Uterine junctional zone thickness in infertile women evaluated by MRI.

PURPOSE: To prospectively evaluate and compare the junctional zone (JZ) and outer myometrial thickness in infertile and healthy nulliparous women at different locations in the uterine wall during the menstrual cycle by magnetic resonance imaging (MRI). MATERIALS AND METHODS: We performed pelvic 1.5T MRI (T2 -weighted turbo spin echo sequences) on 28 infertile women: 5 with infertility of unknown origin, 12 anovulating, and 11 on ovarian stimulation therapy (mean age 28.5, 30.8, and 29.3 years, respectively); and a control group consisting of 18 healthy nulliparous volunteers (mean age 26.4 years). The women with unknown infertility origin and the control group underwent MRI investigations during their follicular, ovulatory, and luteal phase. The JZ and outer myometrial thicknesses were measured at six locations in the uterine wall: anterior and posterior wall of the isthmus, midcorpus, and fundus. RESULTS: The JZ in the anovulating women at the posterior wall of the isthmus (4.2 mm) was significantly thicker compared to the control group (3.2, 3.0, and 2.9 mm, in respectively the three menstrual phases) (P = 0.027). The outer myometrium in the anovulating women was significantly thicker at all measured locations (average 11.5 mm) in comparison to the control group (8.1, 8.0, and 8.5 mm, in respectively the three menstrual phases) (P < 0.050). The infertile women on ovarian stimulation therapy showed a significantly thicker outer myometrium at the anterior wall (isthmus, midcorpus, and fundus) (P < 0.050). CONCLUSION: The results indicate that a thickened JZ, and especially a thickened outer myometrium, might be associated with infertility. LEVEL OF EVIDENCE: 1 J. Magn. Reson. Imaging 2017;45:926-936.

MRI features of ovarian fibroma and fibrothecoma with histopathologic correlation.

OBJECTIVE: The purpose of this article is to evaluate MRI features of ovarian fibroma and fibrothecoma with histopathologic correlation. MATERIALS AND METHODS: In this retrospective study, preoperative MRI examinations of 35 women (mean age, 49 years; range, 24-86 years) with pathologically proven ovarian fibroma (n = 25) or fibrothecoma (n = 10) were reviewed by two radiologists in consensus. MRI features, including visibility of ovaries, presence of capsule, degeneration, T1 and T2 signal, and enhancement pattern, were recorded and correlated with histopathologic features. After administration of gadopentetate dimeglumine, the maximum percentages of enhancement of fibroma or fibrothecoma, myometrium, and, if present, uterine fibroids (11/35 patients) were compared. RESULTS: All fibromas and fibrothecomas appeared well defined, with a mean size of 6.36 × 4.81 cm. Ipsilateral and contralateral ovaries were each seen in 89% (31/35) of patients. Most fibromas and fibrothecomas were isointense to hypointense compared with myometrium on T1-weighted (91% [32/35]) and T2-weighted (77% [27/35]) images. Capsule was noted in 63% (22/35) and degenerative changes were noted in 66% (23/35) of patients. Fibromas and fibrothecomas larger than 6 cm more likely showed capsule (p < 0.0001, Fisher exact probability test), degenerative changes (p = 0.003), peripheral subcapsular cystic areas (p < 0.0001), heterogeneous T2 signal (p = 0.001), and heterogeneous enhancement (p = 0.005). At least four of the above five characteristics were present in 93% (14/15) of fibromas and fibrothecomas larger than 6 cm (p < 0.0001). The maximum percentage of enhancement for fibromas and fibrothecomas (63%) was significantly lower than those for myometrium (131%; p < 0.0001) and fibroids (103%; p < 0.0001), without a statistically significant difference between the maximum percentage enhancement of myometrium and fibroids. A maximum percentage of enhancement less than 75% yielded 92% positive predictive value in differentiating fibromas and fibrothecomas from fibroids. Fibrothecomas had a higher maximum percentage of enhancement than did fibromas (p = 0.01). CONCLUSION: MRI features of ovarian fibromas and fibrothecomas depend on size, with capsule and degenerative changes common with fibromas and fibrothecomas larger than 6 cm. Fibromas and fibrothecomas enhance less than myometrium and fibroids do, and less than 75% maximum percentage enhancement can help in differentiating fibromas and fibrothecomas from fibroids.

Incarceration of the gravid uterus: diagnosis and preoperative evaluation by magnetic resonance imaging.

Incarceration of the gravid uterus is a rare obstetric disorder that is often not recognized despite the ready availability of ultrasound. However, detailed imaging of the disturbed uterine and pelvic anatomy - from an obstetric point of view- is the key in reducing the potentially severe complications of this condition and planning its treatment. In this paper, we will describe the specific magnetic resonance imaging (MRI) features of an incarceration of the gravid uterus and we will discuss the role of magnetic resonance imaging in defining anatomy and in the medical decision whether to operate or not.