Multiparametric magnetic resonance imaging of endometrial polypoid lesions
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REVIEW
Multiparametric magnetic resonance imaging of endometrial polypoid lesions Youkyoung Lee1 · Kyeong Ah Kim1 · Mi Jin Song1 · Yang Shin Park1 · Jongmee Lee1 · Jae Woong Choi1 · Chang Hee Lee1
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Endometrial polypoid lesions encompass various conditions from physiologic changes to benign or malignant disease. Differentiating between the various causes of endometrial polypoid lesions remains difficult by transvaginal sonography. Magnetic resonance imaging (MRI) can provide valuable information regarding endometrial polypoid lesions in situations where it is difficult to obtain histologic samples. Multiparametric MRI including T2-weighted images, T1-weighted fat-saturation contrast-enhanced images, and diffusion-weighted images may be helpful for differentiating the various endometrial polypoid lesions and establishing specific diagnoses and appropriate treatment. Keywords Endometrium · Uterus · Uterus tumor · MRI · Diffusion
Introduction Endometrial polypoid lesions are tissue outgrowths of the endometrium that may be attached to the uterus by a pedicle. They encompass various conditions from physiologic changes to benign or malignant disease. In a pathologic report, most (84%) lesions were benign polyps [1]. The most frequent clinical presentation is vaginal bleeding. Clinically, it is difficult to differentiate between benign and malignant lesions, and imaging studies are frequently indicated [2]. The primary modality for endometrial evaluation is transvaginal ultrasonography (US), which is noninvasive and easily accessible. However, US findings are often nonspecific, and it is difficult to differentiate various polypoid lesions [2]. Sonohysterography may be useful in further evaluation of a suspected endometrial lesion in transvaginal US; however, it is an invasive method [3]. The office-based endometrial biopsy plays an important role in the diagnosis of these lesions but has limitations such as nondiagnostic results and sampling errors leading to a false diagnosis [4]. Computed tomography (CT) has a limited role since it cannot * Kyeong Ah Kim [email protected] 1
Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong‑ro, Guro‑gu, Seoul 08308, South Korea
clearly demonstrate the characteristics of different soft-tissue lesions. In addition, CT has the critical disadvantage of radiation exposure. Magnetic resonance imaging (MRI) can provide valuable information regarding endometrial polypoid lesions in situations where it is difficult to obtain histologic samples, thereby allowing differentiation of various diseases and establishment of specific diagnoses for many diseases [2, 5]. MRI has excellent soft-tissue contrast resolution with multiplanar capability, which makes it useful in demonstrating the extent and morphologic features of the lesion [5]. Recently, there are several reports regarding MRI findings of endometrial lesions including diffusion-weighted imaging (DWI
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