1. Pelvic Applications of Diffusion Magnetic Resonance Images
Antonio C. Coutinho, MD, Arun Krishnaraj, MD, MPH, Cintia E. Pires, MD, Leonardo K. Bittencourt, MD, Alexander R. Guimarães, MD, PhD 
Magnetic Resonance Imaging Clinics 
Volume 19, Issue 1, Pages (February 2011)
DOI: /j.mric
Copyright © 2011 Elsevier Inc. Terms and Conditions

2. Fig. 1
25-year-old woman with pelvic pain and vaginal discharge. T2-weighted axial image (A) and T1 fat-suppressed (T1FS) postcontrast image (B) showing a complex left adnexal cystic lesion. DWI (b = 800) shows hyperintensity within the lesion (C) and ADC maps show hypointensity (D). Findings are consistent with restricted diffusion. Surgery confirmed a diagnosis of a TOA.
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3. Fig. 2
53-year-old woman with unusual vaginal bleeding and contrast material allergy, contraindicating dynamic gadolinium-enhanced imaging. T2-weighted image (A) and fused DW image/T2-weighted image (C) in the coronal plane showing abnormal signal within the endometrial cavity and adjacent myometrium. These lesions show low-signal intensity on ADC map (B) (red arrow) and hyperintensity on DWI (b = 800) (D) (yellow arrow), suggesting malignant neoplasm and myometrial invasion. Pathologic examination confirmed endometrial carcinoma with secondary myometrial involvement.
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4. Fig. 3
History of vaginal bleeding. T2-weighted sagittal (A) fast spin-echo (FSE) showing distended uterine endometrial cavity with T2 hyperintensity. DWI (b = 400) (B) showing hyperintensity in the endometrial cavity and ADC map (C) showing hypointensity. Findings are consistent with restricted diffusion. Pathologic diagnosis confirmed pyometra.
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5. Fig. 4
63-year-old woman with abnormal vaginal bleeding. T2-weighted sagittal (A) and axial (B) images show abnormal thickening and loss of T2 hyperintensity within the endometrial cavity (arrow). This mass shows heterogeneous early enhancement with rapid washout on T1-weighed high-resolution postcontrast images (C), and high signal on DWI (D) and low signal on ADC (E), with a mean ADC value of 0.93 × 10−3 mm2/s, consistent with restricted diffusion. Pathologic examination confirmed a diagnosis of endometrial carcinoma.
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6. Fig. 5
Normal endometrium on a 29-year-old asymptomatic woman (A, B). Note the low-signal intensity on ADC map (C) (red arrow) and the high-signal intensity on DWI (b = 600) (D) (yellow arrow). The mean ADC value was 1.61 × 10−3 mm2/s.
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7. Fig. 6
85-year-old woman with vaginal bleeding. T2-weighted images (A, B, C) show an expansive lesion on the posterior lip of the cervix, extending to the right parametrium (red arrow). Note the marked high-signal intensity on DWI (b = 1000) (D) and a low ADC value (0.6 × 10−3 mm2/s) (E, F), consistent with restricted diffusion and malignancy (yellow arrows). Pathologic examination confirmed the diagnosis of cervical carcinoma with secondary parametrial involvement.
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8. Fig. 7
50-year-old woman with history of heavy menstrual bleeding, fibroids, and enlarged uterus on examination. T2-weighted sagittal FSE (A) showing T2 heterogeneous, hyperintense 10-cm mass along the cephalad, posterior uterus (arrowhead) without the usual signal intensity shown by benign fibroids. Postcontrast T1-weighted image in the sagittal plane (B) shows heterogeneous, early enhancement of this mass. DWI (b = 400) (C) showing hyperintensity and ADC maps (D) showing hypointensity consistent with restricted diffusion. The lower ADC value was 0.87 × 10−3 mm2/s. After resection, this mass was consistent with a leiomyosarcoma arising from fibroid.
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9. Fig. 8
39-year-old asymptomatic woman. Axial (A) and sagittal (B) T2-weighted images showing a hypointense mass on the posterior wall of the uterus. The lesion shows low-signal intensity on DWI (b = 800) (C) and mild hypointensity on ADC map (D), consistent with no restricted diffusion. The mean ADC value was 1.8 × 10−3 mm2/s. Postresection pathologic examination confirmed the diagnosis of a benign leiomyoma.
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10. Fig. 9
36-year-old asymptomatic woman. T2-weighted images on sagittal (A) and axial (B) images show an intermediate-signal intensity nodule in the posterior wall of the uterus. Note the early intense enhancement on the T1FS postcontrast image (C). The lesion showed low-signal intensity on ADC map (D), with a mean ADC value of 1.23 × 10−3 mm2/s. The constellation of findings is consistent with a cellular leiomyoma (pathologically proved).
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11. Fig. 10
T2-weighted axial (A), postcontrast T1-weighted axial (B), DWI (b = 600) (C), and ADC (D) maps in a large, complex septated mass within the pelvis (arrow). On T2-weighted imaging, there are thick and thin septations with nodularity throughout the ovary, all of which show enhancement (B). On DWI, many of these septations and nodules show hyperintensity (C), some of which show low signal on ADC (D) compatible with restricted diffusion. Findings on pathologic examination confirmed a diagnosis of ovarian carcinoma.
