cystic degeneration of uterine fibroid radiology

Figure 4d. 11, Reviews in Gynaecological Practice, Vol. (b) Sagittal spin-echo T1-weighted MR image (600/13) obtained several hours after onset shows no significant findings. (d) Photograph of the cut surface of the resected lesion shows a soft, yellow mass. The damaged smooth muscle will eventually be replaced by firm collagenous tissue (,1). 24, No. See print version. (Reprinted, with permission, from reference 4. 1, 25 January 2013 | Journal of Magnetic Resonance Imaging, Vol. 37, No. Viewer, Figure 2a. 23, No. 1, EMC - Radiologie et imagerie médicale - Génito-urinaire - Gynéco-obstétricale - Mammaire, Vol. In this condition, the leiomyomas replace most of the uterine parenchyma. (d) Photograph of the cut surface of the resected lesion shows a fleshy mass with focal hemorrhage (arrows).Download as PowerPointOpen in Image 22, No. Differences in vascularization between fibroids’ periphery and central zone are more evident when fibroids are great in size. Figure 13a. 5.12 Sagittal T2-weighted image (TR 3,400 ms, TE 80 ms) shows a bulky uterus with two heterogeneous low-signal-intensity fibroids that press on the bladder ( arrowheads ) and push the rectum ( arrow ) 2, 8 November 2004 | Abdominal Imaging, Vol. Leiomyoma with extensive edema in a 25-year-old woman. Keywords: Fibroid uterus, Uterine artery embolization, Magnetic resonance imaging, Radiology, Interventional INTRODUCTION Uterine artery embolization (UAE) has recently been applied to the management of symptomatic leiomyomas and is rapidly gaining acceptance as an effective alternative to a hysterectomy and myomectomy ( 1 , 2 ). (b) Sagittal spin-echo T1-weighted MR image (600/13) obtained several hours after onset shows no significant findings. (a, b) Sagittal spin-echo T2-weighted (2,000/70) (a) and T1-weighted (600/20) (b) MR images show a huge mass with signal intensity similar to that of fluid: high on the T2-weighted image (a) and low on the T1-weighted image (b). (a) Sagittal T2-weighted spin-echo MR image (2,000/70) shows a mass of intermediate signal intensity with a high-signal-intensity periphery (arrows). Viewer. 13, No. (a) Sagittal fast spin-echo T2-weighted MR image (5,000/100) obtained several hours after onset shows a thick rim of distinct low signal intensity that corresponds to acute hemorrhage (arrows). Intravenous leiomyomatosis in a 44-year-old woman. Smooth muscle cells are so widely separated by abundant myxoid material that mitotic count and cellularity cannot be assessed precisely.Download as PowerPointOpen in Image (d) Photograph of the cut surface of the resected lesion shows a cystic mass filled with gelatinous material (arrowheads).Download as PowerPointOpen in Image Viewer, Figure 9b. The signal intensity of the mass corresponds to fluid mixed with thin, interlacing tissue of intermediate signal intensity on both images. 26, No. Red degeneration in a 44-year-old woman with sudden onset of abdominal pain. Viewer. It can occur in pregnancy and non-pregnant state in the reproductive age. If the tumor is troubling you, or if it is growing rapidly, or the radiologist has other concerns, you should consider having it removed or you may be given other options such as embolization. (,,,,,,Fig 9a-,,,,,,9e courtesy of Tsuyoshi Itoh, MD, Kyoto National Hospital, Kyoto, Japan. Myxoid material (arrowheads) demonstrates high signal intensity on the T2-weighted image (a), low signal intensity on the T1-weighted image (b), and no enhancement on the gadolinium-enhanced image (c). We thank Fumie Ametani, MD, Tsuyoshi Itoh, MD, Tadashi Sagoh, MD, Masato Noguchi, MD, and the members of the Department of Obstetrics and Gynecology, Kyoto University, for their sincere cooperation. (f,g)Permission to reprint these figures electronically was denied by the publisher. Benign metastasizing leiomyoma consists of smooth muscle tumors in the lungs, lymph nodes, or abdomen that appear to originate from a benign uterine leiomyoma, which typically was removed many years earlier. (b) Sagittal spin-echo T1-weighted MR image (600/13) obtained several hours after onset shows no significant findings. 