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Pseudolesions Related to Uterine Contraction: Characterization with Multiphase-Multisection T2-weighted MR Imaging¹

¹ From the Departments of Radiology (T.M., M.K., S.K.) and Pathology (S.S.), Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu, Shizuoka 430-8558, Japan; Application Research Group, GE Yokogawa Medical Systems, Hino, Japan (A.N.); and Department of Radiology, Hamamatsu University School of Medicine, Japan (H.S.). Received September 24, 2001; revision requested December 10; final revision received September 9, 2002; accepted October 14. Supported in part by a grant from the Japanese Society for Magnetic Resonance in Medicine. Address correspondence to T.M. (e-mail: masui@sis.seirei.or.jp).

View larger version (32K): [in a new window]   Figure 1. Diagram of the uterus in the sagittal plane for the evaluation of the myometrium and junctional zone at four locations. A line was drawn between two points, the center of the internal cervical os (A) and the fundal portion of the uterine cavity (B). Then, a line (A-B) was drawn perpendicular to the initial line, bisecting it. Four segments were defined: upper anterior (UA), upper posterior (UP), lower anterior (LA), and lower posterior (LP).

View larger version (187K): [in a new window]   Figure 2a. Sagittal MR images in a 41-year-old woman with large intramural leiomyoma. (a) T2-weighted FSE MR image (4,000/85) demonstrates a large low-signal-intensity mass (black arrow) with high intensity foci in the anterior wall. Diffuse low-signal-intensity areas (curved arrow) are identified in the posterior segments compressed by the lower lumbar spine and sacrum. A signal void (straight white arrow) posterior to the upper uterus indicates the left common iliac artery. (b, c) T2-weighted SSFSE MR images (20,000/94, echo train length of 85) in different phases of imaging demonstrate a large uterine mass (black arrow), diffuse low-signal-intensity areas (solid curved arrow) in the posterior segments, and signal void indicating the artery (straight white arrow), which are identical to those in a. An ill-defined focal low-signal-intensity area (open curved arrow in c) is indicated in the upper anterior segment near the fundus, which is not observed in b.

View larger version (183K): [in a new window]   Figure 2b. Sagittal MR images in a 41-year-old woman with large intramural leiomyoma. (a) T2-weighted FSE MR image (4,000/85) demonstrates a large low-signal-intensity mass (black arrow) with high intensity foci in the anterior wall. Diffuse low-signal-intensity areas (curved arrow) are identified in the posterior segments compressed by the lower lumbar spine and sacrum. A signal void (straight white arrow) posterior to the upper uterus indicates the left common iliac artery. (b, c) T2-weighted SSFSE MR images (20,000/94, echo train length of 85) in different phases of imaging demonstrate a large uterine mass (black arrow), diffuse low-signal-intensity areas (solid curved arrow) in the posterior segments, and signal void indicating the artery (straight white arrow), which are identical to those in a. An ill-defined focal low-signal-intensity area (open curved arrow in c) is indicated in the upper anterior segment near the fundus, which is not observed in b.

View larger version (182K): [in a new window]   Figure 2c. Sagittal MR images in a 41-year-old woman with large intramural leiomyoma. (a) T2-weighted FSE MR image (4,000/85) demonstrates a large low-signal-intensity mass (black arrow) with high intensity foci in the anterior wall. Diffuse low-signal-intensity areas (curved arrow) are identified in the posterior segments compressed by the lower lumbar spine and sacrum. A signal void (straight white arrow) posterior to the upper uterus indicates the left common iliac artery. (b, c) T2-weighted SSFSE MR images (20,000/94, echo train length of 85) in different phases of imaging demonstrate a large uterine mass (black arrow), diffuse low-signal-intensity areas (solid curved arrow) in the posterior segments, and signal void indicating the artery (straight white arrow), which are identical to those in a. An ill-defined focal low-signal-intensity area (open curved arrow in c) is indicated in the upper anterior segment near the fundus, which is not observed in b.

