MRI pelvis in a 40-year-old woman with heavy menstrual bleeding shows a 5 cm intramural fibroid with isointense signal on T1, heterogeneous hyperintense signal on T2, and no enhancement on post-contrast. The T2 signal appearance of leiomyomata (fibroids) and their MRI characteristics indicating degeneration are important for pre-surgical planning. A fibroid showing central high T2 signal with no enhancement after contrast indicates:

• A Cystic degeneration — necrosis with fluid accumulation ✓
• B Red (carneous) degeneration — most common in pregnancy
• C Hyaline degeneration — most common type, but this does not show central T2 high signal
• D Calcification — old degenerating fibroid

Explanation

Cystic degeneration of a fibroid represents liquefactive necrosis (usually following any type of degeneration) and appears on MRI as central T2 hyperintensity (fluid signal) with absent enhancement on post-contrast, indicating avascular necrotic/liquefied material. Hyaline degeneration (most common, ~65%) shows homogeneous low T2 signal. Red/carneous degeneration shows high T1 signal (haemorrhage) and is most common in pregnancy. Calcification shows T2 hypointense foci or rim, identifiable on plain X-ray/CT as well.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.