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Updated: Aug 18, 2026
Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques
Published on: June 11, 2019
A thickened or indistinct junctional zone on T2-weighted MR images in patients with endometrial carcinoma: pathologic
Yumiko Oishi Tanaka1, Masato Nishida, Hajime Tsunoda
1Department of Radiology, Institute of Clinical Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8575 Ibaraki, Japan. ytanaka@md.tsukuba.ac.jp
Abstract:
Thickened or indistinct junctional zone (JZ) is a problematic finding in staging endometrial carcinoma. We studied the incidence, pathological cause of this condition correlated to microcirculation, and the utility of dynamic contrast MRI for differential diagnosis. T2-weighted images were analyzed in 119 cases with endometrial carcinoma. The enhancement of the JZ during the dynamic contrast MRI, histopathological causes, and the density of arterioles in the JZ were retrospectively analyzed in cases with thickened or indistinct JZ. The MRI histopathological correlation of all 31 patients with a thickened or indistinct JZ were analyzed, in which it was corresponded to myometrial cancer invasion only in 22%. The sensitivity of a poor early enhancement pattern on dynamic study for detecting myometrial invasion was 71.4%, the specificity was 100%, and the overall accuracy was 92.5%. Although only weak relationship between the contrast enhancement and the arteriole density was revealed, the arteriole density within the JZ with cancer invasion was significantly decreased. Poor enhancement of JZ in early dynamic phase was correlated with the decreased density of arterioles within the myometrium which was invaded by endometrial carcinoma. Dynamic contrast study should be performed in staging endometrial carcinoma especially when JZ was thickened or indistinct.
Insights
A thickened or indistinct junctional zone (JZ) in endometrial carcinoma staging can be challenging. Dynamic contrast MRI is valuable for diagnosis, correlating poor JZ enhancement with decreased microcirculation in myometrial invasion.
Area of Science:
- Radiology and Medical Imaging
- Gynecologic Oncology
- Pathology
Background:
- The junctional zone (JZ) in endometrial carcinoma staging is critical.
- A thickened or indistinct JZ presents diagnostic challenges in endometrial cancer staging.
- Understanding the microcirculatory basis of JZ changes is important for accurate diagnosis.
Purpose of the Study:
- To investigate the incidence and pathological causes of thickened or indistinct JZ in endometrial carcinoma.
- To evaluate the utility of dynamic contrast MRI in the differential diagnosis of JZ abnormalities.
- To correlate MRI findings with microcirculatory changes (arteriole density) and histopathology.
Main Methods:
- Retrospective analysis of T2-weighted and dynamic contrast-enhanced MRI in 119 endometrial carcinoma cases.
- Histopathological examination of JZ, including arteriole density, in 31 patients with thickened or indistinct JZ.
- Correlation of MRI enhancement patterns with histopathological findings and myometrial invasion.
Main Results:
- A thickened or indistinct JZ corresponded to myometrial invasion in only 22% of cases.
- Poor early enhancement of the JZ on dynamic MRI showed high sensitivity (71.4%) and specificity (100%) for detecting myometrial invasion.
- Decreased arteriole density within the JZ was significantly associated with endometrial cancer invasion.
Conclusions:
- Dynamic contrast-enhanced MRI is a valuable tool for staging endometrial carcinoma, particularly when the JZ is thickened or indistinct.
- Poor JZ enhancement in the early dynamic phase is a reliable indicator of myometrial invasion, linked to reduced microcirculation.
- The study highlights the importance of dynamic MRI in differentiating benign from malignant causes of JZ abnormalities.
