Multi-parameter Quantitative Magnetic Resonance Study Of Adenomyosis

Purpose:To explore whether MultiVane XD technique,compared to conventional acquisition technique,can improve the quality of T2 weighted imaging(T2WI)in magnetic resonance imaging(MRI)examination of female pelvis.To explore the correlation between clinical symptoms of patients with adenomyosis and their MRI parameters,both morphologically and functionally.And to explore their difference between patients with different therapeutic reactions to gonadotropin releasing hormone agonists(GnRH-a).Methods:Patients suspected of adenomyosis were involved,and 3.0T pelvic MRI examinations were performed during peri-ovulatory period.Conventional and MVXD T2WI were acquired in both sagittal and axial sections.2 observers rated those 4 series in the aspects of sharpness of uterine border,motion artifacts,overall image quality,identification capability of lesions,confidence of diagnosis and sharpness of junctional zone.Scores of two acquisition techniques were compared.Clinical information,including visual analogue scale of pelvic pain and menstrual blood volume(MBV),were collected.Morphological and functional parameters and uterine peristalsis were acquired via T1,T2,and T2*relaxometry mapping sequence.Amide proton transfer(APT)value and intravoxel incoherent motion(IVIM)-diffusion kurtosis imaging(DKI)parameters were acquired via their corresponding sequences.Difference of clinical symptoms and uterine peristalsis among morphological groups was compared,and correlations with morphological and functional parameters were analysed.Patients were followed regarding their treatment by GnRH-a.Morphological types,morphological parameters and functional parameters were compared between patients with different response to GnRH-a treatment.Results:20 patients were enrolled in Part 1.Compared to conventional acquisition technique,scores of observer A in sharpness of uterine border,motion artifacts,and overall image quality is higher by MVXD.No statistically significant difference was found identification capability of lesions,confidence of diagnosis and sharpness of junctional zone.Similar patterns were found by observer B.60 patients were enrolled in Part 2.12 patients were ruled out and 38 patients were finally enrolled.T2*relaxation time of lesions was negatively correlated with VAS and it's statistically significant.Compared to patients with normal and slightly high MBV,thickness of junctional zone in patients with high MBV was higher,and APT values of lesions were higher.Compared to patients with normal uterine peristalsis,maximal diameters of lesions with abnormal uterine peristalsis were higher,and less uterine peristalsis were observed in patients with lesions of>1/3 of corpora uteri volume than<1/3 of corpora uteri volume.Uterine peristalsis frequencies were found to be positively correlated with T1,T2,and T2*relaxation times of lesions,and negatively correlated with Kurtosis of lesions.12 patients received GnRH-a treatment,with 6 patients having complete response and 6 patients having partial response.Compared to patients with partial response,APT and D*values of lesions were higher compared to patients with complete response.Conclusion:T2WI MVXD,compared to conventional acquisition technique,could improve image quality,with equal capacity of lesion recognition and diagnosis.Pelvic pain VAS in patients with adenomyosis was negatively correlated with T2*relaxation time of lesions.Thickness of junctional zone in patients with high MBV was higher than that of patients with normal or slightly high MBV,and APT values of lesions were higher.Uterine peristalsis was related with maximal diameters of lesion and its volume compared with corpora uteri.Uterine peristalsis frequencies were positively correlated with T1,T2,and T2*relaxation times of lesions,and negatively correlated with Kurtosis of lesions.Compared to patients with partial response to GnRH-a,APT and D*values of lesions were higher compared to patients with complete response.An APT value higher than 2.035%or D*lower than 52.92 mm2/s was considered risk factors of partial response to GnRH-a.