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Erschienen in: European Radiology 8/2003

01.08.2003 | Urogenital

A thickened or indistinct junctional zone on T2-weighted MR images in patients with endometrial carcinoma: pathologic consideration based on microcirculation

verfasst von: Yumiko Oishi Tanaka, Masato Nishida, Hajime Tsunoda, Yoshihito Ichikawa, Yukihisa Saida, Yuji Itai

Erschienen in: European Radiology | Ausgabe 8/2003

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Abstract.

Thickened or indistinct junctional zone (JZ) is a problematic finding in staging endometrial carcinoma. We studied the incidence, pathological cause of this condition correlated to microcirculation, and the utility of dynamic contrast MRI for differential diagnosis. T2-weighted images were analyzed in 119 cases with endometrial carcinoma. The enhancement of the JZ during the dynamic contrast MRI, histopathological causes, and the density of arterioles in the JZ were retrospectively analyzed in cases with thickened or indistinct JZ. The MRI histopathological correlation of all 31 patients with a thickened or indistinct JZ were analyzed, in which it was corresponded to myometrial cancer invasion only in 22%. The sensitivity of a poor early enhancement pattern on dynamic study for detecting myometrial invasion was 71.4%, the specificity was 100%, and the overall accuracy was 92.5%. Although only weak relationship between the contrast enhancement and the arteriole density was revealed, the arteriole density within the JZ with cancer invasion was significantly decreased. Poor enhancement of JZ in early dynamic phase was correlated with the decreased density of arterioles within the myometrium which was invaded by endometrial carcinoma. Dynamic contrast study should be performed in staging endometrial carcinoma especially when JZ was thickened or indistinct.
Literatur
1.
Zurück zum Zitat Lurain JR(1996) Uterine cancer. In:Berek JS, Adashi EY, Hillard PA (eds) Novak's gynecology. Williams and Wilkins, Baltimore, pp1057–1110 Lurain JR(1996) Uterine cancer. In:Berek JS, Adashi EY, Hillard PA (eds) Novak's gynecology. Williams and Wilkins, Baltimore, pp1057–1110
2.
Zurück zum Zitat Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB (1987) Surgical pathologic spread patterns of endometrial cancer. A Gynecologic Oncology Group Study. Cancer 60:2035–2041PubMed Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB (1987) Surgical pathologic spread patterns of endometrial cancer. A Gynecologic Oncology Group Study. Cancer 60:2035–2041PubMed
3.
Zurück zum Zitat Hricak H, Stern JL, Fisher MR, Shapeero LG, Winkler ML, Lacey CG (1987) Endometrial carcinoma staging by MR imaging. Radiology 162:297–305PubMed Hricak H, Stern JL, Fisher MR, Shapeero LG, Winkler ML, Lacey CG (1987) Endometrial carcinoma staging by MR imaging. Radiology 162:297–305PubMed
4.
Zurück zum Zitat Sironi S, Taccagni G, Garancini P, Belloni C, DelMaschio A (1992) Myometrial invasion by endometrial carcinoma: assessment by MR imaging. AJR 158:565–569 Sironi S, Taccagni G, Garancini P, Belloni C, DelMaschio A (1992) Myometrial invasion by endometrial carcinoma: assessment by MR imaging. AJR 158:565–569
5.
Zurück zum Zitat DelMaschio A, Vanzulli A, Sironi S, Spagnolo D, Belloni C, Garancini P, Taccagni GL (1993) Estimating the depth of myometrial involvement by endometrial carcinoma: efficacy of transvaginal sonography vs MR imaging. AJR 160:533–538 DelMaschio A, Vanzulli A, Sironi S, Spagnolo D, Belloni C, Garancini P, Taccagni GL (1993) Estimating the depth of myometrial involvement by endometrial carcinoma: efficacy of transvaginal sonography vs MR imaging. AJR 160:533–538
6.
Zurück zum Zitat Takahashi S, Murakami T, Narumi Y, Kurachi H, Tsuda K, Kim T, Enomoto T, Tomoda K, Miyake A, Murata Y, Nakamura H (1998) Preoperative staging of endometrial carcinoma: diagnostic effect of T2-weighted fast spin-echo MR imaging. Radiology 206:539–547PubMed Takahashi S, Murakami T, Narumi Y, Kurachi H, Tsuda K, Kim T, Enomoto T, Tomoda K, Miyake A, Murata Y, Nakamura H (1998) Preoperative staging of endometrial carcinoma: diagnostic effect of T2-weighted fast spin-echo MR imaging. Radiology 206:539–547PubMed
7.
