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. 2021 Apr-Jun;12(2):168-175.
doi: 10.4103/jmh.jmh_94_21. Epub 2021 Jul 27.

Understanding the Endometrium at Menopause: Magnetic Resonance Imaging: A Radiologist's View

Madhavi Nori  1   2
Affiliations

Understanding the Endometrium at Menopause: Magnetic Resonance Imaging: A Radiologist's View

Madhavi Nori. J Midlife Health. 2021 Apr-Jun.
No abstract available

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Normal postmenopausal endometrium: Sagittal T2-weighted magnetic resonance image obtained in a 60-year-old female 3 years after menopause reveals a small uterus with a normal, thin (<4-mm), hyperintense endometrium (solid arrows) and barely perceptible hypointense junction zone (yellow arrow). The zonal anatomy is best visualized during the reproductive years and may be poorly depicted or absent in prepubertal and postmenopausal women.[5] Note that the uterine corpus has undergone some atrophy and is only slightly bulkier than the cervix. In late menopause, the uterine corpus is smaller than the cervix, and the uterine zonal anatomy may be difficult to appreciate. B = Bladder
Figure 2
Figure 2
Endometrial hyperplasia in a 45-year-old female with: (a) Axial T2-weighted image demonstrating markedly distended endometrial cavity with smooth compressed junctional zone all around, internal morphology is smooth marginated Sol with multiple cysts of varying sizes showing predominant high T2 signal. (b) High b-value (b = 800) diffusion-weighted image shows high SI and (c) apparent diffusion coefficient map shows high SI (arrow) with values 1.7–2.1, which indicates no diffusion restriction
Figure 3
Figure 3
Endometrial polyp in a 50-year-old perimenopausal woman shows representative magnetic resonance imaging findings in a majority of our cases. (a) T2-weighted image in sagittal plane shows a polyp with slightly low signal intensity compared with normal endometrium. There is low signal intensity central fibrous cores (yellow arrow) and small high signal intensity intratumoral cyst (blue arrow). (b) diffusion-weighted image with b value of 1000s/mm2 in the sagittal plane at the same level as in A shows a polyp with low signal intensity compared with endometrium. (c) Apparent diffusion coefficient reveals a value of 1.4 in the fibrous core and 1.6–2.0 in the polyp and intratumoral cystc
Figure 4
Figure 4
Giant endometrial Polyp: Multiplanar T2-weighted image. (a) Sagittal images delineated markedly distended endometrial cavity with smooth compressed uterine myometrium all around and normal cervical canal confirming that it developed within the uterine cavity positioned centrally, signal predominantly showing T2 shine through on diffusion-weighted image. (b) Apparent diffusion coefficient value within the high signal diffusion-weighted image mass was 1.3–1.4 and within the cyst was 2.1–2.3. On plain TI-weighted images (c) reveal the mass mainly isointense on plain T1 images with intratumoral cysts along the periphery and central hemorrhagic areas (hyperintense on T1W, hypointense on T2-weighted, Blue arrows). Ultrasound examination (not shown) revealed a 86 mm mass within the uterus with some central vessels at Doppler examinationb
Figure 5
Figure 5
A 49-year-old female presenting with pain and PV bleeding with endometrial polypoidal SOL: Sagittal (a and b) and Coronal T2-weighted images (c) through uterine axis reveal a long narrow pedicle from the fundus, leading to 3.8-cm sized polypoid lesion (yellow arrow) coursing through the endometrial cavity and distending cervical canal, with low signal intensity (SI) on T2, diffusion-weighted image low signal with low apparent diffusion coefficient values (T2 Dark Phenomena)
Figure 6
Figure 6