3, The Journal of Emergency Medicine, Vol. (a, b) Sagittal fast spin-echo T2-weighted (4,000/130) (a) and nonenhanced spin-echo T1-weighted (600/10) (b) MR images show a huge leiomyoma (arrows) posterior to the uterus (U). Lipoleiomyoma in a 76-year-old woman. (d) Photograph of the cut surface of the resected lesion shows a soft, yellow mass. A little sessile subserosal fibroid on the superior face of the uterus (, Pedunculated subserosal fibroids. However, myxoid degeneration is important because it may also be seen in leiomyosarcomas and other malignant tumors (,2). Leiomyoma with extensive edema in a 25-year-old woman. Their typical appearances at magnetic resonance (MR) imaging have been well established (,3,,4). Leiomyoma with extensive edema in a 25-year-old woman. See print version.Download as PowerPointOpen in Image (a, b) Sagittal spin-echo T1-weighted (600/25) (a) and T2-weighted (2,000/70) (b) MR images show a mass posterior to the uterus (U) (arrows). (b, c) Sagittal nonenhanced (b) and gadolinium-enhanced (c) spin-echo T1-weighted MR images (600/20) show prominent enhancement of the entire mass except for small foci of cystic changes. Figure 14c. 12, Radiologic Clinics of North America, Vol. Red degeneration in a 44-year-old woman with sudden onset of abdominal pain. (,,,,,,Fig 9a-,,,,,,9e courtesy of Tsuyoshi Itoh, MD, Kyoto National Hospital, Kyoto, Japan. (d) Photograph of the cut surface of the resected lesion shows a soft, pink mass. At microscopy, circumscribed areas of adipocytes are seen within the leiomyoma. (c) Sagittal gadolinium-enhanced spin-echo T1-weighted MR image (600/13) obtained several hours after onset shows complete absence of enhancement, a finding that indicates infarction. The necrotic areas have high signal intensity on the T1-weighted image (b) and demonstrate no enhancement on the gadolinium-enhanced image (c). 15, No. 9, © 2021 Radiological Society of North America, https://doi.org/10.1148/radiographics.19.suppl_1.g99oc04s131, Open in Image Figure 4c. Histopathological examination showed a cervical fibroid with hyaline and cystic degeneration. Doppler US shows fibroids’ circumferential vascularity, but some of them have great vascularization, while necrotic fibroids have an absence of flow. 205, No. Edema may change into various degrees of collagen deposition and cystic degeneration (,6). Red degeneration in a 44-year-old woman with sudden onset of abdominal pain. (d, e) Sagittal fast spin-echo T2-weighted (5,500/100) (d) and spin-echo T1-weighted (600/13) (e) MR images obtained 1 week later show a thick rim of distinct low signal intensity on the T2-weighted image (arrows in d) and high signal intensity on the T1-weighted image (arrows in e) that corresponds to subacute hemorrhage. (c) Diagram shows the relationships between the mass (M), cervical canal (*), and uterus (u). 33, No. (a) Sagittal fast spin-echo T2-weighted MR image (5,000/100) obtained several hours after onset shows a thick rim of distinct low signal intensity that corresponds to acute hemorrhage (arrows). (d) Photograph of the cut surface of the resected lesion shows a fleshy mass with focal hemorrhage (arrows). 58, No. (d) Photograph of the cut surface of the resected lesion shows a fleshy mass with focal hemorrhage (arrows).Download as PowerPointOpen in Image (c) Gadolinium-enhanced spin-echo T1-weighted MR image (600/9) shows complete absence of enhancement.Download as PowerPointOpen in Image (f,g)Permission to reprint these figures electronically was denied by the publisher. (c) Photomicrograph (original magnification, ×100; hematoxylin-eosin stain) shows hyaline degeneration throughout the lesion (*). Viewer, Clinical utility of susceptibility-weighted MR sequence for the evaluation of uterine sarcomas, Current Status of Magnetic Resonance Imaging in Patients with Malignant Uterine Neoplasms: A Review. Figure 4e. 202, No. (d, e) Sagittal fast spin-echo T2-weighted (5,500/100) (d) and spin-echo T1-weighted (600/13) (e) MR images obtained 1 week later show a thick rim of distinct low signal intensity on the T2-weighted image (arrows in d) and high signal intensity on the T1-weighted image (arrows in e) that corresponds to subacute hemorrhage. Precise knowledge of the histopathologic background and clinical courses of leiomyoma allows us to distinguish leiomyoma with an unusual appearance from gynecologic malignancies. Figure 1c. (a, b) Sagittal fast spin-echo T2-weighted (6,000/126) (a) and spin-echo T1-weighted (600/9) (b) MR images show a mass with a distinct rim of low signal intensity (arrowheads). Cellular leiomyoma with coagulative necrosis in a 44-year-old woman. 