Zurück zum Zitat Scoutt LM, McCarthy SM, Flynn SD, Lange RC, Long F, Smith RC, Chambers SK, Kohorn E, Schwartz P, Chambers JT (1995) Clinical stage I endometrial carcinoma: pitfalls in preoperative assessment with MR imaging. Work in progress. Radiology194:567–572 Scoutt LM, McCarthy SM, Flynn SD, Lange RC, Long F, Smith RC, Chambers SK, Kohorn E, Schwartz P, Chambers JT (1995) Clinical stage I endometrial carcinoma: pitfalls in preoperative assessment with MR imaging. Work in progress. Radiology194:567–572
8.
Zurück zum Zitat Mark AS, Hricak H, Heinrichs LW, Hendrickson MR, Winkler ML, Bachica JA, Stickler JE (1987) Adenomyosis and leiomyoma: differential diagnosis with MR imaging. Radiology 163:527–529PubMed Mark AS, Hricak H, Heinrichs LW, Hendrickson MR, Winkler ML, Bachica JA, Stickler JE (1987) Adenomyosis and leiomyoma: differential diagnosis with MR imaging. Radiology 163:527–529PubMed
9.
Zurück zum Zitat Togashi K, Nishimura K, Itoh K, Fujisawa I, Noma S, Kanaoka M, Nakano Y, Itoh H, Ozasa H, Fujii S et al. (1988) Adenomyosis: diagnosis with MR imaging. Radiology 166:111–114PubMed Togashi K, Nishimura K, Itoh K, Fujisawa I, Noma S, Kanaoka M, Nakano Y, Itoh H, Ozasa H, Fujii S et al. (1988) Adenomyosis: diagnosis with MR imaging. Radiology 166:111–114PubMed
10.
Zurück zum Zitat Hirano Y, Kubo K, Hirai Y, Okada S, Yamada K, Sawano S, Yamashita T, Hiramatsu Y (1992) Preliminary experience with gadolinium-enhanced dynamic MR imaging for uterine neoplasms. Radiographics 12:243–256PubMed Hirano Y, Kubo K, Hirai Y, Okada S, Yamada K, Sawano S, Yamashita T, Hiramatsu Y (1992) Preliminary experience with gadolinium-enhanced dynamic MR imaging for uterine neoplasms. Radiographics 12:243–256PubMed
11.
Zurück zum Zitat Yamashita Y, Harada M, Sawada T, Takahashi M, Miyazaki K, Okamura H (1993) Normal uterus and FIGO stage I endometrial carcinoma: dynamic gadolinium-enhanced MR imaging. Radiology 186:495–501PubMed Yamashita Y, Harada M, Sawada T, Takahashi M, Miyazaki K, Okamura H (1993) Normal uterus and FIGO stage I endometrial carcinoma: dynamic gadolinium-enhanced MR imaging. Radiology 186:495–501PubMed
12.
Zurück zum Zitat Yamashita Y, Mizutani H, Torashima M, Takahashi M, Miyazaki K, Okamura H, Ushijima H, Ohtake H, Tokunaga T (1993) Assessment of myometrial invasion by endometrial carcinoma: transvaginal sonography vs contrast-enhanced MR imaging. AJR 161:595–599 Yamashita Y, Mizutani H, Torashima M, Takahashi M, Miyazaki K, Okamura H, Ushijima H, Ohtake H, Tokunaga T (1993) Assessment of myometrial invasion by endometrial carcinoma: transvaginal sonography vs contrast-enhanced MR imaging. AJR 161:595–599
13.
Zurück zum Zitat Ito K, Matsumoto T, Nakada T, Nakanishi T, Fujita N, Yamashita H (1994) Assessing myometrial invasion by endometrial carcinoma with dynamic MRI. J Comput Assist Tomogr 18:77–86PubMed Ito K, Matsumoto T, Nakada T, Nakanishi T, Fujita N, Yamashita H (1994) Assessing myometrial invasion by endometrial carcinoma with dynamic MRI. J Comput Assist Tomogr 18:77–86PubMed
14.
