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1 Acquisition Techniques for MR of the Uterus and Adnexa Hanh Vu Nghiem, M.D Oakland University William Beaumont School of Medicine Special thanks to Dr. H. Hussain ( U. of Mich) I do not have any relevant financial relationships with any commercial interests
2 MR Protocol: Uterus and Adnexa T1-w: with and without fat sat T2-w: multiple planes T1-w + fat sat post Gd
3 MRI Female Pelvis: Protocol (U of M) Localizer (T2-w SSFSE or HASTE): Cor T1-w (GRE in-phase/opposed-phase): ax T2-w (FSE): Sag, short axis, long axis T1-w + fat sat (GRE): ax Pre gad Multiphasic post gad Smooth muscle relaxant IM: Glucagon
4 MRI Female Pelvis: Protocol (WBH)
5 MRI Protocol: Uterus and Adnexa T1-w: with and without fat sat T2-w: multiple planes T1-w Gadolinium enhanced imaging
6 High T1-w Signal Ovarian Mass Differential diagnoses: (Blood, fat, mucin containing masses) a. Endometrioma b. Hemorrhagic cyst c. Dermoid cyst d. Ovarian mucinous cystadenoma
7 High SI on T1-w, Fat or Hemorrhage? T1-w Dermoid T1-w Endometrioma T1-w + FS T1-w + FS T1-w without and with fat suppression
8 * * OP IP T1-w GRE OP/IP
9 MRI Protocol: Uterus and Adnexa T1-w: with and without fat sat T2-w: multiple planes T1-w Gadolinium enhanced imaging
10 MRI Female Pelvis: Uterus outer myometrium JZ cervix endometrium vagina Sagittal T2-w FSE
11 MRI Female Pelvis: Ovaries Axial T2-w FSE
12 Sag T2-w Normal Endometrium Endometrial CA with myometrium invasion
13 Adenomyosis Endometrial stroma & glands in myometrium > myometrial hyperplasia Junctional zone focally or diffusely thickened 12 mm (normal < 8 mm) Normal T2-w T2-w
14 Long uterine axis T2-w FSE (assessment of outer fundal contour)
15 Congenital Uterine Anomalies Outer fundal contour distinguishes septate from bicornuate and didelphys Septate: fundal contour is flat or minimally concave (indentation <1 cm) Didelphys Bicornuate Septate
16 Congenital Uterine Anomaly Septate Uterus
17 Congenital Uterine Anomalies Didelphys & bicornuate: deep fundal cleft Didelphys T2-w T2-w Bicornuate bicollis
18 Short uterine axis T2-w FSE (assessment of myometrial abnormalities)
19 Adenomyosis Elliptical, ill defined Contiguous with JZ Minimal mass effect Punctate high T1 & T2 signal Medical or hysterectomy Leiomyoma Round, well demarcated Separate, may compress JZ Mass effect Variable T1 & T2 signal (degeneration) Embolization or surgical Adenomyosis Leiomyoma
20 Short cervical axis T2-w FSE (assessment of cervical abnormalities)
21 Normal cervix Cervical CA confined to cervix
22 Cervical CA with parametrial extension
23 MR Protocol: Uterus and Adnexa T1-w: with and without fat sat T2-w: multiple planes T1-w fat sat: Gadolinium enhanced imaging
24 High T1-w Signal Ovarian Mass Administer Gd to exclude malignancy Assess enhancement: subtraction (post contrast pre contrast) T1-w + FS T1-w + FS + Gd Hemorrhagic cyst Subtraction
25 Complex ovarian mass T1-w A B T2-w Enhanced Cystadeno carcinoma
26 Other available sequences but not routinely performed MRA 3D T2-w Diffusion
27 Figure 26a. (a) MR angiogram before uterine fibroid embolization nicely depicts trifurcation of the right internal iliac artery and a kink at the origin of the uterine artery (UA). (b) Digital subtraction angiogram obtained with selective injection via the right internal iliac artery in the same patient demonstrates good correlation between MR angiography and digital subtraction angiography. Pelage J et al. Radiographics 2005;25:S99-S by Radiological Society of North America
28 Preliminary Clinical Experience at 3 T With a 3D T2- Weighted Sequence Compared With Multiplanar 2D for Evaluation of the Female Pelvis Hecht et al. AJR 2011; 197:W346 W352 Compare 3D T2-weighted sampling perfection with application-optimized contrast with different flip-angle evolutions (SPACE) with three-plane 2D turbo-spin echo (TSE) sequences for female pelvic imaging at 3T CONCLUSION. At 3 T, 3D SPACE has similar image quality and diagnostic quality with shorter scan time when compared with 2D TSE but with reduced contrast between fat and fluid.
29 Uterine Tumors: Comparison of 3D versus 2D T2- weighted Turbo Spin-Echo MR Imaging at 3.0 T Initial Experience 1 Hori et al Radiology, January 2011;258 Results: Mean myometrial SNR was higher on 3D than 2D images Mean SI difference ratios between cervical or endometrial carcinomas and gluteal muscle were higher on 3D images, but those between leiomyoma and myometrium were lower than those on 2D images. Image quality and carcinoma conspicuity were superior with the 3D T2-weighted TSE sequence. No significant differences between 3D and 2D T2-weighted TSE imaging in accuracy of staging for cervical or endometrial carcinoma.
30 Uterine Tumors: Comparison of 3D versus 2D T2-weighted Turbo Spin-Echo MR Imaging at 3.0 T Initial Experience 1 Hori et al Radiology, January 2011;258 Conclusion: The 3D T2-weighted TSE sequence showed certain advantages over the 2D T2-weighted TSE sequence, and it has the potential to improve the performance of MR imaging for the evaluation of uterine carcinoma.
31 THE END
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