence and depth of myometrial invasion, grade, lymphovascular space involvement (LVSI), and lymph node metastasis. The relationship between SEE, PTEs, and each factor was analyzed using univariate and multivariate analyses. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated for SEE. RESULTS: The sensitivity, specificity, PPV, NPV and diagnostic accuracy for myometrial invasion based on SEE disruption on DCE were 96.6%, 32.1-46.4%, 85.8-88.5%, 69.2-76.5%, and 84.4-87.1%. According to multivariate analysis, SEE significantly predicted myometrial invasion (p<0.0001). PTE Type 2 significantly predicted myometrial invasion presence (p<0.05) and depth (p<0.01). CONCLUSION: Diagnosis of myometrial invasion only by using SEE might be difficult on DCE-MRI due to the overestimation by strong focal enhancement of PTE Type 1. PTE Type 2 correlates both with the presence and depth of myometrial invasion and also may play an important role in the diagnosis of LVSI.

MR imaging-based evaluation of morphological changes in the uterus and ovaries of patients following neoadjuvant chemotherapy for cervical cancer.

OBJECTIVE: We used magnetic resonance (MR) imaging and hormonal levels to evaluate the influence of chemotherapy for cervical cancer on female pelvic reproductive organs. MATERIALS AND METHODS: We retrospectively evaluated 16 pre- and 11 postmenopausal patients with cervical cancer who underwent neoadjuvant chemotherapy (NACT) and radical surgery. We evaluated morphological changes in the uterus and ovaries by MR imaging both quantitatively and qualitatively, measuring the volume of the uterine body and bilateral ovaries, endometrial thickness, and signal intensity of the myometrium and bilateral ovaries and assessing visibility of the junctional zone and bilateral ovarian follicles. We compared both quantitative and qualitative factors between pre- and post-NACT. Pre- and post-NACT hormonal values of estradiol, progesterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) of 8 patients in the premenopausal group were obtained and analyzed statistically. RESULTS: In the premenopausal group, we observed a statistically significant decrease in all quantitative parameters as well as in the visibility of the left ovarian follicle. In the postmenopausal group, only endometrial thickness changed significantly. Premenopausal patients showed a statistically significant decrease in levels of progesterone, FSH, and LH after chemotherapy. CONCLUSIONS: MR demonstrated changes in the uterus and ovaries in premenopausal subjects who underwent chemotherapy that resembled those changes classically reported in physiological postmenopausal subjects. These changes are likely due to ovarian toxicity and secondary hormonal changes. MR imaging might be a valuable tool for obtaining information regarding chemotherapy-induced infertility.

"Early esophageal rim enhancement": a new sign of esophageal cancer on dynamic CT.

OBJECTIVE: To retrospectively assess a new CT finding of esophageal cancer, "early esophageal rim enhancement". MATERIALS AND METHODS: Sixty-two patients with pathological proven esophageal squamous cell carcinoma who underwent dual phase CT imaging (arterial and venous phases) were enrolled. Two blinded observes independently evaluated presence of partial or circumferential enhancement of the esophageal periphery on arterial (early esophageal rim enhancement) and venous phase CT images. The radiological assessment was compared with the pathological T-stages. Agreement between the observers was also evaluated with a Cohen' kappa value. RESULTS: Pathologic results found 19, 12, 30 and 1 lesions, respectively for T1, T2, T3 and T4 stages. Agreement between two readers was substantial (κ=0.71). Esophageal rim enhancement was observed in 0, 4, 24 and 1 lesions respectively for T1, T2, T3 and T4 stages at the arterial phase, whereas no esophageal rim enhancement could be detected at the venous phase. Early esophageal rim enhancement was more frequently observed in T3/T4 lesions than T1/T2 lesions with statistical significance (p<0.0001). The sensitivity, specificity and accuracy for the diagnosis of T3 or T4 lesion were 80.6%, 87.1% and 83.9%, respectively. CONCLUSION: Early esophageal rim enhancement may be helpful for assessing invasion into the adventitia.