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MR Imaging of Common and Uncommon Large Pelvic Masses¹

¹ From the Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030. Received May 3, 2002; revision requested June 10 and received October 10; accepted October 10. Address correspondence to J.S. (e-mail: jszklaru@di.mdacc.tmc.edu).

View larger version (191K): [in a new window]   Figure 1a.  Endometrial cancer in a 61-year-old woman. (a) Sagittal fast spin-echo T2-weighted MR image demonstrates an endometrial mass with heterogeneous signal intensity. (b) Axial spin-echo T1-weighted MR image obtained after the intravenous administration of gadopentetate dimeglumine shows the mass with heterogeneous enhancement.

View larger version (202K): [in a new window]   Figure 1b.  Endometrial cancer in a 61-year-old woman. (a) Sagittal fast spin-echo T2-weighted MR image demonstrates an endometrial mass with heterogeneous signal intensity. (b) Axial spin-echo T1-weighted MR image obtained after the intravenous administration of gadopentetate dimeglumine shows the mass with heterogeneous enhancement.

View larger version (159K): [in a new window]   Figure 2a.  High-grade uterine sarcoma in a 61-year-old woman. Sagittal unenhanced gradient-echo MR image of the uterus (a) and contrast-enhanced gradient-echo MR images of the uterus obtained 15 (b) and 35 (c) seconds after intravenous administration of gadopentetate dimeglumine show enhancement of a uterine neoplasm.

View larger version (161K): [in a new window]   Figure 2b.  High-grade uterine sarcoma in a 61-year-old woman. Sagittal unenhanced gradient-echo MR image of the uterus (a) and contrast-enhanced gradient-echo MR images of the uterus obtained 15 (b) and 35 (c) seconds after intravenous administration of gadopentetate dimeglumine show enhancement of a uterine neoplasm.

View larger version (160K): [in a new window]   Figure 2c.  High-grade uterine sarcoma in a 61-year-old woman. Sagittal unenhanced gradient-echo MR image of the uterus (a) and contrast-enhanced gradient-echo MR images of the uterus obtained 15 (b) and 35 (c) seconds after intravenous administration of gadopentetate dimeglumine show enhancement of a uterine neoplasm.

View larger version (135K): [in a new window]   Figure 3a.  Fibroid tumors in a 50-year-old woman. (a) Sagittal fast spin-echo T2-weighted MR image demonstrates intramural fibroid tumors. The anterior tumor has heterogeneous signal intensity, whereas the posterior and superior tumors have the more typical low signal intensity. (b) Sagittal contrast-enhanced gradient-echo T1-weighted MR image demonstrates enhancement of the tumors.

View larger version (119K): [in a new window]   Figure 3b.  Fibroid tumors in a 50-year-old woman. (a) Sagittal fast spin-echo T2-weighted MR image demonstrates intramural fibroid tumors. The anterior tumor has heterogeneous signal intensity, whereas the posterior and superior tumors have the more typical low signal intensity. (b) Sagittal contrast-enhanced gradient-echo T1-weighted MR image demonstrates enhancement of the tumors.

View larger version (173K): [in a new window]   Figure 4a.  Endometrial stromal sarcoma in a 35-year-old woman. (a) Sagittal fast spin-echo T2-weighted MR image demonstrates a high-signal-intensity mass in the endometrial canal that originates from the corpus uteri. (b) Axial contrast-enhanced spin-echo T1-weighted MR image shows enhancement of the mass.

View larger version (149K): [in a new window]   Figure 4b.  Endometrial stromal sarcoma in a 35-year-old woman. (a) Sagittal fast spin-echo T2-weighted MR image demonstrates a high-signal-intensity mass in the endometrial canal that originates from the corpus uteri. (b) Axial contrast-enhanced spin-echo T1-weighted MR image shows enhancement of the mass.

View larger version (190K): [in a new window]   Figure 5a.  Pelvic adenosarcoma in a 47-year-old woman. (a) Sagittal fast spin-echo T2-weighted MR image reveals a mass with heterogeneous signal intensity. (b) Axial contrast-enhanced spin-echo T1-weighted MR image demonstrates enhancement of the mass.