Degenerated leiomyoma prolapsing into the endometrial cavity: Ultrasound is commonly the first examination to be performed, but it has limitations in the characterization of masses. This is why magnetic resonance imaging is helpful in such cases. (a and b) TVS and color Doppler images reveal thick endometrium with Swiss cheese appearance with vascularity not typical pedicle pattern of endometrial polyp and the margins of endometrial cavity are ill defined anteriorly (yellow circle).(c and d) Sagittal and oblique axial T2-weighted images reveal submucosal anterior wall leiomyoma with degeneration prolapsing into the endometrial cavity (orange dashed line) occupying the fundus and body with defect in the continuity of the junctional zone anteriourly (Blue arrow). Seedling intramural anterior wall myoma present in upper body (Red arrow). diffusion-weighted image showed low signal on high B value with apparent diffusion coefficient values 1.6–1.7, suggesting no restricted diffusion-weighted image (T2 SHINE THROUGH): HPE: Degenerated leiomyoma prolapsing into endometrial cavity
Figure 7
Figure 7
(a) Sagittal T2- and (b) axial T2-weighted images show submucosal mass projecting into the cavity with hyperintense small cystic components (yellow arrows). (c) diffusion-weighted image and (d) apparent diffusion coefficient show T2 dark phenomenon with projection of junctional zone into the endometrial cavity with nodular morphology and ill-defined borders (white arrows): polypoid adenomyoma
Figure 8
Figure 8
Stage 1A endometrial cancer in a 52-year-old female. (a) Sagittal T2-weighted magnetic resonance image shows distension of the endometrial cavity by an intermediate-signal-intensity tumor (*). (b) Axial oblique T2-weighted magnetic resonance image shows the intermediate signal intensity tumor (yellow arrow) within the hyperintense endometrial cavity along left lateral aspect. The junctional zone is well delineated, with no evidence of invasion. (c) diffusion-weighted image shows restricted diffusion-weighted image and with focal decreased apparent diffusion coefficient (d and e) within this area (0.8–0.9, white arrow) suggesting area of neoplastic changes. ACD within rest of the endometrial cavity is (1.3-1.4 arrow head)
Figure 9
Figure 9
Stage 1B endometrial cancer in a 53-year-old female. (a and b) Coronal oblique T2-weighted magnetic resonance images demonstrates a tumor (*) with invasion of the myometrium and poor tumor-to-myometrium contrast (arrow). (c and d) Axial T2-weighted magnetic resonance image shows a large iso- to hypointense endometrial tumor (*) with poor tumor-to-myometrium contrast (arrow) and invasion of the outer half of the myometrium (short arrow)
Figure 10
Figure 10
Postmenopausal bleeding in an 85-year old women with poor/limited characterization on USG owing to large posterior wall myoma obscuring the endometrial cavity. (a and b) Sagittal, axial T2-weighted magnetic resonance image shows a large posterior wall intramural myoma showing variable predominantly low T2-weighted signal indenting along left posterior wall distorting the uterine cavity (*). Coexisting lesion seen in the endometrial cavity as focal sessile mass hypointense to the bright endometrium along anterior upper body on the left side (Yellow arrow, the depth of myometrial invasion is difficult to determine owing to poor tumor-to-myometrium contrast (White arrow). (c and d) On a sagittal diffusion-weighed magnetic resonance image (b = 800 s/mm) and axial apparent diffusion coefficient map, the tumor (*) has high signal intensity extending into the junctional zone (arrow) with the apparent diffusion coefficient values of 0.7–0.8. Here, the posterior wall leiomyoma demonstrated (T2-weighted variable signal, diffusion-weighted image low signal with apparent diffusion coefficient high values: Benign morphology). However, the endometrial cavity sessile lesion demonstrated T2 intermediate signal with diffusion-weighted image high and low apparent diffusion coefficient value: Restricted Diffusion suggesting malignant etiology: Final HPE revealed Stage 1B Grade 1 endometrial carcinoma involving up to 50% of uterine myometrium. This case illustrated the clinical utility of magnetic resonance imaging with diagnostic value of diffusion-weighted image and apparent diffusion coefficient in detecting and differentiating between benign and malignant lesions
Figure 11
Figure 11