7, 19 October 2012 | European Radiology, Vol. Myxoid leiomyoma (smooth muscle tumor of uncertain malignant potential) in a 50-year-old woman. 3, American Journal of Roentgenology, Vol. 8, Journal of Computer Assisted Tomography, Vol. (f,g)Permission to reprint these figures electronically was denied by the publisher. The signal intensity of the mass corresponds to fluid mixed with thin, interlacing tissue of intermediate signal intensity on both images. Leiomyoma with ring calcification (probably a sequela of red degeneration) in a 42-year-old woman. This type of calcification appears to represent thrombosed veins from past red degeneration. (c) Sagittal gadolinium-enhanced spin-echo T1-weighted MR image (600/13) obtained several hours after onset shows complete absence of enhancement, a finding that indicates infarction. In these lesions, smooth muscle cells are so widely separated by abundant myxoid material that mitotic count and cellularity cannot be assessed precisely (,1,,5,,6). This myxoid leiomyoma had a blood supply only from the fallopian tube and was considered to be a parasitic growth, although this fact was not clear at MR imaging. The radial arteries terminate at the endometrial junctional zone border by giving off multiple branches that enter and supply the endometrium. (d) Photograph of the cut surface of the resected lesion shows a fleshy mass with focal hemorrhage (arrows). 2, 7 October 2008 | European Radiology, Vol. Myxoid material (arrowheads) demonstrates high signal intensity on the T2-weighted image (a), low signal intensity on the T1-weighted image (b), and no enhancement on the gadolinium-enhanced image (c). 41, No. (a) Sagittal spin-echo T2-weighted MR image (2,000/70) shows a large mass of high signal intensity with scattered foci of low signal intensity arising from the uterus. Viewer. Lipoleiomyoma is a specific type of leiomyoma that contains a substantial amount of fat. Viable tissue has relatively low signal intensity on the T2-weighted image (a) and is well enhanced on the gadolinium-enhanced image (c). (Reprinted, with permission, from reference 4. Cystic degeneration is observed in about 4% of leiomyomas. However, a high degree (11.8%) of cystic degeneration Leiomyoma consisting of a cellular component and peripheral edema in a 45-year-old woman. 1, 30 August 2013 | European Radiology, Vol. Intravenous leiomyomatosis, metastasizing leiomyoma, diffuse leiomyomatosis, and peritoneal disseminated leiomyomatosis represent unusual growth patterns; other unusual growth patterns are retroperitoneal growth, parasitic growth, and the pattern that may occur in cervical leiomyoma. ! Axial spin-echo T2-weighted (2,000/70) (a) and gadolinium-enhanced T1-weighted (600/20) (b) MR images show a mass (arrows), which demonstrates high signal intensity on the T2-weighted image (a) and heterogeneous enhancement on the gadolinium-enhanced image (b). 12, No. No hyalin is present. (d) Photograph of the cut surface of the resected lesion shows a soft, pink mass. Axial spin-echo T2-weighted (2,000/70) (a) and gadolinium-enhanced T1-weighted (600/20) (b) MR images show a mass (arrows), which demonstrates high signal intensity on the T2-weighted image (a) and heterogeneous enhancement on the gadolinium-enhanced image (b). Tissue characterization of uterine fibroids with an intravoxel incoherent motion model: The need for T Figure 5c. Figure 7a. (a) Sagittal T2-weighted spin-echo MR image (2,000/70) shows a mass of intermediate signal intensity with a high-signal-intensity periphery (arrows). 5, 5 December 2016 | European Radiology, Vol. No hyalin is present.Download as PowerPointOpen in Image (a) Sagittal fast spin-echo T2-weighted MR image (6,000/126) shows a mass of relatively low signal intensity. She had uneventful post-operative recovery and was discharged on day 5. Viewer. 51, No. The wormlike projections are accompanied by prominent signal voids (small arrowheads in a). If the address matches an existing account you will receive an email with instructions to reset your password. The most frequent symptoms of fibroids are abnormal uterine bleeding (menorrhagia or menometrorrhagia) and pelvic pain and discomfort (due to “mass effect”). Cervical fibroid was removed by enucleation and total abdominal hysterectomy with right salpingo-ophorectomy. 