Polycystic ovary syndrome: dynamic contrast-enhanced ovary MR imaging

Carcinosarcoma of the ovary: MR and clinical findings compared with high-grade serous carcinoma

PURPOSE

To clarify imaging and clinical characteristics of ovarian carcinosarcoma (CS) compared with high-grade serous carcinoma (HGSC).

METHODS

We retrospectively reviewed MR imagings of 12 patients with CS and 30 patients with HGSC and evaluated tumor size, shape, appearance, nature of cystic and solid components, hemorrhage, and necrosis. Age, premenopausal or postmenopausal, histologic subtype, presence of endometriosis, tumor markers, and stage were also evaluated. These parameters were compared using the Mann-Whitney U test and the chi-square test/Fisher's exact test.

RESULTS

The mean size of CSs was 13.6 cm, and significantly larger than that of HGSCs (mean 9.0 cm, p = 0.022). The stained-glass appearance (67% vs. 23%, p = 0.013), hemorrhage (100% vs. 50%, p = 0.003), necrosis (75.0% vs. 13%, p = 0.000), and endometriosis (33% vs. 7%, p = 0.012) were significantly more common in CSs. The postmenopausal ratio of CSs was 100% and significantly higher than that of HGSCs (70.0%, p = 0.041). Among the tumor makers, only CA-125 was significantly lower in CSs than in HGSCs (mean 715.1 U/ml vs. 1677.1 U/ml, p = 0.009). The stage distribution was similar and was not significantly different.

CONCLUSION

CSs formed larger masses, and the stained-glass appearance, hemorrhage, and necrosis were more frequently observed in CSs.

Ovarian morphology assessed by magnetic resonance imaging in women with and without polycystic ovary syndrome and associations with antimüllerian hormone, free testosterone, and glucose disposal rate

OBJECTIVE

To characterize ovarian morphology and perfusion by magnetic resonance imaging (MRI) in women with and without polycystic ovary syndrome (PCOS) and to investigate associations with antimüllerian hormone (AMH), free T, and glucose disposal rate (GDR).

DESIGN

Explorative cross-sectional study.

SETTING

University hospital.

PATIENT(S)

Fifty-eight women with PCOS and 31 controls from the general population.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Antral follicle count (AFC), ovarian/stromal volume, perfusion, AMH, free T, and GDR.

RESULT(S)

Antral follicles of 1-3 and 4-6 mm, but not 7-9 mm, were more numerous, and total AFC (1-9 mm) was higher in women with PCOS. Ovarian volume was larger in women with PCOS. AMH and free T were higher and GDR was lower in women with PCOS. All values were more deranged in classic compared with nonclassic PCOS. There was a positive correlation between AMH and AFC, 1-3 mm (r = 0.81), and between AMH and total AFC (r = 0.87). In receiver operating characteristic analyses, the area under the curve was 0.89 for total AFC, 0.86 for AMH, and 0.90 for free T. PCOS was independently associated with AFC and free T but not with AMH or GDR when adjusted for age and body mass index.

CONCLUSION(S)

Counting antral follicles down to 1 mm in size by MRI yielded higher AFCs than previously reported. AFC, AMH, and free T discriminated with high accuracy between women with PCOS and controls, but AMH was not independently associated with PCOS.

CLINICAL TRIAL REGISTRATION NUMBER

NCT00484705.

Polycystic ovary syndrome: clinical and imaging features

Polycystic ovary syndrome is the most common endocrine disorder occurring in reproductive-age women. The syndrome is complex, multifactorial, and not always easily defined. Diagnosis is based upon a combination of clinical and biochemical criteria and ovarian morphology. The following review describes the clinical features, pathophysiology, diagnosis, and the role of imaging. Diagnostic imaging techniques are discussed, with emphasis on ultrasound as the main modality used worldwide. Contributions of 3-dimensional and Doppler ultrasound are addressed in addition to potential indications for magnetic resonance imaging in the evaluation of patients with suspected polycystic ovary syndrome.

MR Imaging of Gynecologic Diseases at 3T

MR imaging using anatomic, chemical, and functional information offers huge potential for the management of the gynecologic patient. By differentiating benign from malignant disease with very high specificity, it can aid the selection of patients requiring further treatment and determine the level of urgency. Staging accuracy, which equals that obtained at laparotomy, allows appropriate clinical expertise to be organized before surgery or the deferment of surgery until later in the treatment pathway and is a cost-effective use of resources. This article compares and contrasts MR imaging of gynecologic conditions at 1.5 and 3T and defines a role for high field imaging for these clinical conditions.

Nodular endometriosis: dynamic MR imaging

PURPOSE

In this study we aimed to investigate the value of contrast enhanced dynamic MR imaging (DMI) in the diagnosis of nodular abdominal endometriosis.

