Abstract
Diffusion-weighted imaging (DWI) is widely used in protocols for magnetic resonance imaging (MRI) of the female pelvis. It provides functional and structural information about biological tissues, without the use of ionizing radiation or intravenous administration of contrast medium. High signal intensity on DWI with simultaneous low signal intensity on apparent diffusion coefficient maps is usually associated with malignancy. However, that pattern can also be seen in many benign lesions, a fact that should be recognized by radiologists. Correlating DWI findings with those of conventional (T1- and T2-weighted) MRI sequences and those of contrast-enhanced MRI sequences is mandatory in order to avoid potential pitfalls. The aim of this review article is the description of the most relevant physiological and benign pathological conditions of the female pelvis that can show restricted diffusion on DWI.
Highlights
The use of diffusion-weighted imaging (DWI) in magnetic resonance imaging (MRI) of the pelvis has become more widespread in recent years
The interpretation and correlation of DWI sequences with conventional T1W and T2W images is mandatory, given that DWI is considered only a complementary sequence
DWI is a noninvasive sequence and its cost-effectiveness has been proven, T1W images with fat suppression before and after the intravenous administration of gadolinium-based contrast media remains a cornerstone in the characterization of lesions on pelvic MRI—we get a more detailed characterization of the lesion but can establish its boundaries and perfusion
Summary
The use of diffusion-weighted imaging (DWI) in magnetic resonance imaging (MRI) of the pelvis has become more widespread in recent years. For an accurate DWI analysis, parametric maps of the apparent diffusion coefficient (ADC), based on at least two different b values, are created for each voxel of an image. Duarte AL et al / Pitfalls of DWI of the female pelvis strength and show the different tissue diffusion properties at different b values, displaying them in gray-scale images[1,2,7,12,13,14]. Areas with “free” water molecule movement will show high SI on ADC maps and low SI on DWI with high b values, whereas areas with restricted diffusion, such as tumor tissue, will show low ADC values (“darker” images) and high SI at high b values[3,5,6,7,10,11,14,16]. Radiologists should be aware of some potential pitfalls of using DWI to evaluate the uterus, exercising caution in order to avoid mistaking benign conditions for malignancy
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