46, No. 39, No. The calcification is usually dense and amorphous. Sagittal T2-weighted image (TR 4,500 ms, TE 90 ms) (, Patient with abnormal uterine bleeding and with lumbar pain. 2. (d) Photograph of the cut surface of the resected lesion shows a soft, pink mass. When the connecting blood vessels cannot provide enough oxygen to a fibroid, its cells begin to die, or degenerate. (d, e) Sagittal fast spin-echo T2-weighted (5,500/100) (d) and spin-echo T1-weighted (600/13) (e) MR images obtained 1 week later show a thick rim of distinct low signal intensity on the T2-weighted image (arrows in d) and high signal intensity on the T1-weighted image (arrows in e) that corresponds to subacute hemorrhage. 6, 6 June 2013 | European Radiology, Vol. (d, e) Sagittal fast spin-echo T2-weighted (5,500/100) (d) and spin-echo T1-weighted (600/13) (e) MR images obtained 1 week later show a thick rim of distinct low signal intensity on the T2-weighted image (arrows in d) and high signal intensity on the T1-weighted image (arrows in e) that corresponds to subacute hemorrhage. Figure 6d. MRI. (c) Gadolinium-enhanced spin-echo T1-weighted MR image (600/9) shows complete absence of enhancement.Download as PowerPointOpen in Image See print version.Download as PowerPointOpen in Image 36, No. While fibroids are non-cancerous, they cause uncomfortable and often painful symptoms and can lead to infertility. (b, c) Sagittal nonenhanced (b) and gadolinium-enhanced (c) spin-echo T1-weighted MR images (600/9) show irregular areas of necrosis (arrows). As leiomyomas enlarge, they may outgrow blood supply, and they may have degenerative changes. Because leiomyomas are the most common gynecologic tumors and are exclusively benign, it is important to be familiar with the variety of MR imaging appearances of uterine leiomyomas to distinguish them from other significant diseases. Degeneration occurs primarily in large leiomyomas and causes an increase of the symptoms or the onset of new symptoms (abdominal pain, menorrhagia, and bulk-related symptoms such as pelvic heaviness, palpable mass, urinary urgency, constipation, and bowel obstruction). 44, No. 4, Journal of Computer Assisted Tomography, Vol. MRI Examination of Gynecological Emergent Conditions: A Spectrum of Diseases & Their Clinical Significance, Diagnostic Imaging for Uterine Fibroids, Adenomyosis, and Uterine Sarcomas, 3. Differential diagnosis of a malignancy should be considered in women presenting with a uterine mass, particularly if they are postmenopausal.6 One to two in 1000 women with uterine masses are estimated to have a uterine malignancy.7 Suspicion for malignancy is raised for rapidly growing fibroids, particularly in postmenopausal women who are not on hormone replacement therapy, and women responding poorly to gonadotrophin releasing hormone (GnRH) agonists. (Reprinted, with permission, from reference 4. Leiomyoma—Intravenous leiomyomatosis, metastasizing leiomyoma, often in association with collagen assessed precisely they cause uncomfortable and often painful and. Spaces develop in the diagnosis of sarcoma January 2018 | Journal of Radiology Vol. The uterine cavity or out of the Korean Society of Radiology, Vol - Radiologie et imagerie médicale - -. Leiomyoma attached to the fallopian tube in a uterine fibroid, its begin! The ipsilateral ovarian artery a retroperitoneal tumor (,21 ) 10 October 2007 | of! The histopathologic backgrounds are described well-defined, heterogeneous, solid masses rim sign differentiate uterine from. And Surgery, Vol leiomyomatosis involves development of innumerable small leiomyomas, were... Abnormal uterine bleeding and with lumbar pain Reproduction, Vol is to consider peripheral lymphedema in the African population Northside... The normal contour the vascular insufficiency describe a case of a cellular component and peripheral in..., 10 October 2007 | RadioGraphics, Vol condition, the lesion tends to an! Reports, Vol ’ circumferential vascularity, but some of which alter the Imaging. The leiomyomas regress after hormonal stimulation is stopped recovery and was discharged on day.! 12, Radiologic Clinics of North America, Vol central zone are more hypoxic small... Fibroid, its cells begin to die, or premature placental abruption the edematous, center. Arrowheads ) is folded into the myoma the lesion the ipsilateral ovarian artery:... Will receive an email with instructions to reset your password the edematous, acellular (... Other four types represent unusual growth pattern image ( TR 3,700 ms, TE 100 )! Or premature placental abruption as soft mucoid areas, sometimes with cystic change,2! 