Diffusion-weighted MR Imaging of Female Pelvic Tumors: A Pictorial Review

Published Online:https://doi.org/10.1148/rg.293085130

Functional imaging is becoming increasingly important in the evaluation of cancer patients because of the limitations of morphologic imaging, particularly in the assessment of response to therapy. Diffusion-weighted magnetic resonance (MR) imaging has been established as a useful functional imaging tool in neurologic applications for a number of years, but recent technical advances now allow its use in abdominal and pelvic applications. Diffusion-weighted MR imaging studies of female pelvic tumors have shown reduced apparent diffusion coefficient (ADC) values within cervical and endometrial tumors. In addition, this unique noninvasive modality has demonstrated the capacity to help discriminate between benign and malignant uterine lesions and to help assess the extent of peritoneal spread from gynecologic malignancies. Potential pitfalls can be avoided by reviewing diffusion-weighted MR imaging findings in conjunction with anatomic imaging findings. Increasing familiarity with ADC calculation and manipulation software will allow radiologists to provide new information for the care of patients with known or suspected gynecologic malignancies.

© RSNA, 2009


  • 1 KohDM, Collins DJ. Diffusion-weighted MRI in the body: applications and challenges in oncology. AJR Am J Roentgenol2007; 188: 1622–1635. Crossref, MedlineGoogle Scholar
  • 2 NaganawaS, Sato C, Kumada H, Ishigaki T, Miura S, Takizawa O. Apparent diffusion coefficient in cervical cancer of the uterus: comparison with the normal uterine cervix. Eur Radiol2005; 15: 71–78. Crossref, MedlineGoogle Scholar
  • 3 McVeighPZ, Syed AM, Milosevic M, Fyles A, Haider MA. Diffusion-weighted MRI in cervical cancer. Eur Radiol2008; 18: 1058–1064. Crossref, MedlineGoogle Scholar
  • 4 TamaiK, Koyama T, Saga T, et al. Diffusion-weighted MR imaging of uterine endometrial cancer. J Magn Reson Imaging2007; 26: 682–687. Crossref, MedlineGoogle Scholar
  • 5 InadaY, Matsuki M, Nakai G, et al. Body diffusion-weighted MR imaging of uterine endometrial cancer: is it helpful in the detection of cancer in nonenhanced MR imaging? Eur J Radiol2008 Jan 5 [Epub ahead of print]. Google Scholar
  • 6 TamaiK, Koyama T, Saga T, et al. The utility of diffusion-weighted MR imaging for differentiating uterine sarcomas from benign leiomyomas. Eur Radiol2008; 18: 723–730. Crossref, MedlineGoogle Scholar
  • 7 FujiiS, Matsusue E, Kigawa J, et al. Diagnostic accuracy of the apparent diffusion coefficient in differentiating benign from malignant uterine endometrial cavity lesions: initial results. Eur Radiol2008; 18: 384–389. Crossref, MedlineGoogle Scholar
  • 8 FujiiS, Matsuse E, Kanasaki Y, et al. Detection of peritoneal dissemination in gynaecological malignancy: evaluation by diffusion-weighted MR imaging. Eur Radiol2008; 18: 18–23. Crossref, MedlineGoogle Scholar
  • 9 StejskalEO, Tanner JE. Spin diffusion measurements: spin-echo in the presence of a time dependent field gradient. J Chem Phys1965; 42: 288–292. CrossrefGoogle Scholar
  • 10 PattersonDM, Padhani AR, Collins DJ. Technology insight: water diffusion MRI—a potential new biomarker of response to cancer therapy. Nat Clin Pract Oncol2008; 5: 220–233. Crossref, MedlineGoogle Scholar
  • 11 KohDM, Takahara T, Imai Y, Collins DJ. Practical aspects of assessing tumors using clinical diffusion-weighted imaging in the body. Magn Reson Med Sci2007; 6: 211–224. Crossref, MedlineGoogle Scholar
  • 12 ShenSH, Chiou YY, Wang JH, et al. Diffusion-weighted single-shot echo-planar imaging with parallel technique in assessment of endometrial cancer. AJR Am J Roentgenol2008; 190: 481–488. Crossref, MedlineGoogle Scholar
  • 13 TangjitgamolS, Manusirivithaya S, Jesadapatarakul S, Leelahakorn S, Thawaramara T. Lymph node size in uterine cancer: a revisit. Int J Gynecol Cancer2006; 16: 1880–1884. Crossref, MedlineGoogle Scholar
  • 14 SumiM, Ichikawa Y, Nakamura T. Diagnostic ability of apparent diffusion coefficients for lymphomas and carcinomas in the pharynx. Eur Radiol2007; 17: 2631–2637. Crossref, MedlineGoogle Scholar
  • 15 SumiM, Van Cauteren M, Nakamura T. MR micro-imaging of benign and malignant nodes in the neck. AJR Am J Roentgenol2006; 186: 749–757. Crossref, MedlineGoogle Scholar
  • 16 HamstraDA, Rehemtulla A, Ross BD. Diffusion magnetic resonance imaging: a biomarker for treatment response in oncology. J Clin Oncol2007; 25: 4104–4109. Crossref, MedlineGoogle Scholar
  • 17 SchepkinVD, Chenevert TL, Kuszpit K, et al. Sodium and proton diffusion MRI as biomarkers for early therapeutic response in subcutaneous tumors. Magn Reson Imaging2006; 24: 273–278. Crossref, MedlineGoogle Scholar
  • 18 ChenevertTL, McKeever PE, Ross BD. Monitoring early response of experimental brain tumors to therapy using diffusion magnetic resonance imaging. Clin Cancer Res1997; 3: 1457–1466. MedlineGoogle Scholar
  • 19 EinarsdottirH, Karlsson M, Wejde J, Bauer HC. Diffusion-weighted MRI of soft tissue tumours. Eur Radiol2004; 14: 959–963. Crossref, MedlineGoogle Scholar
  • 20 NoguchiK, Watanabe N, Nagayoshi T, et al. Role of diffusion-weighted echo-planar MRI in distinguishing between brain abscess and tumour: a preliminary report. Neuroradiology1999; 41: 171–174. Crossref, MedlineGoogle Scholar
  • 21 ChangSC, Lai PH, Chen WL, et al. Diffusion-weighted MRI features of brain abscess and cystic or necrotic brain tumours: comparison with conventional MRI. Clin Imaging2002; 26: 227–236. Crossref, MedlineGoogle Scholar
  • 22 ParkSH, Chang KH, Song IC, Kim YJ, Kim SH, Han MH. Diffusion-weighted MRI in cystic or necrotic intracranial lesions. Neuroradiology2000; 42: 716–721. Crossref, MedlineGoogle Scholar

Article History

Published in print: May 2009