Zurück zum Zitat Joja I, Asakawa M, Asakawa T, Nakagawa T, Kanazawa S, Kuroda M, Togami I, Hiraki Y, Akamatsu N, Kudo T (1996) Endometrial carcinoma: dynamic MRI with turbo-FLASH technique. J Comput Assist Tomogr 20:878–887CrossRefPubMed Joja I, Asakawa M, Asakawa T, Nakagawa T, Kanazawa S, Kuroda M, Togami I, Hiraki Y, Akamatsu N, Kudo T (1996) Endometrial carcinoma: dynamic MRI with turbo-FLASH technique. J Comput Assist Tomogr 20:878–887CrossRefPubMed
15.
Zurück zum Zitat Savci G, Ozyaman T, Tutar M, Bilgin T, Erol O, Tuncel E (1998) Assessment of depth of myometrial invasion by endometrial carcinoma: comparison of T2-weighted SE and contrast-enhanced dynamic GRE MR imaging. Eur Radiol 8:218–223CrossRef Savci G, Ozyaman T, Tutar M, Bilgin T, Erol O, Tuncel E (1998) Assessment of depth of myometrial invasion by endometrial carcinoma: comparison of T2-weighted SE and contrast-enhanced dynamic GRE MR imaging. Eur Radiol 8:218–223CrossRef
16.
Zurück zum Zitat Reinhold C, McCarthy S, Bret PM, Mehio A, Atri M, Zakarian R, Glaude Y, Liang L, Seymour RJ (1996) Diffuse adenomyosis: comparison of endovaginal US and MR imaging with histopathologic correlation. Radiology199:151–158 Reinhold C, McCarthy S, Bret PM, Mehio A, Atri M, Zakarian R, Glaude Y, Liang L, Seymour RJ (1996) Diffuse adenomyosis: comparison of endovaginal US and MR imaging with histopathologic correlation. Radiology199:151–158
17.
Zurück zum Zitat Hricak H, Alpers C, Crooks LE, S PE (1983) Magnetic resonance imaging of the female pelvis: initial experience. AJR 141:1119–1128 Hricak H, Alpers C, Crooks LE, S PE (1983) Magnetic resonance imaging of the female pelvis: initial experience. AJR 141:1119–1128
18.
Zurück zum Zitat Demas BE, Hricak H, Jaffe RB (1986) Uterine MR imaging: effects of hormonal stimulation. Radiology159:123–126 Demas BE, Hricak H, Jaffe RB (1986) Uterine MR imaging: effects of hormonal stimulation. Radiology159:123–126
19.
Zurück zum Zitat McCarthy S, Tauber C, Gore J (1986) Female pelvic anatomy: MR assessment of variations during the menstrual cycle and use of oral contraceptives. Radiology160:119–123 McCarthy S, Tauber C, Gore J (1986) Female pelvic anatomy: MR assessment of variations during the menstrual cycle and use of oral contraceptives. Radiology160:119–123
20.
Zurück zum Zitat McCarthy S, Scott G, Majumdar S, Shapiro B, Thompson S, Lange R, Gore J (1989) Uterine junctional zone: MR study of water content and relaxation properties. Radiology171:241–243 McCarthy S, Scott G, Majumdar S, Shapiro B, Thompson S, Lange R, Gore J (1989) Uterine junctional zone: MR study of water content and relaxation properties. Radiology171:241–243
21.
Zurück zum Zitat Brown HK, Stoll BS, Nicosia SV, Fiorica JV, Hambley PS, Clarke LP, Silbiger ML (1991) Uterine junctional zone: correlation between histologic findings and MR imaging. Radiology 179:409–413PubMed Brown HK, Stoll BS, Nicosia SV, Fiorica JV, Hambley PS, Clarke LP, Silbiger ML (1991) Uterine junctional zone: correlation between histologic findings and MR imaging. Radiology 179:409–413PubMed
22.
Zurück zum Zitat Scoutt LM, Flynn SD, Luthringer DJ, McCauley TR, McCarthy SM (1991) Junctional zone of the uterus: correlation of MR imaging and histologic examination of hysterectomy specimens. Radiology 179:403–407PubMed Scoutt LM, Flynn SD, Luthringer DJ, McCauley TR, McCarthy SM (1991) Junctional zone of the uterus: correlation of MR imaging and histologic examination of hysterectomy specimens. Radiology 179:403–407PubMed
23.
