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Endometrial Carcinoma in Adenomyosis: Assessment of Myometrial Invasion on T2-Weighted Spin-Echo and Gadolinium-Enhanced T1-Weighted Images

¹ Department of Radiology, Kumamoto University School of Medicine, 1-1-1, Honjo, Kumamoto, Kumamoto 860-8556, Japan.
² Department of Obstetrics and Gynecology, Kumamoto University School of Medicine, Kumamoto 860-8556, Japan.
³ Department of Radiology, Kinki University School of Medicine, 377-2, Ohnohigashi Hazayama, Osaka 589-8511, Japan.

View larger version (184K): [in a new window]   Fig. 1A. —62-year-old woman with superficial (20%) invasion of myometrium by endometrial cancer coexisting with adenomyosis. Sagittal T2-weighted image shows thickening of junctional zone. Border (arrows) between tumor and dorsal myometrium is indistinguishable.

View larger version (149K): [in a new window]   Fig. 1B. —62-year-old woman with superficial (20%) invasion of myometrium by endometrial cancer coexisting with adenomyosis. Dynamic MRI obtained before contrast enhancement shows no tumor–myometrium contrast.

View larger version (142K): [in a new window]   Fig. 1C. —62-year-old woman with superficial (20%) invasion of myometrium by endometrial cancer coexisting with adenomyosis. Contrast-enhanced dynamic MRIs obtained during early phase (C) and delayed phase (D) show tumor as slightly enhanced lesion in endometrial cavity that contrasts well with well-enhanced myometrium. Marked enhancement of inner layer of myometrium (arrows) can be seen during early phase (C). Contrast between tumor and myometrium is better on contrast-enhanced images than on unenhanced images (B). Abnormal signal intensity of tumor is confined to inner half of myometrium.

View larger version (148K): [in a new window]   Fig. 1D. —62-year-old woman with superficial (20%) invasion of myometrium by endometrial cancer coexisting with adenomyosis. Contrast-enhanced dynamic MRIs obtained during early phase (C) and delayed phase (D) show tumor as slightly enhanced lesion in endometrial cavity that contrasts well with well-enhanced myometrium. Marked enhancement of inner layer of myometrium (arrows) can be seen during early phase (C). Contrast between tumor and myometrium is better on contrast-enhanced images than on unenhanced images (B). Abnormal signal intensity of tumor is confined to inner half of myometrium.

View larger version (143K): [in a new window]   Fig. 2A. —47-year-old woman with deep (90%) myometrial invasion by endometrial cancer in adenomyosis. Sagittal T2-weighted image shows low-signal-intensity mass (arrows) in dorsal wall, but assessing myometrial invasion is difficult.

View larger version (136K): [in a new window]   Fig. 2B. —47-year-old woman with deep (90%) myometrial invasion by endometrial cancer in adenomyosis. Dynamic MRI obtained before contrast enhancement shows no tumor–myometrium contrast.

View larger version (153K): [in a new window]   Fig. 2C. —47-year-old woman with deep (90%) myometrial invasion by endometrial cancer in adenomyosis. Contrast-enhanced dynamic MRI obtained during early phase shows marked enhancement of inner layer of myometrium. Tumor (arrows) interrupts well-enhanced inner layer of myometrium (arrowhead).

View larger version (146K): [in a new window]   Fig. 2D. —47-year-old woman with deep (90%) myometrial invasion by endometrial cancer in adenomyosis. Contrast-enhanced dynamic MRI obtained during delayed phase shows poor tumor–myometrium contrast.

View larger version (179K): [in a new window]   Fig. 3A. —54-year-old woman with deep (95%) myometrial invasion by endometrial cancer arising from adenomyosis that was confirmed at pathology. Sagittal T2-weighted image shows slightly high-signal-intensity mass (arrow) in dorsal wall extending to outer myometrium.

View larger version (166K): [in a new window]   Fig. 3B. —54-year-old woman with deep (95%) myometrial invasion by endometrial cancer arising from adenomyosis that was confirmed at pathology. Dynamic MRI obtained before contrast enhancement shows poor tumor–myometrium contrast.

View larger version (159K): [in a new window]   Fig. 3C. —54-year-old woman with deep (95%) myometrial invasion by endometrial cancer arising from adenomyosis that was confirmed at pathology. Contrast-enhanced dynamic MRIs in early phase (C) and delayed phase (D) show extension of mass to outer myometrium. During early phase (C), tumor (arrows) contrasts well with well-enhanced inner layer of myometrium (arrowhead, C). Well-enhanced inner layer is interrupted by tumor.

View larger version (183K): [in a new window]   Fig. 3D. —54-year-old woman with deep (95%) myometrial invasion by endometrial cancer arising from adenomyosis that was confirmed at pathology. Contrast-enhanced dynamic MRIs in early phase (C) and delayed phase (D) show extension of mass to outer myometrium. During early phase (C), tumor (arrows) contrasts well with well-enhanced inner layer of myometrium (arrowhead, C). Well-enhanced inner layer is interrupted by tumor.

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