Stage II endometrial cancer in a 64-year-old female. (a) Sagittal T2-weighted magnetic resonance image shows the distention of the endometrial cavity by a tumor (*) that extends into the cervix (arrow). Signal intensity of the tumor is intermediate on T2-weighted with restricted diffusion showing apparent diffusion coefficient values of 0.8–0.9 (images not included here)
Figure 12
Figure 12
Stage 3 Stage IIIA endometrial cancer in a 65-year-old female: (a) Sagittal T2-weighted, (b) Axial T2-weighted, (c) T1FAT SAT, (d) SWI, (e-g) Sag and Axial DWl with apparent diffusion coefficient map: Sagittal T2-weighted ME image shows a large endometrial tumor (*). The depth of myometrial invasion is difficult to determine qwing to poor tumor-to-myometrium contrast (arrow). (b) Axial oblique T2-weighted magnetic resonance image shows extension of the endometrial tumor (*) up to the serosa. The tumor is isonitense relative to the adjacent myometrium. In addition, the uterus is distorted by two leiomyomas (L), whose presence is a commonly reported pitfall in staging. (c) T1FATSAT image reveals bright signal which shows corresponding blooming on SWI (arrow). (d) Suggestive of hemorrhage. (e and g) diffusion-weighted image reveals high signal with low apparent diffusion coefficient values of 0.5–0.6 (F): Restricted diffusion. HPE Mucinous adenocarcinoma
Figure 13
Figure 13
Stage IVB endometrial cancer in a 66-year-old female. (a) Sagittal T2-weighted magnetic resonance image shows a bulky endometrial tumor (*) with poor tumor-to-myometrium contrast (arrow). (b) On an Oblique coronal magnetic resonance image, the mass is extending and crossing the serosa and also there is bone marrow involvement of the left ischial tuberosity (yellow arrow) suggesting distant metastatic spread downstaging the tumor to IV B (c) On an Axial T2-weighted magnetic resonance image right external iliac lymph node seen (white arrow) (d) Sections through upper abdomen demonstrates Enlarged paraaortic and paracaval lymph nodes which are similar in signal intensity to the endometrial cavity mass (yellow star)
Figure 14
Figure 14
Stage 3 Stage IIIA endometrial cancer in a 65-year-old female: (a) Sagittal T2-weighted, (b) Axial T2-weighted. (c) T1FAT SAT. (d) SWI, (e-g) Sag and Axial DWl with apparent diffusion coefficient map: Sagittal T2-weighted ME image shows a large endometrial tumor (*). The depth of myometrial invasion is difficult to determine qwing to poor tumor-to-myometrium contrast (arrow). (b) Axial oblique T2-weighted magnetic resonance image shows extension of the endometrial tumor (*) up to the serosa. The tumor is isonitense relative to the adjacent myometrium. In addition, the uterus is distorted by two leiomyomas (L), whose presence is a commonly reported pitfall in staging. (c) T1FATSAT image reveals bright signal which shows corresponding blooming on SWI (arrow). (d) suggestive of hemorrhage. (e and g) diffusion-weighted image reveal high signal with low apparent diffusion coefficient values of 0.5–0.6. (f) Restricted diffusion. HPE Mucinous adenocarcinoma
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References

    1. Smith-Bindman R, Weiss E, Feldstein V. How thick is too thick. When endometrial thickness should prompt biopsy in postmenopausal women without vaginal bleeding? Ultrasound Obstet Gynecol. 2004;24:558–65. - PubMed
    1. Lee Y, Kim KA, Song MJ, Park YS, Lee J, Choi JW, et al. Multiparametric magnetic resonance imaging of endometrial polypoid lesions. Abdom Radiol (NY) 2020;45:3869–81. - PubMed
    1. Beddy P, O'Neill AC, Yamamoto AK, Addley HC, Reinhold C, Sala E. FIGO staging system for endometrial cancer: Added benefits of MR imaging. Radiographics. 2012;32:241–54. - PubMed
    1. Çavuşoğlu M, Sözmen Ciliz D, Ozsoy A, Duran S, Elverici E, Atalay CR, et al. Diffusion-weighted mri of postmenopausal women with vaginal bleeding and endometrial thickening: Differentiation of benign and malignant lesions. J Belg Soc Radiol. 2016;100:70. - PMC - PubMed
    1. Nalaboff KM, Pellerito JS, Ben-Levi E. Imaging the endometrium: Disease and normal variants. Radiographics. 2001;21:1409–24. - PubMed