Zurück zum Zitat Togashi K, Kawakami S, Kimura I, Asato R, Takakura K, Mori T, Konishi J (1993) Sustained uterine contractions: a cause of hypointense myometrial bulging. Radiology 187:707–710 Togashi K, Kawakami S, Kimura I, Asato R, Takakura K, Mori T, Konishi J (1993) Sustained uterine contractions: a cause of hypointense myometrial bulging. Radiology 187:707–710
24.
Zurück zum Zitat Togashi K, Nakai A, Sugimura K (2001) Anatomy and physiology of the female pelvis: MR imaging revisited. J Magn Reson Imaging 13:842–849CrossRefPubMed Togashi K, Nakai A, Sugimura K (2001) Anatomy and physiology of the female pelvis: MR imaging revisited. J Magn Reson Imaging 13:842–849CrossRefPubMed
25.
Zurück zum Zitat Masui T, Katayama M, Kobayashi S, Nakayama S, Nozaki A, Kabasawa H, Ito T, Sakahara H (2001) Changes in myometrial and junctional zone thickness and signal intensity: demonstration with kinematic T2-weighted MR imaging. Radiology 221:75–85PubMed Masui T, Katayama M, Kobayashi S, Nakayama S, Nozaki A, Kabasawa H, Ito T, Sakahara H (2001) Changes in myometrial and junctional zone thickness and signal intensity: demonstration with kinematic T2-weighted MR imaging. Radiology 221:75–85PubMed
26.
Zurück zum Zitat Kurman RJ, Zaino RJ, Norris HJ (1994) Endometrial carcinoma. In: Kurman RJ (ed) Blaustein's pathology of the female genital tract. Springer, Berlin Heidelberg, New York, pp 439–486 Kurman RJ, Zaino RJ, Norris HJ (1994) Endometrial carcinoma. In: Kurman RJ (ed) Blaustein's pathology of the female genital tract. Springer, Berlin Heidelberg, New York, pp 439–486
27.
Zurück zum Zitat Ascher SM, Arnold LL, Patt RH, Schruefer JJ, Bagley AS, Semelka RC, Zeman RK, Simon JA (1994) Adenomyosis: prospective comparison of MR imaging and transvaginal sonography. Radiology190:803–806 Ascher SM, Arnold LL, Patt RH, Schruefer JJ, Bagley AS, Semelka RC, Zeman RK, Simon JA (1994) Adenomyosis: prospective comparison of MR imaging and transvaginal sonography. Radiology190:803–806
28.
Zurück zum Zitat Reinhold C, Tafazoli F, Mehio A, Wang L, Atri M, Siegelman ES, Rohoman L (1999) Uterine adenomyosis: endovaginal US and MR imaging features with histopathologic correlation. Radiographics 19:S147–S160PubMed Reinhold C, Tafazoli F, Mehio A, Wang L, Atri M, Siegelman ES, Rohoman L (1999) Uterine adenomyosis: endovaginal US and MR imaging features with histopathologic correlation. Radiographics 19:S147–S160PubMed
29.
Zurück zum Zitat Hricak H, Hamm B, Semelka RC, Cann CE, Nauert T, Secaf E, Stern JL, Wolf KJ (1991) Carcinoma of the uterus: use of gadopentetate dimeglumine in MR imaging. Radiology 181:95–106PubMed Hricak H, Hamm B, Semelka RC, Cann CE, Nauert T, Secaf E, Stern JL, Wolf KJ (1991) Carcinoma of the uterus: use of gadopentetate dimeglumine in MR imaging. Radiology 181:95–106PubMed
30.
Zurück zum Zitat Kinkel K, Kaji Y, Yu KK, Segal MR, Lu Y, Powell CB, Hricak H (1999) Radiologic staging in patients with endometrial cancer: a meta-analysis. Radiology 212:711–718PubMed Kinkel K, Kaji Y, Yu KK, Segal MR, Lu Y, Powell CB, Hricak H (1999) Radiologic staging in patients with endometrial cancer: a meta-analysis. Radiology 212:711–718PubMed
31.
