Pitfalls of diffusion-weighted imaging of the female pelvis

Area of Science:

• Radiology
• Medical Imaging
• Gynecologic Imaging

Background:

• Diffusion-weighted imaging (DWI) is integral to female pelvic magnetic resonance imaging (MRI).
• DWI offers functional and structural tissue insights without ionizing radiation or contrast agents.
• Restricted diffusion patterns on DWI can be misinterpreted, necessitating careful evaluation.

Purpose of the Study:

• To review physiological and benign pathological conditions in the female pelvis exhibiting restricted diffusion on DWI.
• To aid radiologists in differentiating benign from malignant lesions based on DWI characteristics.
• To highlight potential pitfalls in DWI interpretation for pelvic MRI.

Main Methods:

• Review of existing literature on DWI findings in the female pelvis.
• Analysis of DWI characteristics in physiological and benign pathological states.
• Correlation of DWI findings with conventional (T1- and T2-weighted) and contrast-enhanced MRI sequences.

Main Results:

• Certain benign lesions and physiological states can present with restricted diffusion on DWI, mimicking malignancy.
• High DWI signal intensity with low apparent diffusion coefficient (ADC) map signal is not exclusively indicative of malignancy.
• Accurate interpretation requires integration of DWI with other MRI sequences.

Conclusions:

• Radiologists must be aware of benign conditions that manifest restricted diffusion on pelvic DWI.
• Comprehensive MRI assessment, including conventional and contrast-enhanced sequences, is crucial for accurate diagnosis.
• Understanding these mimics improves diagnostic accuracy and patient management in gynecologic imaging.