View larger version (159K): [in a new window]   Figure 5b.  Pelvic adenosarcoma in a 47-year-old woman. (a) Sagittal fast spin-echo T2-weighted MR image reveals a mass with heterogeneous signal intensity. (b) Axial contrast-enhanced spin-echo T1-weighted MR image demonstrates enhancement of the mass.

View larger version (154K): [in a new window]   Figure 6a.  Carcinosarcoma in a 69-year-old woman. (a) Axial spin-echo T1-weighted MR image shows a mass with intermediate signal intensity that replaces the uterine corpus and cervix and extends through the internal os. (b) On a sagittal fast spin-echo T2-weighted MR image, the mass has high signal intensity and replaces the endometrial canal.

View larger version (176K): [in a new window]   Figure 6b.  Carcinosarcoma in a 69-year-old woman. (a) Axial spin-echo T1-weighted MR image shows a mass with intermediate signal intensity that replaces the uterine corpus and cervix and extends through the internal os. (b) On a sagittal fast spin-echo T2-weighted MR image, the mass has high signal intensity and replaces the endometrial canal.

View larger version (161K): [in a new window]   Figure 7a.  Squamous cell carcinoma of the cervix in a 37-year-old woman. (a) On an axial spin-echo T1-weighted MR image, a mass with intermediate signal intensity is seen to arise from the uterine cervix. Note the enlarged external iliac nodes on the right side. (b) On a sagittal fast spin-echo T2-weighted MR image, the mass has intermediate signal intensity. The area of hyperintensity on T1- and T2-weighted images represents blood products. There is no extension of tumor to the bladder or rectum.

View larger version (144K): [in a new window]   Figure 7b.  Squamous cell carcinoma of the cervix in a 37-year-old woman. (a) On an axial spin-echo T1-weighted MR image, a mass with intermediate signal intensity is seen to arise from the uterine cervix. Note the enlarged external iliac nodes on the right side. (b) On a sagittal fast spin-echo T2-weighted MR image, the mass has intermediate signal intensity. The area of hyperintensity on T1- and T2-weighted images represents blood products. There is no extension of tumor to the bladder or rectum.

View larger version (198K): [in a new window]   Figure 8a.  Fallopian tube adenocarcinoma in a 76-year-old woman with a history of the disease. The patient had a recurrent large mass in the cul-de-sac that extended to the vaginal cuff and compressed the rectosigmoid colon. The mass was inseparable from small bowel loops. (a) Sagittal fast spin-echo T2-weighted MR image demonstrates the mass with areas of high and intermediate signal intensity. (b) Axial contrast-enhanced T1-weighted MR image shows enhancement of the solid component of the mass with areas of necrosis.

View larger version (160K): [in a new window]   Figure 8b.  Fallopian tube adenocarcinoma in a 76-year-old woman with a history of the disease. The patient had a recurrent large mass in the cul-de-sac that extended to the vaginal cuff and compressed the rectosigmoid colon. The mass was inseparable from small bowel loops. (a) Sagittal fast spin-echo T2-weighted MR image demonstrates the mass with areas of high and intermediate signal intensity. (b) Axial contrast-enhanced T1-weighted MR image shows enhancement of the solid component of the mass with areas of necrosis.

View larger version (198K): [in a new window]   Figure 9a.  Clear cell carcinoma of the ovary in a 41-year-old woman. (a) Sagittal fast spin-echo T2-weighted MR image demonstrates a hyperintense mass. (b) On an axial contrast-enhanced spin-echo T1-weighted MR image, the mass demonstrates heterogeneous enhancement.

View larger version (180K): [in a new window]   Figure 9b.  Clear cell carcinoma of the ovary in a 41-year-old woman. (a) Sagittal fast spin-echo T2-weighted MR image demonstrates a hyperintense mass. (b) On an axial contrast-enhanced spin-echo T1-weighted MR image, the mass demonstrates heterogeneous enhancement.