SUBJECTS AND METHODS

Fourteen patients with surgically and pathologically proven endometriosis were examined with DMI. The patients were 22-54 years old (mean age 30.8 years). The dynamic MR studies of these patients were retrospectively reviewed by two radiologists who were aware of the clinical data. Nodular masses showing enhancement were evaluated for size, margins, and signal intensity on T1- and T2-weighted MR sequences. The protocol was tailored to selectively determine the diagnostic utility of signal intensity time course analysis for the behavior of nodular endometriosis and endometrial tissue, in DMI. Contrast-enhanced DMI was performed and the time-intensity curves of the lesions and the uterine endometrial tissue of each patient were compared. Mean enhancement values were calculated. Each DMI was evaluated for signal intensity value.

RESULTS

In 8 (57%) of 14 patients, we found endometriosis in the abdominal wall. All patients with abdominal wall endometriosis had pelvic surgical operation history. Diameter of nodular endometriosis determined in the abdominus muscle ranged between 3 and 40 mm. Of eight cases, five had only one lesion and three had multiple lesions. Remaining 6 (43%) cases had deep pelvic endometriosis located in the uterosacral ligaments (n = 3), rectosigmoid (n = 2), and rectovaginal septum (n = 1). Diameter of pelvic endometriosis ranged between 9 and 53 mm. Noncontrast mean signal intensity of endometriosis and endometrial tissue were 280 +/- 73 and 216 +/- 20, respectively. The mean values of both endometriosis and normal endometrial tissue were calculated for each patient examined with five-slice DMI. All of the curves showed significant correlation. The lesion showed significant enhancement in the course of time similar to the endometrial tissue in all patients.

CONCLUSION

Our study was inspired from the fact that endometriosis is the ectopic endometrial tissue and we thought that endometrial tissue and endometriomas should have similar vascularity. In this way imaging with MR, getting the time-intensity curves and experiencing the correlation between the endometriosis and endometrial tissue may support the diagnosis in the cases with suspected endometriosis. This first study shows that the ectopic nodular endometriosis can easily be identified with dynamic MRI. It may be used to differentiate nodular endometriosis from the other pathologic conditions of abdominal wall and pelvis.

Complicated giant polycystic ovary mimicking tumor: MR imaging findings

A previously healthy 14-year-old girl presented with a 1-year history of abdominal pain that had worsened during the past 4 days. She had a right lower abdominal mass that was initially diagnosed as an ovarian tumor. MR imaging revealed a unilaterally enlarged and partially torted left polycystic ovary. Polycystic ovary is a common cause of increased ovarian volume in women of reproductive age. It is characterized by numerous small peripherally located follicles and increased stroma. It may mimic a neoplasm and lead to difficulties in diagnosis. In this case report, we discuss the unusual MR imaging findings and the pitfalls in diagnosis.

Enhancement kinetics of normal ovaries on dynamic contrast-enhanced MR imaging

OBJECTIVE

The objective was to determine the enhancement kinetics of the normal ovaries in healthy women on dynamic contrast-enhanced magnetic resonance (DCE-MR) imaging.

METHOD

Twenty-one women who had normal ovulatory cycles (volunteers; mean age=26.3 years, range=20-35), normal hormone profile, and apparently normal ovaries on ultrasonographic scan underwent DCE-MR imaging on a 1.5-T system (Philips Medical Systems, Gyroscan Intera, Best, The Netherlands) using a phased array pelvic coil. Sequential images with an imaging time of 14.4s per dynamic image were acquired before and after injection of a contrast bolus at 30s and at 1, 2, 3, 4, and 5 min. On postprocessing examination the following measurements were obtained for ovarian and muscle tissue: the signal intensity value per dynamic study, early phase enhancement rate, time to peak enhancement (Tp), and percentage of wash-out at the fifth minute were determined. Data of the ovaries and skeletal muscle were compared using Wilcoxon's rank sum test.

RESULTS

Most of the mean values of the postcontrast signal intensity measurements, the mean values of the early phase enhancement rate, and the percentage of wash-out at the fifth minute were found to be significantly higher in ovary than in muscle (p<0.05). The mean values of Tp, on the other hand, were nonsignificantly lower in ovary than in muscle (p>0.05). On the examination of the mean signal intensity-time data graphics the ovary showed a tendency toward greater and quicker enhancement and wash-out.

CONCLUSION

In our opinion, DCE-MR imaging, which determines contrast enhancement such as wash-in and wash-out kinetics, can provide knowledge of ovarian vascularization. Thus, by using DCE-MR imaging, determination of these vascularization changes in various ovarian diseases may provide us with additional parameters in the diagnosis of and treatment strategies for ovarian diseases.