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12. Fig. 11
35-year-old woman with palpable right adnexal mass. MR imaging shows a T2 (A) hyperintense 6.5-cm mass with areas of macroscopic fat on T1-weighted fat-saturated images (B) and no significant enhancement. There are areas within the mass that show DWI bright foci (C) and ADC low-signal intensity (D). Pathologic examination confirmed a benign teratoma.
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13. Fig. 12
MR images of a right adnexal lesion show a T1 (A) and T2 (B) hyperintense lesion that shows DWI hyperintensity and ADC hypointensity compatible with restricted diffusion. Pathologic diagnosis confirmed the diagnosis of a benign endometrioma (C, D).
Magnetic Resonance Imaging Clinics  , DOI: ( /j.mric )
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14. Fig. 13
62-year-old woman with diffuse abdominal pain and history of contrast material allergy. Gadolinium intravenous administration could not be performed. T2-weighted images (A, B) show bilateral ovarian masses (red arrows) and a retrocervical lesion in intimate association with the anterior rectal wall (yellow arrow). (C) High-signal intensity on DWI (b = 1000) (white arrows) and (D) low-signal intensity on ADC map (arrowheads) indicate restricted diffusion. Pathologic diagnosis confirmed ovarian adenocarcinoma with a serosal implant.
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15. Fig. 14
62-year-old man with anemia and constipation. T2-weighted images on axial (A) and coronal (B) images showing thickening of the posterior rectal wall. The lesion showed high-signal intensity on DWI (b = 1000) (C) and low-signal intensity on ADC map (D). These findings are consistent with restricted diffusion. Pathologic examination confirmed the diagnosis of adenocarcinoma of the rectum.
Magnetic Resonance Imaging Clinics  , DOI: ( /j.mric )
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16. Fig. 15
Axial T2 (A), T1 postcontrast (B), DWI (C), and ADC (D) maps show a circumferential enhancing mass lesion (red arrows) in the rectum with a small adjacent lymph node (yellow arrow), which shows restricted diffusion on DWI and ADC maps. Also noted are multiple small pararectal and right iliac lymph nodes (yellow arrow), which also show restricted diffusion (E, F). All the lesions were positive for malignancy.
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17. Fig. 16
66-year-old man with abnormal digital rectal examination for prostate cancer screening. MR images show a large hypointense mass on the left peripheral zone of the prostate on T2-weighted images (A, B), with heterogeneous enhancement on T1FS after contrast (C). The mass is better delineated on DWI (b = 1000) (E, G) as a hyperintense lesion, with low-signal intensity on ADC map (D, F). These findings are consistent with restricted diffusion and malignancy.
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18. Fig. 17
69-year-old man with hematuria. T2-weighted images on axial (A) and coronal (B, C) planes showing a mildly hypointense mass arising in a bladder diverticula. The lesions show marked hypointensity on ADC map (D) and hyperintensity on DWI (b = 800) (E), indicating restricted diffusion. Pathologic examination confirmed a diagnosis of transitional cell carcinoma arising in urinary bladder diverticula.
Magnetic Resonance Imaging Clinics  , DOI: ( /j.mric )
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19. Fig. 18
57-year-old man with chronic renal insufficiency and hematuria. MR images show a hypointense polypoid mass in the vesical lumen (A, B), which shows marked low-signal intensity on ADC map (C), with a mean ADC value of 0.97 × 10−3 mm2/s. Fused DW images/T2-weighted images (D) are consistent with restricted diffusion within the mass. A high histologic grade malignant tumor (G3) was confirmed on pathologic diagnosis after resection.
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20. Fig. 19
Investigation of a 43-year-old woman with generalized lymphadenopathy. (A) Pelvic MR shows multiple pathologically enlarged lymph nodes along the common and external iliac chains. These nodes show high-signal intensity on DWI (B) and hypointensity on ADC map (C). These findings are consistent with restricted diffusion. Biopsy confirmed a diagnosis of diffuse large B-cell lymphoma.
Magnetic Resonance Imaging Clinics  , DOI: ( /j.mric )
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21. Fig. 20
34-year-old woman with dyspareunia and suspicious Papanicolaou smear. DWI (b = 1000) (A) and ADC map (C) showing restricted diffusion within the cervical mass (yellow arrowhead) in the axial plane with a large lymph node (red arrowhead) in the mesorectal fascia. CT imaging (B) shows a large, bulky enhancing mass centered in the upper vagina and lower cervix with a large lymph node posterior to the mass and anterior to the rectum. There is FDG avidity (D) within the mass. Biopsy showed cervical adenocarcinoma.
Magnetic Resonance Imaging Clinics  , DOI: ( /j.mric )
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22. Fig. 21
35-year-old asymptomatic woman. Both ovaries show high-signal intensity on DWI (b = 600) (A, B). However, signal intensity is also high on ADC map (C), consistent with no restricted diffusion (T2 shine-through effect).
Magnetic Resonance Imaging Clinics  , DOI: ( /j.mric )
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