View larger version (165K): [in a new window]   Figure 10a.  Metastatic breast cancer in the ovary in a 66-year-old woman. (a) Axial fast spin-echo T2-weighted MR image shows a left adnexal mass with both cystic and solid components and a right adnexal mass that is mostly solid. (b) On an axial contrast-enhanced spin-echo T1-weighted MR image, there is enhancement of the solid components of the adnexal masses.

View larger version (170K): [in a new window]   Figure 10b.  Metastatic breast cancer in the ovary in a 66-year-old woman. (a) Axial fast spin-echo T2-weighted MR image shows a left adnexal mass with both cystic and solid components and a right adnexal mass that is mostly solid. (b) On an axial contrast-enhanced spin-echo T1-weighted MR image, there is enhancement of the solid components of the adnexal masses.

View larger version (187K): [in a new window]   Figure 11a.  Metastatic renal cell carcinoma in the right ovary in a 62-year-old woman. The patient had a history of supracervical hysterectomy, which had revealed this tumor. (a) Sagittal fast spin-echo T2-weighted MR image demonstrates a mass with heterogeneous signal intensity. (b) On an axial contrast-enhanced T1-weighted MR image, the mass demonstrates variable enhancement.

View larger version (169K): [in a new window]   Figure 11b.  Metastatic renal cell carcinoma in the right ovary in a 62-year-old woman. The patient had a history of supracervical hysterectomy, which had revealed this tumor. (a) Sagittal fast spin-echo T2-weighted MR image demonstrates a mass with heterogeneous signal intensity. (b) On an axial contrast-enhanced T1-weighted MR image, the mass demonstrates variable enhancement.

View larger version (168K): [in a new window]   Figure 12a.  Multicystic mesothelioma in a 54-year-old woman. (a) Axial fast spin-echo T2-weighted MR image shows a mass with areas of high and intermediate signal intensity. There is mass effect on the sigmoid colon. (b) Axial contrast-enhanced T1-weighted MR image demonstrates minimal enhancement of the multiloculated mass.

View larger version (160K): [in a new window]   Figure 12b.  Multicystic mesothelioma in a 54-year-old woman. (a) Axial fast spin-echo T2-weighted MR image shows a mass with areas of high and intermediate signal intensity. There is mass effect on the sigmoid colon. (b) Axial contrast-enhanced T1-weighted MR image demonstrates minimal enhancement of the multiloculated mass.

View larger version (158K): [in a new window]   Figure 13a.  Pseudomyxoma peritonei in a 67-year-old woman. (a) Axial fast spin-echo T2-weighted MR image demonstrates a mostly high-signal-intensity mass. (b) Axial contrast-enhanced fat-saturated T1-weighted MR image shows enhancement of the solid components of the mass.

View larger version (156K): [in a new window]   Figure 13b.  Pseudomyxoma peritonei in a 67-year-old woman. (a) Axial fast spin-echo T2-weighted MR image demonstrates a mostly high-signal-intensity mass. (b) Axial contrast-enhanced fat-saturated T1-weighted MR image shows enhancement of the solid components of the mass.

View larger version (164K): [in a new window]   Figure 14a.  Locally invasive pelvic desmoid tumor in a 25-year-old woman. (a) Axial fast spin-echo T2-weighted MR image demonstrates a hypointense mass. (b) On an axial contrast-enhanced T1-weighted MR image, the mass demonstrates only minimal enhancement.

View larger version (155K): [in a new window]   Figure 14b.  Locally invasive pelvic desmoid tumor in a 25-year-old woman. (a) Axial fast spin-echo T2-weighted MR image demonstrates a hypointense mass. (b) On an axial contrast-enhanced T1-weighted MR image, the mass demonstrates only minimal enhancement.

View larger version (182K): [in a new window]   Figure 15a.  Locally advanced rectal cancer in a 68-year-old woman. There was a large mass that extended posteriorly to the sacrum, the pelvic sidewall, the piriformis muscles, and the posterior wall of the vagina. (a) Sagittal fast spin-echo T2-weighted MR image shows a hyperintense mass. (b) On an axial contrast-enhanced T1-weighted MR image, the mass demonstrates heterogeneous enhancement.

