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Pelvic MRI Structural & Functional MRI Jeong Yeon Cho, M.D. Department of Radiology Seoul National University Hospital, Seoul, Korea CONTENTS Structural MRI of Female Pelvis - Normal MRI findings - Imaging protocols - MRI findings of common GY diseases Functional MRI of Female Pelvis MRI of Prostate - Imaging protocols - MRI findings of prostate cancer - Functional MRI of prostate Normal Findings of Female Pelvis T2WI CE-T1WI Normal Findings of Female Pelvis T2WI CE-T1WI MRI Protocols of Female Pelvis SNUH CMC AMC ax T1 FSE ± FS ax T1 FSE ax T1 FSE 3 T2 FSE 3 T2 FSE, cor T2 SSFSE ax & sag T2 FSE AMC (Cx ca) ax T1 FSE 3 T2 FSE (FOV,15cm), ax T2 FSE, ax DWI Pelvis ax dynamic T1 FS LAVA Abdomen 영남대 3 T2 FSE sag dynamic T1 fSPGR ax (ov)/sag (cx) dynamic T1 FLASH sag (ov)/ax (cx) post T1 FSE sag post T1 FSE ax & sag post T1 FS FSE 3 post T1 FSE ax T1 SPGR ax post T1 FS SPGR ax T2 FSE, cor T1 FS SPGR, DWI ax T2 FSE, DWI ax T2 HASTE 2007년 대한비뇨생식기영상의학회 학술대회 MRI Protocols of Female Pelvis Pelvis NCC 단국대 동아대 분당서울대 SMC ax T1 FSE 3 T1 FSE ax & sag T1 FSE ax T1 FSE ax T1 FSE ± FS 3 T2 FSE, obliq ax T2 FSE 3 T2 FSE, ax T2 FS FSE 3 T2 FSE 3 T2 FSE 3 T2 FSE sag 3D dynamic FFE (3T), ax DWI (3T) ax & sag post T1 FS FSE Abdomen ax & cor T2 FSE ax or sag dynamic T1 LAVA ax & cor post T1 FSE Sag post T1 FSE ax FIESTA sag dynamic T1 fSPGR ax & sag post T1 FS FSE ax & sag post T1 FSE ± ax post T1 FS ax T1 FSE ax T1 FS SPGR & T2 FSE 2007년 대한비뇨생식기영상의학회 학술대회 Buscopan Subtraction Common Benign Conditions of Uterus Myomas Adenomyosis Congenital Uterine Anomalies Uterine didelphys Septated uterus Malignant Uterine Diseases: Cx Ca IIA IIB Malignant Uterine Diseases: Em Ca IC IA Ovary and Adnexal Lesions T2WI T1WI Fat-sat T1WI T2WI T1WI Fat-sat T1WI Ovary and Adnexal Lesions Mucinous cystadenoma Endometrioid carcinoma Functional MRI of Female Pelvis Dynamic contrast enhanced MRI Diffusion weighted image & ADC map Cine MRI Improvement of diagnostic accuracy - tumor detection - local staging - lymph node metastasis - peritoneal seeding Dynamic Contrast Enhanced MRI Endometrial cancer : myometrial invasion Cervix cancer : early stage lesion Recurrence vs. fibrosis Monitoring therapeutic outcome by perfusion and kinetic parameter Dynamic Contrast Enhanced MRI T2WI T1WI 3 min 5 min 1 min Subtraction DWI of Gynecological Lesions Difference in molecular diffusion by Brownian motion ADC value: microscopic water diffusibility Acute cerebral ischemia & malignant tumors DWI in GY diseases - SENSE/SSEPI, high b-value (800 or 1000) - peritoneal seeding leiomyosarcoma vs. leiomyoma DDX of metastatic L/N DDx of ovarian tumor Functional MR imaging of the female pelvis. Koyama T, Togashi G. J Magn Reson Imaging 2007 DWI of Gynecological Lesions Cx Ca Lymph node Ov tumor Cine MRI Contraction Functional MR imaging of the female pelvis. Koyama T, Togashi G. J Magn Reson Imaging 2007 Peristalsis Cine MRI 27/F with severe dysmenorrhea Prostate MRI protocols NCC (3T) 단국대 동아대 분당서울대 (3T) SMC (3T) ax T1 FSE ax & sag T1 FSE ax T1 FSE ax T1 FSE ax T1 FSE 3 T2 FSE 3 T2 FSE, ax T2 FS FSE 3 T2 FSE, ax T2 (FOV 크게) 3 T2 FSE 3 T2 FSE ax DTI ax DWI (0, 700) & DTI (0,1000) 3 DWI (0, 1000) ax dynamic 3D FFE (30 rep) ax dynamic T1 LAVA ax dynamic 3D FFE (58*5s), subtraction MRS, abd (ax T2 FSE) ax & cor post T1 FS FSE ax & cor post T1 FS FSE MRS 2007년 대한비뇨생식기영상의학회 학술대회 Prostate MRI Protocols SNUH (3T) CMC (ERC) AMC (3T) 영남대 ax T1 FSE + ax T1 (kidurethra) Ax & sag T1 FSE Ax T1 FSE Ax T1 (PPA,ERC) 3 T2 FSE 3 T2 FSE 3 T2 FSE 3 T2 (PPA, ERC) Ax DWI & DTI Ax DWI Ax DWI (0-1000) Ax DWI (PPA) Ax dyn T1 3D FSPGR, Subtraction Ax dyn T1 Ax dyn 3D FFE (200 * 3s) Post T1 FSE Sag & cor post T1 SPIR MRS, body DWI 3 post T1 (ERC), abd (T2 HASTE) 2007년 대한비뇨생식기영상의학회 학술대회 Normal Prostate MRI Findings T1WI T2WI T2WI MRI findings of Prostate Cancer T2WI T1WI Accuracy of staging: 54 - 93% Dynamic Contrast Enhanced MRI T2WI: 65%, 60% Parametric: 96%, 82% Wash-in rate on the basis of dynamic contrast-enhanced MRI: usefulness for prostate cancer detection and localization. Kim JK, et al. J Magn Reson Imaging 2005 Dynamic Contrast Enhanced MRI Subtraction Kep Kel AH Err DCE-MRI: SV Invasion T2WI DWI DCE *SV Invasion: Sensitivity(71% 94%), Specificity(65% 77%) DWI & ADC T2WI T1WI T2WI DCE DWI ADC DWI & ADC Diffusion-Weighted Imaging of the Prostate at 3 T for Differentiation of Malignant and Benign Tissue in Transition and Peripheral Zones. Kim CK, et al. J Comput Assist Tomogr. 2007 Diffusion-weighted MR imaging for the evaluation of seminal vesicle invasion in prostate cancer: Initial results Kim CK, et al. J Magn Reson Imaging. 2008 MRS Prostate cancer - high choine/citrate - high creatinine/citrate T2WI + MRS : 95% sensitivity/specificity Long acquisition time Variable interpretation No periprostatic anatomy SUMMARIES Role of pelvic and prostate MRI - local staging - differential diagnosis of GY lesions Functional MRI - increase of detection and staging accuracy - necessity of further evaluation - future innovation
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