Zurück zum Zitat Frei KA, Kinkel K, Bonel HM, Lu Y, Zaloudek C, Hricak H (2000) Prediction of deep myometrial invasion in patients with endometrial cancer: clinical utility of contrast-enhanced MR imaging: a meta-analysis and Bayesian analysis. Radiology 216:444–449PubMed Frei KA, Kinkel K, Bonel HM, Lu Y, Zaloudek C, Hricak H (2000) Prediction of deep myometrial invasion in patients with endometrial cancer: clinical utility of contrast-enhanced MR imaging: a meta-analysis and Bayesian analysis. Radiology 216:444–449PubMed
32.
Zurück zum Zitat Saez F, Urresola A, Larena JA, Martin Ji, Pijuan Ji, Schneider J, Ibanez E (2000) Endometrial carcinoma: assessment of myometrial invasion with plain and gadolinium-enhanced MR imaging. J Magn Reson Imaging 12:460–466CrossRefPubMed Saez F, Urresola A, Larena JA, Martin Ji, Pijuan Ji, Schneider J, Ibanez E (2000) Endometrial carcinoma: assessment of myometrial invasion with plain and gadolinium-enhanced MR imaging. J Magn Reson Imaging 12:460–466CrossRefPubMed
33.
Zurück zum Zitat Lee EJ, Byun JY, Kim BS, Koong SE, Shinn KS (1999) Staging of early endometrial carcinoma: assessment with T2-weighted and gadolinium-enhanced T1-weighted MR imaging. Radiographics19:937–946 Lee EJ, Byun JY, Kim BS, Koong SE, Shinn KS (1999) Staging of early endometrial carcinoma: assessment with T2-weighted and gadolinium-enhanced T1-weighted MR imaging. Radiographics19:937–946
34.
Zurück zum Zitat Frei KA, Kinkel K (2001) Staging endometrial cancer: role of magnetic resonance imaging. J Magn Reson Imaging 13:850–855CrossRefPubMed Frei KA, Kinkel K (2001) Staging endometrial cancer: role of magnetic resonance imaging. J Magn Reson Imaging 13:850–855CrossRefPubMed
35.
Zurück zum Zitat Ueda M, Otsuka M, Hatakenaka M, Sakai S, Ono M, Yoshimitsu K, Honda H, Torii Y (2001) MR imaging findings of uterine endometrial stromal sarcoma: differentiation from endometrial carcinoma. Eur Radiol 11:28–33PubMed Ueda M, Otsuka M, Hatakenaka M, Sakai S, Ono M, Yoshimitsu K, Honda H, Torii Y (2001) MR imaging findings of uterine endometrial stromal sarcoma: differentiation from endometrial carcinoma. Eur Radiol 11:28–33PubMed
36.
Zurück zum Zitat Abulafia O, Triest WE, Sherer DM (1999) Angiogenesis in malignancies of the female genital tract. Gynecol Oncol 72:220–231CrossRefPubMed Abulafia O, Triest WE, Sherer DM (1999) Angiogenesis in malignancies of the female genital tract. Gynecol Oncol 72:220–231CrossRefPubMed
37.
Zurück zum Zitat Healy DL, Rogers PA, Hii L, Wingfield M (1998) Angiogenesis: a new theory for endometriosis. Hum Reprod Update 4:736–740PubMed Healy DL, Rogers PA, Hii L, Wingfield M (1998) Angiogenesis: a new theory for endometriosis. Hum Reprod Update 4:736–740PubMed
38.
Zurück zum Zitat Ota H, Igarashi S, Tanaka T (1998) Morphometric evaluation of stromal vascularization in the endometrium in adenomyosis. Hum Reprod 13:715–719CrossRefPubMed Ota H, Igarashi S, Tanaka T (1998) Morphometric evaluation of stromal vascularization in the endometrium in adenomyosis. Hum Reprod 13:715–719CrossRefPubMed
Metadaten
Titel
A thickened or indistinct junctional zone on T2-weighted MR images in patients with endometrial carcinoma: pathologic consideration based on microcirculation
verfasst von
Yumiko Oishi Tanaka
Masato Nishida
Hajime Tsunoda
Yoshihito Ichikawa
Yukihisa Saida
Yuji Itai
Publikationsdatum
01.08.2003
Verlag
Springer-Verlag
Erschienen in
European Radiology / Ausgabe 8/2003
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-002-1799-y

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