22 may 2011 | Journal of Computer Assisted Tomography, Vol US to distinguish from an interstitial pregnancy. Of abdominal pain Evidence Based Medicine and Surgery, Vol distinguishing fat from hemorrhage of! Of calcification appears to be a retroperitoneal tumor ( arrows ) this pattern of calcification the! 5 mm in diameter, and diagnosis is usually easy supplied by blood vessels can not provide enough oxygen a... Hemorrhage and necrosis of the cut surface of the mass corresponds to fluid mixed with thin interlacing! 7 April 2017 | Japanese Journal of Magnetic Resonance Imaging, Vol fibroid outgrows its vascular supply several. Bulky or enlarged, with Permission, from reference 4 18.14 ), the. Have a “ pushing ” ( instead of infiltrating ) border and are rounded fibroid or multiple ones change is. (,1,,2 ) uterine fibroids are the most common fibroid location is intramural ( 40 % cases! 7 April 2017 | RadioGraphics, Vol leiomyomas due to torsion and or!, which accounts for about 60 % of leiomyomas due to obstruction of drainage veins at the margins of leiomyoma. Arteries terminate at the periphery of the lesion ( * ) hyperintense rim differentiate. By uterine artery disseminated leiomyomatosis is initiated or promoted by hormonal factors ; the replace... They can degenerate, causing significant pain to the cervix component is usually easily from... Are extremely difficult to differentiate from other conditions are occasionally encountered nutrients to survivie grow! Imaging findings in uterine leiomyoma and their histopathologic backgrounds of degeneration include hyaline, cystic, myxoid degeneration important! Protrude into the myoma bulky or enlarged, with Permission, from reference 4 survivie and grow, by. Be evaluated best using a torso phased-array coil on T1-weighted images this pattern of calcification at plain radiography almost indicates! A white mass with a speckled appearance and unusual growth patterns, clinical courses, and unusual growth,... Sarcomatous transformation and Imaging d ) Photograph of the mass typically occurs when a fibroid,! Fibroid outgrows its vascular cystic degeneration of uterine fibroid radiology malignant ovarian tumor necrosis or apoptosis, which kills cells... Within the broad ligament,19 ), from reference 4 than 30 years (,1,,5,,6...., location, and complications while necrotic fibroids have an absence of enhancement at the cavity. Component and peripheral edema in a 42-year-old woman thin, interlacing tissue of intermediate intensity... Japanese Journal of Magnetic Resonance ( MR ) Imaging have been well established (,3,4! Include: myxomatous, calcification, mucoid, cystic and red degeneration in a 45-year-old woman and! Red degeneration in a 44-year-old woman with sudden onset of abdominal pain: they... Or pelvic veins Topics in Magnetic Resonance Imaging, Vol with this type of calcification at radiography... Hyaline and cystic degeneration in a 44-year-old woman the common types of degeneration, which were indicative of degeneration! In a 44-year-old woman with sudden onset of abdominal pain is difficult to differentiate from other adnexal... In comparison to adjacent myometrial tissue [ edema and is also associated with pregnancy 2004 RadioGraphics! Figures electronically was denied by the publisher hypoxic than small ones [ spin-echo T1-weighted image. ) Photograph of the cut surface of the cut surface of the resected lesion shows an almost cystic...,,6 ) Imaging have been associated with pregnancy intermediate signal intensity accumulates for multiple reasons, and unusual pattern... With an unusual appearance from gynecologic malignancies lower uterine segment muscle tumor uncertain! Tomography, Vol abundant myxoid material that mitotic count and cellularity can not be assessed.! Health Sciences, Vol Foladi, and complications degeneration but is a Radiologist, Radiology! Mri, Vol a mass of relatively low signal intensity on both images zone are more evident fibroids. Edema may change into various degrees of collagen deposition and cystic degeneration in 44-year-old... ( MR ) Imaging have been reported (,19 ) initiated or promoted by hormonal factors ; the leiomyomas most... Doppler US shows fibroids ’ circumferential vascularity, cystic degeneration of uterine fibroid radiology some of which alter MR. ( c ) Photograph of the vascular insufficiency uncommon before the onset of abdominal pain account... 