MRI appearance of primary giant ovarian leiomyoma in a hysterectomised woman

Primary leiomyoma is a rare, benign tumour of the ovary. We describe the MRI features of an ovarian leiomyoma identified in a 51-year-old woman after hysterectomy. The tumour appeared as a well-circumscribed low signal intensity mass on T(1) weighted imaging, with mixed signal intensity on T2 weighted imaging. Areas of high signal intensity on T2 weighted imaging corresponded to degeneration of leiomyoma. Dynamic contrast-enhanced imaging revealed early enhancement of the lesion. MRI appearance was thus similar to that of uterine leiomyoma. This case suggests the potential usefulness of dynamic contrast-enhanced MRI for the diagnosis of ovarian leiomyoma.     

The value of MR imaging in distinguishing leiomyomas from other solid pelvic masses when sonography is indeterminate

The differentiation of a uterine leiomyoma from other solid pelvic masses on sonography is usually straightforward. Occasionally, the sonographic appearance of a pedunculated uterine leiomyoma may simulate that of a solid adnexal mass. The purpose of this study was to determine if MR imaging adds specificity to the diagnosis of indeterminate solid pelvic masses visualized with sonography. Nineteen patients were imaged with MR after sonography revealed the presence of a solid pelvic mass adjacent to the uterus but could not be used to determine whether the mass was a leiomyoma or some other type of tumor. The diagnostic criteria for a leiomyoma on MR imaging included (1) the presence of a mass adjacent to the uterus and (2) a mass that was predominantly low signal intensity or isointense compared with normal myometrium on T1-weighted images and predominantly low signal intensity on T2-weighted images. In 11 of 13 patients, the masses that met these MR criteria for leiomyoma were proved to be uterine leiomyomas at surgery. Another mass that met the criteria was shown to be a leiomyoma in the broad ligament; the other was an ovarian fibroma. Of the six cases that did not meet the MR criteria for the diagnosis of leiomyoma, three were proved to be degenerated fibroids, one was squamous cell carcinoma of the cervix, and two were ovarian malignant tumors. Because leiomyomas often have an MR appearance that is distinct from that of solid pelvic malignant tumors, MR imaging can be useful for the diagnosis of some indeterminate solid pelvic masses.     

MR imaging of a case of adenomatoid tumor of the adrenal gland

The aim of this case report is to describe the appearance on magnetic resonance imaging (MRI) of an incidentally found adenomatoid tumor of the adrenal gland, and to evaluate the utility of MRI in characterizing this type of tumor. The appearance of the tumor was nonspecific on T1-weighted in-phase, opposed-phase, and T2-weighted images, as well as its behavior after paramagnetic contrast administration, outlining the differential diagnosis among carcinoma, metastatic tumors, and pheochromocytoma. After surgery, the pathologic diagnosis was adenomatoid benign tumor of mesothelial origin. Although MRI enables the characterization of most benign lesions of the adrenal gland, the appearance of other lesions is nonspecific. In our case, MRI did not assist in preoperative diagnosis, guiding us towards a diagnosis of malignancy. Received: 16 February 1998; Revision received: 17 April 1998; Accepted: 12 May 1998     

子宫肌瘤的低场MRI表现及诊断价值(附24例分析)

目的探讨子宫肌瘤的低场MRI表现及其诊断价值。方法对24例子宫肌瘤患者行MRI检查,SE序列,常规T1WI、T2WI及多方位成像,对其MRI表现进行回顾性分析。结果18例多发肌瘤,5例单发肌瘤,MRI共检出41个病灶,所有病灶在T1WI上表现为等或低信号,在T2WI上表现为低或混杂信号。其中23例经手术治疗,1例行介入栓塞治疗。结论低场MRI对子宫肌瘤在观察大小、形态、位置与子宫腔的关系和肌瘤在定性方面上有较高的诊断价值,可作为B超检查的重要补充手段。     

Leiomyoma of the seminal vesicle

We report a case of leiomyoma of the seminal vesicle in a 74-year-old man who presented with left hemilumbago. Computed tomography and magnetic resonance imaging revealed a mass containing coarse calcification and low signal intensity areas on T1- and T2-weighted images. The clinical features of previously reported cases of leiomyoma of the seminal vesicle are presented, including those of the present case. There remains a lack of consensus regarding surgical resection of leiomyoma of the seminal vesicle.     