View larger version (177K): [in a new window]   Figure 3a. Sagittal MR images in a 36-year-old woman with endometriosis. (a) T2-weighted FSE MR image (4,000/85) demonstrates well-defined focal low-signal-intensity area (straight arrow) in the anterior lower segment and irregular low-signal-intensity areas (solid curved arrow), which are continuous to the junctional zone. In the posterior segment, thick bandlike low-signal-intensity areas (open curved arrow) are noted. Fluid in the cul-de-sac is demonstrated. (b, c) T2-weighted SSFSE MR images (20,000/94, echo train length of 85) in different phases of imaging demonstrate effects of uterine contraction. (b) In the anterior segments, ill-defined low-signal-intensity areas (solid curved arrow) are noted in the myometrium. A low-signal-intensity area (open curved arrow) in the posterior segment, which has a different shape from that in a, is noted. An ill-defined focal low-signal-intensity area (straight arrow) appears in the posterior segment. Fluid in the cul-de-sac is also noted. (c) With uterine contraction, a slightly different shape of the uterus is noted compared with that in a and b. Low-signal-intensity areas (solid curved arrow) in the anterior segment have disappeared, indicating contraction-induced low signal intensity. In the upper posterior segment, low-signal-intensity areas (open curved arrow), which have slightly different orientation from that in a, are demonstrated. The ill-defined lower signal intensity (straight arrow) in the posterior segment is recognized as in b.

View larger version (178K): [in a new window]   Figure 3b. Sagittal MR images in a 36-year-old woman with endometriosis. (a) T2-weighted FSE MR image (4,000/85) demonstrates well-defined focal low-signal-intensity area (straight arrow) in the anterior lower segment and irregular low-signal-intensity areas (solid curved arrow), which are continuous to the junctional zone. In the posterior segment, thick bandlike low-signal-intensity areas (open curved arrow) are noted. Fluid in the cul-de-sac is demonstrated. (b, c) T2-weighted SSFSE MR images (20,000/94, echo train length of 85) in different phases of imaging demonstrate effects of uterine contraction. (b) In the anterior segments, ill-defined low-signal-intensity areas (solid curved arrow) are noted in the myometrium. A low-signal-intensity area (open curved arrow) in the posterior segment, which has a different shape from that in a, is noted. An ill-defined focal low-signal-intensity area (straight arrow) appears in the posterior segment. Fluid in the cul-de-sac is also noted. (c) With uterine contraction, a slightly different shape of the uterus is noted compared with that in a and b. Low-signal-intensity areas (solid curved arrow) in the anterior segment have disappeared, indicating contraction-induced low signal intensity. In the upper posterior segment, low-signal-intensity areas (open curved arrow), which have slightly different orientation from that in a, are demonstrated. The ill-defined lower signal intensity (straight arrow) in the posterior segment is recognized as in b.

View larger version (182K): [in a new window]   Figure 3c. Sagittal MR images in a 36-year-old woman with endometriosis. (a) T2-weighted FSE MR image (4,000/85) demonstrates well-defined focal low-signal-intensity area (straight arrow) in the anterior lower segment and irregular low-signal-intensity areas (solid curved arrow), which are continuous to the junctional zone. In the posterior segment, thick bandlike low-signal-intensity areas (open curved arrow) are noted. Fluid in the cul-de-sac is demonstrated. (b, c) T2-weighted SSFSE MR images (20,000/94, echo train length of 85) in different phases of imaging demonstrate effects of uterine contraction. (b) In the anterior segments, ill-defined low-signal-intensity areas (solid curved arrow) are noted in the myometrium. A low-signal-intensity area (open curved arrow) in the posterior segment, which has a different shape from that in a, is noted. An ill-defined focal low-signal-intensity area (straight arrow) appears in the posterior segment. Fluid in the cul-de-sac is also noted. (c) With uterine contraction, a slightly different shape of the uterus is noted compared with that in a and b. Low-signal-intensity areas (solid curved arrow) in the anterior segment have disappeared, indicating contraction-induced low signal intensity. In the upper posterior segment, low-signal-intensity areas (open curved arrow), which have slightly different orientation from that in a, are demonstrated. The ill-defined lower signal intensity (straight arrow) in the posterior segment is recognized as in b.