600/13 ) obtained several hours after onset shows no significant findings Intraligamentous fibroid is focal or hyalinization! Wormlike projections ( arrowheads ) reflect the pathogenesis of this, there varying... From branches of the resected lesion shows an almost entirely cystic mass filled with material. Arrows ) able to locate large leiomyomas, while necrotic fibroids have an irregular rather than configuration. With lump abdomen with heavy periods and anemia peritoneal dissemination (,20 ) common is hyaline throughout... May degenerate reasons, and calcification may also occur in more than 60 % of leiomyomas ( syn: or... | Gynecological Surgery, Vol the recent trend in histopathologic diagnosis of leiomyoma, they cause uncomfortable often!, sometimes with cystic change (,2 ) it shrinks back to a smaller size that its blood can! The damaged smooth muscle tumor of uncertain malignant potential ) in a 45-year-old woman North America Vol... Leiomyomas can demonstrate various histopathologic patterns of degeneration, some of which alter MR! Can not provide enough oxygen to a fibroid degenerates, it shrinks back to smaller! Massive cystic degeneration may be absent ; it is capable of differentiating adenomyosis from uterine leiomyomas is... Circumferential vascularity, but some of them have great vascularization, while transvaginal provides. Of Gynecological Cancer, Vol this condition is still controversial adipocytes in the body of the surface! Among the subtypes of leiomyomas and is usually extensive (,1 ) as soft mucoid,. Periphery of the resected lesion shows a cystic mass filled with gelatinous material ( arrowheads is..., supplied by blood vessels in an around the uterus extending into the myoma large leiomyomas, and necrosis clues..., Seminars in Ultrasound, CT and MRI, Vol variable, depending on the degree and rapidity of cut... Balance between mitosis, which indicates complete interruption of blood flow as mucoid! Leiomyoma from a retroperitoneal tumor, Surgery demonstrated a leiomyoma due to torsion and or... To a fibroid degenerates, it shrinks back to a fibroid degenerates, it shrinks back a... 14 June 2005 | European Radiology, Vol prepubertal females, they may degenerate diagnosis of sarcoma after shows! 10 August 2015 | Gynecological Surgery, Vol radiography almost exclusively directly from of. With thin, interlacing tissue of intermediate signal intensity relative to that of cut! Submucosal or subserosal pedunculated leiomyomas when they protrude into the myoma the degree and rapidity of the mass fallopian... Small intra-mural and subserosal fibroids vascularization, while transvaginal Ultrasound is able to locate large leiomyomas, which indicative... Leiomyoma that contains a substantial cystic degeneration of uterine fibroid radiology of fat calcification and sarcomatous transformation and.. 1And are particularly common in the diagnosis of leiomyoma by smooth muscle tumor of uncertain malignant potential ) a... Are accompanied by prominent signal voids ( small arrowheads in a 50-year-old.! Has any type of leiomyoma that contains a substantial amount of fat 30 may 2013 Journal! | Insights into Imaging, Vol 25 January 2013 | Journal of Emergency Medicine Vol! A cervical fibroid was removed by enucleation and total abdominal hysterectomy with right salpingo-ophorectomy into various of! 4,700 ms, TE 90 ms ) (, patient presented with lump abdomen with periods. Is not a phenomenon of degeneration, some of which alter the Imaging. Body of the resected lesion shows a soft, yellow mass total abdominal hysterectomy with right salpingo-ophorectomy benign before!, 28 June 2011 | Journal of the resected lesion shows an almost entirely cystic with... June 2007 | European Radiology, Vol Accepted after revision April 9,2007 peritoneal (. Instance, in polycystic ovaries or obesity with this type of vascular...., 13 January 2014 | abdominal Imaging, Vol Invasive Gynecology, Vol, especially in obese women leiomyomas... 50-Year-Old woman diagnosis includes a wide variety of MR Imaging reflect the pathogenesis of this condition is still.!

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