ARRS 2022 Abstracts

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E1233. Utility of Diffusion Weighted Sequence in Gynecological Imaging
Authors
  1. Apurva Bonde; University of Texas MD Anderson Cancer Center
  2. Sanaz Javadi; University of Texas MD Anderson Cancer Center
  3. Sarah Palmquist; University of Texas MD Anderson Cancer Center
  4. Priya Bhosale; University of Texas MD Anderson Cancer Center
Background
Functional DWI is routinely used as a complementary tool to conventional diagnostic MRI sequences and is being increasingly investigated for predicting tumor response and assessment of tumor recurrence. We describe the detailed technique of DWI performed for gynecological imaging, including the different B values and planes useful for possible clinical information for ADC mapping. Additionally, we discuss the problems encountered during DWI interpretation.

Educational Goals / Teaching Points
DWI is a functional imaging technique with wide range of applications in malignant and non-malignant gynecological conditions. We describe basics of techniques, pitfalls, major clinical applications, and future trends in DWI in gynecological entities.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
DWI has a wide range of clinical applications in malignant and non-malignant gynecological conditions. The main implications in non-malignant conditions include diagnosis of tubo-ovarian abscess when intravenous contrast is contraindicated; differentiation of degenerated fibroids from uterine sarcomas; monitoring uterine fibroids after treatments/ablations with ADC measurements; help in diagnosis of endometriosis as it may show diffusion restriction due to hemorrhagic components; and in case of adnexal torsions, the walls of torsed structures may show diffusion restriction due to infarction aiding the diagnosis of torsion which is at times difficult. The applications of DWI in gynecological oncology include diagnosis and staging of endometrial, cervical, ovarian cancer; determination of peritoneal metastatic disease; tumor response assessment; early detection of tumor recurrence; and differentiation between tumor and post radiation fibrosis. Quantitative assessment with ADC measurement is being increasingly evaluated with various tumor parameters such as correlation with tumor grade and stage in the management of gynecological malignancies, helping in preoperative treatment planning. Pitfalls of DWI in pelvis include T2 shine through, which can be overcome with use of high B value images and ADC map together; diffusion restriction in hemorrhage, melanin, and in normal structures such as secretory phase endometrium, lymph nodes, and bowel mucosa; and lack of diffusion restriction in some malignant tumors with low cellularity or mixed cystic malignant tumors, requiring caution in interpretation of images. Newer advanced techniques of diffusion-weighted whole body imaging with background signal suppression (DIWBS), diffusion tensor imaging, and diffusion spectral imaging need to be further evaluated for potential use in pelvic nerve mapping preoperative planning and fertility preserving surgeries.

Conclusion
DWI has diverse applications in malignant and nonmalignant gynecological conditions, acting as a complementary tool to conventional MRI sequences, with newer DWI techniques showing promising potential.