MRI, CT, US and ERCP in the evaluation of bile duct hamartomas (von Meyenburg complex): a case report

A case of multiple bile duct hamartomas (von Meyenburg complex) of the liver accompanied by exudative and in part necrotizing pancreatitis is presented. Magnetic resonance imaging (fat suppressed, T2-weighted images with prolonged echo time) could exclude diffuse tumor infiltration of the liver, which had not been possible with CT, sonography, or ERCP. To our knowledge, no comparable case has been reported. Received 15 September 1997; Revision received 5 January 1998; Accepted 4 February 1998     

Pearls and Potential Pitfalls for Correct Diagnosis of Ovarian Cystadenofibroma in MRI: A Pictorial Essay

Ovarian cystadenofibroma is a benign ovarian tumor that is characterized by a consistent percentage of masses, which remain indeterminate in ultrasonography and require magnetic resonance (MR) investigation; they may mimic borderline or malignant lesions. Three main morphologic patterns, resembling different ovarian neoplasms, can be identified in cystadenofibromas: multilocular solid lesions, unilocular cystic lesions with parietal thickening, and purely cystic masses. However, a cystoadenofibroma has typical features, such as T2-weighted hypointensity associated with no restrictions in diffusion-weighted imaging (the so-called “dark-dark appearance”) and progressive post-contrast enhancement (type I perfusion curve). The purpose of this study was to review the features of ovarian cystadenofibromas in MR imaging and to suggest pearls and pitfalls regarding their correct diagnosis.     

Ovarian clear cell carcinoma arising in a large endometrioma — A case report with pathological correlation and literature review

Endometriosis-associated ovarian cancer represents the most common form of malignancy associated with this benign disease. It has a better prognosis than most types of ovarian cancer, with endometrioid adenocarcinoma and clear cell carcinoma as the main histological types. Clinical presentation is usually nonspecific and tumor biomarkers can be misleading, since they can also be elevated in the presence of benign ovarian endometriosis. We report a case of a 52-year-old woman with known ovarian and deep pelvic endometriosis, who developed ovarian clear cell carcinoma within a large endometrioma. The imaging findings highlight the key role of magnetic resonance imaging in detecting suspicious features such as loss of the “T2 shading” sign, loss of high T1 signal of an endometrioma, or the presence of mural nodules. Early detection of these malignancies is fundamental for adequate surgical treatment and overall outcome.     

动态MRI对卵巢纤维瘤与浆膜下子宫肌瘤的鉴别诊断价值

目的　探讨MR早期动态增强对MR平扫表现为T2 WI等或低信号的卵巢纤维瘤与浆膜下子宫肌瘤鉴别诊断的价值。方法　分析经手术病理证实的 4 5例卵巢纤维瘤及浆膜下子宫肌瘤MR平扫及早期动态增强表现 ,其中卵巢纤维瘤 10例 ,浆膜下子宫肌瘤 35例。结果　卵巢纤维瘤2例T2 WI呈等信号 ,8例呈低信号 ,T1WI皆为低信号 ,增强早期多为弱强化 ,延迟期消退缓慢 ,早期强化率值 (SI10 0 )低 ,曲线达到高峰所需时间 (TTP2 0 0 )长 ;浆膜下子宫肌瘤 7例T2 WI呈等信号 ,2 8例呈低信号 ,T1WI皆为低信号 ,增强扫描早期多为中 高度强化 ,早期强化率值SI10 0 高 ,曲线达到高峰所需时间TTP2 0 0 短 ;两组强化曲线形态不同 ,差异有显著性意义 (P <0 0 0 1)。结论　MR平扫表现相似的卵巢纤维瘤和浆膜下子宫肌瘤 ,早期动态增强扫描强化曲线形态不同 ,有助于两者的鉴别。     

Meningeal leiomyoma in an adult with AIDS: CT and MRI with pathological correlation