View larger version (155K): [in a new window]   Figure 15b.  Locally advanced rectal cancer in a 68-year-old woman. There was a large mass that extended posteriorly to the sacrum, the pelvic sidewall, the piriformis muscles, and the posterior wall of the vagina. (a) Sagittal fast spin-echo T2-weighted MR image shows a hyperintense mass. (b) On an axial contrast-enhanced T1-weighted MR image, the mass demonstrates heterogeneous enhancement.

View larger version (138K): [in a new window]   Figure 16a.  GIST of the rectovaginal septum in a 61-year-old woman. (a) Axial spin-echo T1-weighted MR image demonstrates a mass with intermediate signal intensity. (b) Sagittal fast spin-echo T2-weighted MR image demonstrates the mass in the rectovaginal septum. (c) On an axial contrast-enhanced T1-weighted MR image, the mass demonstrates marked enhancement.

View larger version (175K): [in a new window]   Figure 16b.  GIST of the rectovaginal septum in a 61-year-old woman. (a) Axial spin-echo T1-weighted MR image demonstrates a mass with intermediate signal intensity. (b) Sagittal fast spin-echo T2-weighted MR image demonstrates the mass in the rectovaginal septum. (c) On an axial contrast-enhanced T1-weighted MR image, the mass demonstrates marked enhancement.

View larger version (144K): [in a new window]   Figure 16c.  GIST of the rectovaginal septum in a 61-year-old woman. (a) Axial spin-echo T1-weighted MR image demonstrates a mass with intermediate signal intensity. (b) Sagittal fast spin-echo T2-weighted MR image demonstrates the mass in the rectovaginal septum. (c) On an axial contrast-enhanced T1-weighted MR image, the mass demonstrates marked enhancement.

View larger version (127K): [in a new window]   Figure 17a.  Large pelvic hemangiopericytoma in a 36-year-old woman. (a) Axial spin-echo T1-weighted MR image demonstrates a mass with intermediate signal intensity in the left sacrum, ileum, and surrounding structures. (b) On a sagittal fast spin-echo T2-weighted MR image, the mass demonstrates increased signal intensity. (c) On an axial contrast-enhanced T1-weighted MR image, the mass demonstrates enhancement.

View larger version (161K): [in a new window]   Figure 17b.  Large pelvic hemangiopericytoma in a 36-year-old woman. (a) Axial spin-echo T1-weighted MR image demonstrates a mass with intermediate signal intensity in the left sacrum, ileum, and surrounding structures. (b) On a sagittal fast spin-echo T2-weighted MR image, the mass demonstrates increased signal intensity. (c) On an axial contrast-enhanced T1-weighted MR image, the mass demonstrates enhancement.

View larger version (132K): [in a new window]   Figure 17c.  Large pelvic hemangiopericytoma in a 36-year-old woman. (a) Axial spin-echo T1-weighted MR image demonstrates a mass with intermediate signal intensity in the left sacrum, ileum, and surrounding structures. (b) On a sagittal fast spin-echo T2-weighted MR image, the mass demonstrates increased signal intensity. (c) On an axial contrast-enhanced T1-weighted MR image, the mass demonstrates enhancement.

View larger version (144K): [in a new window]   Figure 18.  Large, well-differentiated pelvic liposarcoma in a 68-year-old woman. The mass extended inferiorly from the common iliac level, with considerable adipose tissue and solid components, and abutted the presacral fascia. (a) Axial spin-echo T1-weighted MR image shows a hyperintense mass. (b) On a sagittal fast spin-echo T2-weighted MR image, the mass shows increased signal intensity.

View larger version (171K): [in a new window]   Figure 18.  Large, well-differentiated pelvic liposarcoma in a 68-year-old woman. The mass extended inferiorly from the common iliac level, with considerable adipose tissue and solid components, and abutted the presacral fascia. (a) Axial spin-echo T1-weighted MR image shows a hyperintense mass. (b) On a sagittal fast spin-echo T2-weighted MR image, the mass shows increased signal intensity.