Triple-Phase Dynamic MRI of Intratumoral Vessel Density and Hyalinization Grade in Uterine Leiomyomas
Ken Shimada1,2,
Isamu Ohashi2,
Ichiro Kasahara3,4,
Naoyuki Miyasaka5 and
Hitoshi Shibuya2
1 Department of Radiology, Toride Kyodo General Hospital, 2-1-1 Hongo,
Toride-shi, Ibaraki 302-0022, Japan.
2 Department of Radiology, School of Medicine, Tokyo Medical and Dental
University, Tokyo 113-8549, Japan.
3 Department of Human Pathology, Graduate School, Tokyo Medical and Dental
University, Tokyo 113-8549, Japan.
4 Department of Pathology, Tokyo Metropolitan Geriatric Medical Center, Tokyo
173-0015, Japan.
5 Department of Obstetrics and Gynecology, School of Medicine, Tokyo Medical and
Dental University, Tokyo 113-8549, Japan.
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Fig. 1A. —Photomicrographs of histologic specimens show hyalinization
in uterine leiomyomas. (H and E, x100) Slight (grade 1) hyalinization is
seen in intercellular spaces of densely proliferating leiomyoma cells.
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Fig. 1B. —Photomicrographs of histologic specimens show hyalinization
in uterine leiomyomas. (H and E, x100) Intermediate (grade 2)
hyalinization and widening of intercellular space is seen in association with
shrinkage and displacement of leiomyoma cell groups.
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Fig. 1C. —Photomicrographs of histologic specimens show hyalinization
in uterine leiomyomas. (H and E, x100) Severe (grade 3) hyalinization of
leiomyoma tissue is seen in which few leiomyoma cells and capillaries remain
in tissue.
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Fig. 2. —Scatterplot of results obtained at 60 sec shows significant
positive correlation between enhancement index and intratumoral vessel density
of leiomyomas. r = 0.69, p = 0.0028.
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Fig. 3. —Scatterplot shows enhancement indexes of leiomyomas for each
grade of hyalinization (grade 1, slight; grade 2, intermediate; grade 3,
severe) at triple-phase dynamic MRI and mean values with error bars (standard
deviations) of enhancement indexes for each grade of hyalinization. Note that
at each dynamic phase, leiomyomas with more severe hyalinization show smaller
mean enhancement indexes.
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Fig. 4. —Scatterplot shows intratumoral vessel density of leiomyomas
for each grade of hyalinization (grade 1, slight; grade 2, intermediate; grade
3, severe) and mean values with error bars (standard deviations) of
intratumoral vessel density for each grade of hyalinization. Note that
leiomyomas with more severe hyalinization tend to show smaller values of
intratumoral vessel density, although intratumoral vessel density values
overlap considerably among three grades of hyalinization.
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Fig. 5A. —29-year-old woman with three subserosal leiomyomas having
severe hyalinization and few vessels. Preoperative gonadotropin-releasing
hormone analogues were not administered. Axial T2-weighted turbo spin-echo
image reveals three subserosal uterine leiomyomas (arrows) with low
signal intensity.
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Fig. 5B. —29-year-old woman with three subserosal leiomyomas having
severe hyalinization and few vessels. Preoperative gonadotropin-releasing
hormone analogues were not administered. Axial T1-weighted spoiled
gradient-echo image obtained before injection of contrast medium shows three
subserosal uterine leiomyomas with low signal intensity. Regions of interest
(circles) were placed over three leiomyomas. Asterisk indicates
leiomyoma that was sampled histopathologically.
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Fig. 5C. —29-year-old woman with three subserosal leiomyomas having
severe hyalinization and few vessels. Preoperative gonadotropin-releasing
hormone analogues were not administered. Axial T1-weighted spoiled
gradient-echo images were also obtained at 20 (C), 60 (D), and
180 (E) sec after injection of contrast medium. All leiomyomas show
little enhancement in each dynamic phase image. Enhancement indexes of
leiomyoma (asterisks) at 20, 60, and 180 sec are 0.02, 0.08, and
0.14, respectively.