We describe the imaging features of a meningeal leiomyoma with pathological correlation in an adult with AIDS. On CT the tumour showed a central low-attenuation area and an enhancing peripheral ring. It gave low signal on T1 weighting and on T2-weighted images a central high-signal area was surrounded by a markedly low-signal band, which showed contrast enhancement. As far as we know, this is the first report of this condition in the radiological literature. Received: 19 January 1998 Accepted: 24 December 1998     

肝脏原发性平滑肌瘤的影像表现

目的探讨肝脏原发性平滑肌瘤的影像特征。方法回顾性分析经病理证实的3例无免疫缺陷的肝脏原发性平滑肌瘤患者CT和MRI表现，及其与临床、病理间的联系。2例行CT检查，2例行MR检查。结果2例CT检查者病灶呈低密度，2例MRI检查者病灶呈长T1、长T2信号。1例密度和信号均匀，呈明显均匀强化；2例不均匀，1例增强后不均匀强化。3例均有假包膜征，无肝硬化和静脉瘤栓。病理示梭形肿瘤细胞增殖，毛细血管增生；1例伴中心玻璃样变，1例伴中心液化坏死。结论肝脏原发性平滑肌瘤是富血管性有假包膜的肿瘤，CT和MR检查对诊断有一定帮助。     

Bilateral renal cell carcinoma in a horseshoe kidney: preoperative assessment with MRI and digital subtraction angiography

Renal cell carcinoma in a horseshoe kidney is an unusual entity. To our knowledge, only 123 cases have been published to date. We report the first bilateral case of two clear-cell carcinomas in an asymmetrically fused kidney. Optimum preservation of renal function after radical tumor removal requires accurate preoperative imaging. Since the vascular supply in fusion anomalies is extremely variable, angiography is mandatory. Magnetic resonance imaging was most suitable to predict the tumor extent and localization, because it simultaneously gave the most comprehensive anatomical overview of the malformation. Received 8 January 1998; Revision received 16 February 1998; Accepted 17 February 1998     

Value of dynamic enhanced magnetic resonance imaging for distinguishing between ovarian fibroma and subserous uterine leiomyoma

PURPOSE: The purpose of this study was to assess the accuracy of magnetic resonance imaging (MRI), particularly, dynamic MRI, in distinguishing ovarian fibromas from subserous uterine leiomyomas. MATERIAL AND METHODS: Fifteen ovarian fibromas and 15 subserous uterine leiomyomas were retrospectively reviewed. All MR examinations included dynamic contrast-enhanced (DCE) sequences. Morphological criteria (size, T1 and T2 signals, ovarian tissue, associated uterine leiomyoma, and pelvic fluid), arterial vessels, time-intensity curves (maximal enhancement and signal intensity at 30, 60, and 90 seconds), and signal intensity on delayed T1-weighted images were compared between the 2 groups. RESULTS: No significant difference in morphological criteria was noted between the 2 types of masses. Visualization of arterial vessels was more frequent in uterine leiomyomas than in ovarian fibromas (P= 0.002). The DCE MR enhancement rate was higher for uterine leiomyomas than for ovarian fibromas in terms of both maximal enhancement (P < 0.001) and enhancement rate at 30 (P = 0.009), 60 (P = 0.007), and 90 seconds (P = 0.0009). On delayed T1 postcontrast sequence, no statistical difference exists between signal intensity of ovarian fibromas and uterine leiomyomas. CONCLUSION: Our findings suggest that DCE MRI can distinguish ovarian fibromas from uterine leiomyomas and should be used if sonography fails to show the origin of a pelvic mass.     

Endometrial stromal sarcoma located in the myometrium with a low‐intensity rim on T2‐weighted images: Report of three cases and literature review

Endometrial stromal sarcoma (ESS) most commonly grows from the uterine endometrium into the endometrial cavity; it is rarely located in the myometrium alone, where it may resemble degenerated leiomyoma on magnetic resonance imaging (MRI). We present three cases of intramyometrial ESS mimicking degenerated leiomyoma, all of which have a characteristic low‐intensity rim on T2‐weighted images. Histopathological examination revealed the rim to consist of fibrous tissue layers and/or a decrease in free water caused by distortion of myometrial tissue following tumor expansion. ESS should be included in the differential diagnosis of intramyometrial mass with low‐intensity rim on T2‐weighted image, especially if the mass shows degeneration with no or mild intratumoral hemorrhage. J. Magn. Reson. Imaging 2010;31:975–979. ©2010 Wiley‐Liss, Inc.     

