1SERVIÃO DE RADIOLOGIA do Hospital de Egas Moniz. 2SERVIÃO DE ANATOMIA PATOLÃGICA do Instituto Português de Oncologia de Lisboa. 3SERVIÃO ...
High signals in the uterine cervix on T2-MRI Isa Martins1; Ana Félix2 ; Teresa Margarida Cunha3; 1SERVIÇO
DE RADIOLOGIA do Hospital de Egas Moniz 2SERVIÇO DE ANATOMIA PATOLÓGICA do Instituto Português de Oncologia de Lisboa 3SERVIÇO DE RADIOLOGIA do Instituto Português de Oncologia de Lisboa
Aim: To correlate female pelvic MRI with high signal intensity in uterine cervix on T2-weighted sequences with pathological diagnosis.
Normal T2 MR appearance of the uterine cervix Sagittal T2-weighted image shows a central high signal intensity corresponding to endocervical glands delineated by a peripheral low signal intensity rim.
Fig. 1: A 43-year-old woman with normal cervix.
Axial T2-weighted image shows the annular low-signal intensity stroma.
a)
b)
Fig. 2: a) and b) A 15 and a 17-year-old women with an didelphys uterus with two cervical canals. b) and two endometrial cavities.
Benign pathology Fig. 3: A 39-year-old woman with Nabothian cyst.
Nabothian cysts presented as single or multiple round cystic with small size and well defined margins in the cervical stroma. Cervical Endometrioses is a rare entity and may be presented as high signal intensity on T2-weighted images or as a voluminous cervix of low signal intensity. When there are Blood clots in the cervix, they appear as high signal intensity on T2weighted images. Chronic Cervicitis appears as a round lesion in the cervix, with heterogeneous high signal intensity on T2–weighted images. Pedunculated degenerated Leiomyomas as mucous Polyps may protrude into the endocervix canal.
Fig. 5: A 52-year-old woman with Pedunculated Prolapsed Leiomyoma.
Fig. 4: A 41-year-old woman with Polypoid Endometriosis of the cervix.
Fig. 6: A 48-year-old woman with Chronic Cervicitis. Fig.7: A 48-year-old woman on THS with enlargement of the cervix attributed to hemorrhage fluid due to a stenotic external os.
Fig. 8: A 43-year-old woman on tamoxifen with Pedunculated Prolapsed Polyp that protrude into the endocervical canal.
Fig. 9: A 68-year-old woman with Persistent Cervical Carcinoma with neuroendocrine differentiation, 6 month after chemotherapy.
Fig. 10: A 71-year-old woman with Recurrent Cervical Carcinoma 2 years after radiotherapy.
Malignant pathology Cervical Cancers have moderately high signal intensity on T2 weighted images. They appear as a thickened endocervical stripe of increased signal delineated by the low intensity signal of the stroma or, as a tumor mass within the cervix.
Fig. 11: A 52-year-old woman with cervical cancer (adenocarcinoma)
In the post-radiotherapy patient, MR may be helpful to distinguish fibrosis from recurrent or residual tumor. Fig. 12: A 52-year-old woman with an adenocarcinoma of the cervix.
Fig. 13: A 48-year-old woman with cervical extension of an Endometrial Carcinoma (FIGO Stage - IIB).
Fig. 14: A 71-year-old woman with Vaginal Carcinoma (with cervical invasion).
Fig.15: A 40-year-old woman with a cervical Choriocarcinoma.
Conclusion:
High signal intensity is a common finding in pathological uterine cervix on T2-MR sequences and it may correspond to a variety of lesions that represent benign or malignant uterine pathology. This findings has to be correlated to their corresponding signal on T1 sequences. References: 1. Audet P.;Pressacco J.;Burke M.; Reinhold C. MR imaging of female pelvis malignancies. MRI Clin North Am 2000;8:887-914.
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4. Hamm B.; Kubik-Huch R.; Fleige B.; MRI and CT of the female pelvis. Eur Radiol, 1999;9:3-15.
6. Mezrich R.; Magnetic ressonance imaging applications in uterine cervical cancer. MRI Clin North Am, 1994;2:211-243.
7. Sugimura K.; Li H.; Okizuka H.; Yoshida M.; Maruyama R.; Takahashi K.; Miyazaki K.; Markedly high signal itensity lesions in uterine cervix on T2-weigted imaging:differentiation between mucin-producing carcinomas and nabothian cysts. Radiat med, 1999;17:137-143.
8. Togashi K.; Nishimura K.; itoh K. et al. Uterine cervical cancer: assessment with high field MR imaging. Radiology, 1986;160:431-435.
11th EUROPEAN SYMPOSIUM ON UROGENITAL RADIOLOGY SANTIAGO DE COMPOSTELA, SPAIN, 9-12 September 2004
