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Primary Ovarian Endometrioid Adenocarcinoma

Magnetic Resonance Imaging Findings Including a Preliminary Observation on Diffusion-Weighted Imaging

Li, Hai Ming MD*†; Qiang, Jin Wei MD, PhD*; Xia, Gan Lin MD; Zhao, Shu Hui MD; MA, Feng Hua MD*; Cai, Song Qi MD*; Feng, Feng MD; Fu, Ai Yan MD

Journal of Computer Assisted Tomography: May/June 2015 - Volume 39 - Issue 3 - p 401–405
doi: 10.1097/RCT.0000000000000210
Abdominal Imaging

Objective This study aimed to investigate the magnetic resonance imaging (MRI) features of ovarian endometrioid adenocarcinoma (OEC) and to evaluate conventional MRI and diffusion-weighted imaging (DWI) for diagnosing OEC.

Materials and Methods Twenty patients with OEC proven by surgery and pathology underwent MRI. The MRI features of the tumors evaluated included laterality, shape, size, configuration, mural nodules, signal intensity, apparent diffusion coefficient (ADC) values, enhancement, peritoneal implants, ascites, and synchronous primary cancer (SPC) of the ovary and endometrium.

Results Unilateral ovarian masses were observed in 18 (90%) of the 20 patients with 22 OEC lesions, whereas the remaining 2 (10%) patients had bilateral masses. Oval, lobulated, and irregular shapes were observed in 13 (59%), 6 (27%), and 3 (14%) tumors, respectively. The maximum diameter of the tumors ranged from 3.7 to 22.5 cm, with a mean of 11.2 ± 5.1 cm. Fifteen (68%) masses were mainly cystic with mural nodules, 5 (23%) were mixed cystic-solid, and 2 (9%) were solid. The solid components of tumors showed isointensity (100%) on T1-weighted imaging (T1WI), heterogeneous hyperintensity on T2-weighted imaging (T2WI) (86%), and hyperintensity on DWI (82%), with a mean ADC value of (0.96 ± 0.20) × 10−3 mm2/s. The cystic components showed isointensity or hyperintensity (85%) on T1WI, hyperintensity on T2WI (100%), and hypointensity on DWI (63%), with a mean ADC value of (2.27 ± 0.27) × 10−3 mm2/s. Ten (50%) of the patients were SPC. The mean ADC values of the solid components were (0.85 ± 0.19) × 10−3 mm2/s and (1.08 ± 0.15) × 10−3 mm2/s in only-OEC and SPC, respectively, with a statistically significant difference (P = 0.012).

Conclusions Ovarian endometrioid adenocarcinoma usually appears as a large, oval, or lobulated cystic mass with mural nodules. Cystic components show isointensity or hyperintensity on T1WI, solid components and hyperintensity on T2WI and DWI. Synchronous primary cancer of the ovary endometrium is another characteristic feature of OEC.

From the *Department of Radiology, Jinshan Hospital and Shanghai School of Medicine, Fudan University, Shanghai; †Department of Radiology, Nantong Cancer Hospital, Nantong, Jiangsu; and ‡Department of Radiology, Xinhua Hospital and Shanghai School of Medicine, Jiao Tong University, Shanghai, China.

Received for publication September 5, 2014; accepted November 26, 2014.

Reprints: Jin Wei Qiang, MD, PhD, Jinshan Hospital, Fudan University, 1508 Longhang Rd, Jinshan District, Shanghai 201508, China (e-mail:; Gan Lin Xia, MD (e-mail:

Supported by the National Natural Science Foundation of China (Grant 81471628), Shanghai Municipal Commission of Science and Technology (Grant 124119a3300), and Shanghai Municipal Commission of Health and Family Planning (Grants 2013SY075 and ZK2012A16).

The authors declare no conflict of interest.

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