Keywords:
Pathology, Diagnostic procedure, MR, Soft tissues / Skin, Pelvis, Musculoskeletal soft tissue
Authors:
B. S. Seker, G. YILMAZ, M. Atalar, B. Yıldız; SIVAS/TR
DOI:
10.1594/ecr2018/C-1386
Conclusion
AWE appears following the implantation of endometrial cells into the soft tissues of the abdominal wall after open uterine surgeries like Cesarean sections.
The incidence rate is reported at 0.4% to 0.1%.4 The disease is characterized by the triad of mass in the abdominal wall,
periodic pain associated with menses,
and history of abdominal surgery.
Its treatment is recognized to be broad surgical excision.3 The literature mostly contains single case reports or case series about AWE. AWE lesions can be seen almost anywhere on the abdominal wall from muscle to soft tissue.
However,
the most frequently affected anatomic structure is rectus abdominis muscle.
5,6 In this study,
we presented 16 cases of AWE in sixteen patients.
At MR images,
typical appearance was iso- to hyperintensity on T1W,
hyperintensity to heterogeneous on T2W,
and focal hyperintense spots (due to hemorrhage) on T1 FS series on almost all lesions.
Most of the lesions had irregular edges and showed the infiltrative nature of AWE.After Gadolinium contrast injection,
the lesions showed mild to moderate contrast enhancement. In our study,
diffusion showed a mean ADC value of 1.12 ± 0.05x10–3 (range: 0.99 to 1.19x10-3 mm2/s). In the study of Busard et al.7,
the mean ADC value for five AWEs was 0.93×10–3 mm2/s (range: 0.79 to 1.10x10–3 mm2/s). In the study of Franz et al.8,
the mean ADC value for four AWEs was 1.25x10-3 mm2/s.
Genc et al.9 found that the mean ADC values in AWE cases may vary according to the stages of the menstrual cycle.
In their study,
the ADC measurements were significantly lower in the menstrual phase than during the luteal phase (menstrual phase: 0.937x0.256 mm2/s,
luteal phase: 1.256x0.215 mm2/s).Our results were consistent with the literature.
The present study has some limitations.
First,
the number of patients with AWE was limited in this study.
The second possible restriction was that there was no comparison with normal-appearing endometrium in different phases of menstrual cycle. Another limitation was that there was no comparison with other pathologies affecting the abdominal wall.
As a result,
we think that DWI,
particularly ADC map,
can provide useful information for the diagnosis of AWE.