View larger version (182K): [in a new window]   Figure 4a. Sagittal MR images in a 51-year-old woman with multiple leiomyoma and endometrial carcinoma. (a) T2-weighted FSE MR image (4,000/85) shows leiomyoma in the myometrium as low signal intensity (large straight arrows). Diffuse thickening of the endometrium (small arrow) indicates endometrial carcinoma. Fluid was identified in the cul-de-sac (curved arrow). (b, c) T2-weighted SSFSE MR images (22,000/95, echo train length of 85) in different phases of imaging demonstrate the effect of uterine contraction. The shape and signal intensity of the uterus are almost identical to those in a. Leiomyoma (large white arrows), endometrial carcinoma (small arrow), and fluid (black arrow) in the cul-de-sac are also seen. With uterine contraction, a well-defined focal low-signal-intensity area (open curved arrow in c) at the junctional zone of the anterior wall is noted, mimicking leiomyoma.

View larger version (176K): [in a new window]   Figure 4b. Sagittal MR images in a 51-year-old woman with multiple leiomyoma and endometrial carcinoma. (a) T2-weighted FSE MR image (4,000/85) shows leiomyoma in the myometrium as low signal intensity (large straight arrows). Diffuse thickening of the endometrium (small arrow) indicates endometrial carcinoma. Fluid was identified in the cul-de-sac (curved arrow). (b, c) T2-weighted SSFSE MR images (22,000/95, echo train length of 85) in different phases of imaging demonstrate the effect of uterine contraction. The shape and signal intensity of the uterus are almost identical to those in a. Leiomyoma (large white arrows), endometrial carcinoma (small arrow), and fluid (black arrow) in the cul-de-sac are also seen. With uterine contraction, a well-defined focal low-signal-intensity area (open curved arrow in c) at the junctional zone of the anterior wall is noted, mimicking leiomyoma.

View larger version (179K): [in a new window]   Figure 4c. Sagittal MR images in a 51-year-old woman with multiple leiomyoma and endometrial carcinoma. (a) T2-weighted FSE MR image (4,000/85) shows leiomyoma in the myometrium as low signal intensity (large straight arrows). Diffuse thickening of the endometrium (small arrow) indicates endometrial carcinoma. Fluid was identified in the cul-de-sac (curved arrow). (b, c) T2-weighted SSFSE MR images (22,000/95, echo train length of 85) in different phases of imaging demonstrate the effect of uterine contraction. The shape and signal intensity of the uterus are almost identical to those in a. Leiomyoma (large white arrows), endometrial carcinoma (small arrow), and fluid (black arrow) in the cul-de-sac are also seen. With uterine contraction, a well-defined focal low-signal-intensity area (open curved arrow in c) at the junctional zone of the anterior wall is noted, mimicking leiomyoma.

View larger version (173K): [in a new window]   Figure 5a. Sagittal MR images in a 37-year-old woman with leiomyoma and uterine septum. (a) T2-weighted FSE MR image (4,000/85) demonstrates two discrete bandlike low-signal-intensity areas (arrows) in the junctional zone in the anterior wall. Fluid is noted in the cul-de-sac. (b, c) T2-weighted SSFSE MR images (20,000/94, echo train length of 85) in different phases of imaging demonstrate a different number and shape of bandlike low signal intensities (arrows).

View larger version (165K): [in a new window]   Figure 5b. Sagittal MR images in a 37-year-old woman with leiomyoma and uterine septum. (a) T2-weighted FSE MR image (4,000/85) demonstrates two discrete bandlike low-signal-intensity areas (arrows) in the junctional zone in the anterior wall. Fluid is noted in the cul-de-sac. (b, c) T2-weighted SSFSE MR images (20,000/94, echo train length of 85) in different phases of imaging demonstrate a different number and shape of bandlike low signal intensities (arrows).

View larger version (170K): [in a new window]   Figure 5c. Sagittal MR images in a 37-year-old woman with leiomyoma and uterine septum. (a) T2-weighted FSE MR image (4,000/85) demonstrates two discrete bandlike low-signal-intensity areas (arrows) in the junctional zone in the anterior wall. Fluid is noted in the cul-de-sac. (b, c) T2-weighted SSFSE MR images (20,000/94, echo train length of 85) in different phases of imaging demonstrate a different number and shape of bandlike low signal intensities (arrows).