Hemorrhagic necrosis due to peliosis hepatis: imaging findings and pathological correlation

Peliosis hepatis is an uncommon liver condition characterized by blood-filled cavities. We report the CT, angiographic and MR features of a case of peliosis hepatis with no obvious etiology and spontaneously regressing hemorrhagic necrosis. Helical CT showed multiple peripheral low-density regions with foci of spontaneous high density suggesting the presence of blood component. On MR imaging, the multiple peripheral lesions were hypointense on T1-weighted and hyperdense on T2-weighted images, with bright foci on all sequences suggesting subacute blood. Angiography showed no evidence of tumor or vascular malformation; multiple nodular vascular lesions filling in the parenchymal phase and persisting in the venous phase suggested blood-filled cavities. Pathological examination showed blood-filled spaces with no endothelial lining, characteristic of the parenchymal type of peliosis. Knowledge of the imaging features of hemorrhagic necrosis due to peliosis hepatis is important since it can be responsive to antibiotic therapy. Furthermore, differentiating hemorrhagic necrosis from hepatic abscess avoids dangerous and sometimes fatal percutaneous drainage. Received: 24 September 1997; Revision received: 20 February 1998; Accepted: 27 May 1998     

Value of magnetic resonance imaging for the diagnosis of ovarian tumors: a review

This article reviews the value of magnetic resonance imaging (MRI) for the diagnosis of ovarian tumors especially when ultrasonography is indeterminate. Although ultrasonography is the first imaging technique used to investigate suspected pelvic masses, it has a limited capacity for tissue characterization. In addition to morphological characteristics, many tissue parameters such as T1, T2, perfusion, and diffusion contribute to signal intensity, so MRI is able to identify various types of tissue contained in pelvic masses. Magnetic resonance imaging helps to locate large solid masses and to distinguish benign from malignant ovarian tumors, with an overall accuracy of 88% to 93% for the diagnosis of malignancy. The aims of this review are 3-fold. First, we review state-of-the-art and usual MRI techniques and published findings. Second, we recall the MR features most useful for assessing the main ovarian tumors. Finally, we discuss the relevance of various features for distinguishing between benign, borderline, and invasive ovarian tumors.     

Hypointensity on postcontrast MR imaging from compression of the sacral promontory in enlarged uterus with huge leiomyoma and adenomyosis.

PURPOSE: In patients with huge leiomyoma and with adenomyosis of the uterus, a peculiar area of hypointensity was occasionally observed on postcontrast magnetic resonance (MR) imaging in the dorsal portion of the enlarged uterus near the sacral promontory. We describe the imaging characteristics of these MR findings and correlate them with histopathological findings to examine whether the areas represent specific pathological changes. METHODS: Ten patients with huge leiomyomas and two with huge adenomyotic lesions whose imaging revealed the hypointensity were enrolled. All had enlarged uteri that extended beyond the sacral promontory. MR findings of the hypointense areas were evaluated and correlated with histopathological findings in 5 patients with leiomyoma and two with adenomyosis who had hysterectomy. RESULTS: The ten patients with leiomyoma showed flare-shaped hypointensity arising from the dorsal surface of the uterine body that extended deep into the tumor. The base of the hypointense areas was narrow in 5 patients with intramural leiomyoma and broad in five with subserosal leiomyoma. Two patients with adenomyosis showed nodular-shaped areas of hypointensity in front of the sacral promontory. Precontrast T(1)- and T(2)-weighted MR images showed no signal abnormalities in the portions corresponding to the hypointensity in any of the 12 patients. Pathological examinations showed no specific findings in the portions corresponding to the hypointensity in the 7 patients who had hysterectomy. CONCLUSION: The areas of hypointensity may represent functional changes, such as decreased localized blood flow caused by compression of the sacral promontory.     

