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Abstract D iffusion-weighted magnetic resonance (MR) imaging is a functional imaging technique whose contrast derives from the random motion of water molecules within tissues. Although its use in intracranial imaging has been established for a number of years, problems with motion and susceptibility artifacts have limited its application in abdominal and pelvic imaging. However, the development of new imaging techniques, particularly novel methods of data acquisition and parallel imaging, has allowed much faster data acquisition with fewer artifacts, resulting in significant improvement in image quality in body applications. Because image contrast is derived from inherent differences in the restriction of the movement of water molecules, no exogenous contrast medium adminis-ration is required, so that diffusion-weighted sequences can now be included in routine patient assessment. When diffusion-weighted MR imaging is used in gynecologic applications, cervical cancers have been shown to have significantly lower apparent diffusion coefficient (ADC) values compared with normal cervical tissue. Similar findings have been noted in endometrial cancers, with a tendency toward lower ADC values in higher-grade lesions. In addition, diffusion-weighted MR imaging shows promise as a biomarker for treatment response, with increasing ADC values noted in cervical carcinomas responding to radiation therapy. Diffusion-weighted MR imaging also shows promise in discriminating between benign and malignant lesions within the myometrium and endometrial cavity and in detecting peritoneal dissemination of gynecologic tumors. In this article, we review the means of acquiring diffusion-weighted MR images, discuss and illustrate the clinical applications of this modality in women with gynecologic malignancies, provide image interpretation guidelines. |