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Fig. 5D. —29-year-old woman with three subserosal leiomyomas having
severe hyalinization and few vessels. Preoperative gonadotropin-releasing
hormone analogues were not administered. Axial T1-weighted spoiled
gradient-echo images were also obtained at 20 (C), 60 (D), and
180 (E) sec after injection of contrast medium. All leiomyomas show
little enhancement in each dynamic phase image. Enhancement indexes of
leiomyoma (asterisks) at 20, 60, and 180 sec are 0.02, 0.08, and
0.14, respectively.
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Fig. 5E. —29-year-old woman with three subserosal leiomyomas having
severe hyalinization and few vessels. Preoperative gonadotropin-releasing
hormone analogues were not administered. Axial T1-weighted spoiled
gradient-echo images were also obtained at 20 (C), 60 (D), and
180 (E) sec after injection of contrast medium. All leiomyomas show
little enhancement in each dynamic phase image. Enhancement indexes of
leiomyoma (asterisks) at 20, 60, and 180 sec are 0.02, 0.08, and
0.14, respectively.
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Fig. 5F. —29-year-old woman with three subserosal leiomyomas having
severe hyalinization and few vessels. Preoperative gonadotropin-releasing
hormone analogues were not administered. Photomicrograph of leiomyoma marked
with asterisks in B–E shows homogeneous matrix without
recognizable cells, corresponding to severe (grade 3) hyaline degeneration
findings. Intratumoral vessel density of leiomyoma was 0.7. (H and E,
x100)
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Fig. 6A. —41-year-old woman with intramural leiomyoma showing little
hyalinization and many vessels. Preoperative gonadotropin-releasing hormone
analogues were not administered. Sagittal T2-weighted turbo spin-echo image
reveals uterine leiomyoma (arrow) with low signal intensity in
anterior wall of uterine corpus.
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Fig. 6B. —41-year-old woman with intramural leiomyoma showing little
hyalinization and many vessels. Preoperative gonadotropin-releasing hormone
analogues were not administered. Axial T1-weighted spoiled gradient-echo image
obtained before injection of contrast medium shows uterine leiomyoma with low
signal intensity in anterior wall of uterine corpus. Region of interest
(circle) was placed over this tumor.
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Fig. 6C. —41-year-old woman with intramural leiomyoma showing little
hyalinization and many vessels. Preoperative gonadotropin-releasing hormone
analogues were not administered. Axial T1-weighted spoiled gradient-echo
images were also obtained at 20 (C), 60 (D), and 180 (E)
sec after injection of contrast medium. These dynamic images show strong
contrast enhancement in tumor. Enhancement index values at 20, 60, and 180 sec
were 1.23, 1.79, and 2.03, respectively.
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Fig. 6D. —41-year-old woman with intramural leiomyoma showing little
hyalinization and many vessels. Preoperative gonadotropin-releasing hormone
analogues were not administered. Axial T1-weighted spoiled gradient-echo
images were also obtained at 20 (C), 60 (D), and 180 (E)
sec after injection of contrast medium. These dynamic images show strong
contrast enhancement in tumor. Enhancement index values at 20, 60, and 180 sec
were 1.23, 1.79, and 2.03, respectively.
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Fig. 6E. —41-year-old woman with intramural leiomyoma showing little
hyalinization and many vessels. Preoperative gonadotropin-releasing hormone
analogues were not administered. Axial T1-weighted spoiled gradient-echo
images were also obtained at 20 (C), 60 (D), and 180 (E)
sec after injection of contrast medium. These dynamic images show strong
contrast enhancement in tumor. Enhancement index values at 20, 60, and 180 sec
were 1.23, 1.79, and 2.03, respectively.
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Fig. 6F. —41-year-old woman with intramural leiomyoma showing little
hyalinization and many vessels. Preoperative gonadotropin-releasing hormone
analogues were not administered. Photomicrograph of leiomyoma shows typical
whorls of smooth-muscle cells with intervening collagen. Only slight (grade 1)
hyalinization is observed, but many intratumoral vessels (arrowheads)
are visible. Intratumoral vessel density of this leiomyoma was 16.8. (H and E,
x100)
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Copyright © 2004 by the American Roentgen Ray Society.
