Diffusion-weighted and diffusion-tensor imaging of normal and diseased uterus

Figure 1 Forty-three years old woman with stage III squamous cell carcinoma of the uterine cervix invading vagina. A: Sagittal T2-weighted image of the uterus shows cervical cancer (long arrows) extending both to the corpus uteri and vagina (short arrows); B: Sagittal contrast-enhanced T1-weighted image with fat suppression shows enhancing cervical cancer (arrows). The tumor invades anterior vaginal wall (short arrows); C: Axial contrast-enhanced T1-weighted image with fat suppression shows enhancing cervical cancer (long arrows). There is suspicious invasion of the mass to the rectum (short arrows); D: Diffusion-weighted imaging with b = 1000 s/mm² clearly shows a well-defined hyperintensity mass in the cervical area with no invasion to rectum (short arrows); E: On the apparent diffusion coefficient (ADC) map the tumor is hypointense (arrows). The ADC value within the mass is 0.73 × 10^-3 mm²/s.

Figure 2 A 57-year-old woman with endometrial carcinoma. A: Sagittal contrast-enhanced T1-weighted image with fat suppression shows enhancing endometrial cancer with infiltration of myometrium (arrows); B: Sagittal T2-weighted image demonstrating hyperintense endometrial cancer with infiltration of myometrium (arrows); C: Coronal fat supressed T2-weighted image reveals a tumor in the corpus uteri (long arrows), and bilateral metastatic lymphadenopathies along the iliac chains (short arrows); D: Coronal DWI (b = 1000 s/mm²) shows a marked hyperintense tumor in the corpus uteri (long arrows), and bilateral metastatic lymphadenopathies along the iliac chains (short arrows); E: Axial apparent diffusion coefficient map reveals the right sided metastatic lymph node and endometrium with restricted diffusion.

Figure 3 A 42-year-old woman with endometrial polyp. A: Hypointense polyp in the endometrial cavity on sagittal T2-weighted image mimicking low grade endometrial carcinoma (arrows); B: Sagittal contrast-enhanced T1-weighted image with fat suppression shows enhancing endometrial polyp (arrows); C: On the axial DWI (b = 1000 s/mm²) image, the mass is hypointense clearly excluding malignancy (arrows); D: Corresponding axial apparent diffusion coefficient (ADC) map. The ADC value within the mass is 1.85 × 10^-3 mm²/s.

Figure 4 Thirty two years old volunteer. A: Sagittal T2-weighted image of a normal uterus; B: 3D whole tractography image of the normal uterus. Red colors represent a right-left orientation, blue represents a cranio-caudal orientation and green represents an antero-posterior orientation of diffusion. Changes in the intensity of the color represent different strengths of anisotropy.