阔韧带平滑肌瘤的影像诊断(附九例报告)

目的 研究阔韧带平没肌瘤的影像诊断。方法 回顾性总结９例经手术和病理证实为阔韧带平滑肌瘤的Ｂ超、ＣＴ及ＭＲＩ表现。结果 ９例Ｂ超检查表现为盆腔内、子宫外实性肿块,呈低回声灶,４例内有斑点状液性暗区或不均匀光点,５例显示包膜,７例边界清晰。８例ＣＴ检查７例表现为实性肿块,边界较清晰,平扫密度较均匀,与子宫肌密度相当或稍低;１例为混合密度灶,可见液化、坏死与囊变;８例增强扫描实性部分均见明显强化,４例     

Pseudolesions related to uterine contraction: characterization with multiphase-multisection T2-weighted MR imaging

PURPOSE: To evaluate whether multiphase-multisection T2-weighted magnetic resonance (MR) images help exclude pseudolesions mimicking leiomyoma and adenomyosis on static T2-weighted fast spin-echo (FSE) MR images and to characterize temporal changes in uterine signal intensity related to uterine contraction. MATERIALS AND METHODS: T2-weighted FSE and multiphase-multisection single-shot FSE (SSFSE) MR imaging were performed in 43 patients who underwent hysterectomy. Each imaging set was evaluated separately by two independent readers, and receiver operating characteristic analysis was performed. In the 43 patients and in 49 other patients suspected of having pelvic abnormality, a combination of signal intensity changes on FSE and SSFSE MR images was classified into five patterns, and temporal low-signal-intensity changes on SSFSE MR images were characterized. RESULTS: For detection of leiomyoma on FSE and SSFSE MR images, the respective values of the area under the receiver operating characteristic curve were 0.98 and 0.97 for reader 1 and 0.96 and 0.96 for reader 2; for detection of adenomyosis on FSE and SSFSE MR images, the respective values were 0.82 and 0.84 for reader 1 and 0.80 and 0.89 for reader 2 (P >.05). SSFSE MR images helped exclude pseudolesions in 1%-3% cases of leiomyoma and in 3%-4% cases of adenomyosis. Temporal signal intensity changes were observed in 53% of 368 segments. The most frequent shape of temporal low signal intensity was diffuse followed by ill-defined focal type. Characteristic shape of temporal low signal intensities was band- or sticklike, which was observed in as many as 19% of 368 segments. CONCLUSION: Multiphase-multisection T2-weighted SSFSE MR images do not improve accuracy in detection of leiomyoma and adenomyosis compared with FSE MR images; however, they helped characterize features of temporal low signal intensities in the uterus, which are related to uterine contractions.     

Methotrexate (MTX)-associated malignant lymphoma of the bilateral breast: imaging features in comparison to other nipple-areolar tumors

Tumors originating from the nipple-areolar complex of the breast are rare. We herein report the case of a patient with metachronous bilateral areolar methotrexate (MTX)-associated lymphoma. The patient was a 67-year-old woman who presented with a rapidly enlarging tumor in the areolar region of her left breast. She had a long history of rheumatoid arthritis and had taken MTX for many years. On ultrasonography, the tumor showed well-demarcated margins and hyper-vascularity. On magnetic resonance imaging, the tumor showed a homogeneous low-to-moderate signal intensity that was similar to that of the nipple on both T1- and T2-weighted imaging; the diffusion was significantly reduced on diffusion-weighted images. The tumor showed a medium-plateau pattern on dynamic contrast-enhanced imaging. No necrotic change was observed. Based on the imaging findings, we considered the tumor to have originated from the areola. According to the internal homogeneity, the rapid growth and hyper-cellularity, the potential diagnoses included a small round cell tumor (including malignant lymphoma) and a mesenchymal neoplasm (especially leiomyoma or leiomyosarcoma, which frequently originate from the areolar region).An excisional biopsy of the tumor was performed. The pathological diagnosis was diffuse large, non GC B-cell lymphoma that we suspected was associated with MTX. The tumor shrank rapidly after the withdrawal of MTX.After three months, we detected a B-cell lymphoma of the same type originating in the contralateral areola. We compared the characteristics of the imaging findings of the MTX-associated lymphoma with the nipple-areolar or periareolar tumors and primary breast lymphoma.