Endometrial cancer MRI: Difference between revisions

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==Overview==
==Overview==
Pelvic MRI may be diagnostic of endometrial cancer.
The MRI is not needed for the diagnosis of endometrial cancer. However, an MRI may be helpful in staging of the disease.<ref name=":0">{{Cite web | title =endometrial cancer MRI  | url =http://radiopaedia.org/articles/endometrial-carcinoma}}</ref>


==Pelvic MRI==
==Pelvic MRI==
A dedicated pelvic MRI protocol is recommended for optimal assessment.<ref>{{Cite web | title =endometrial cancer MRI  | url =http://radiopaedia.org/articles/endometrial-carcinoma}}</ref>
The MRI is not needed for the diagnosis of endometrial cancer. However, an MRI may be helpful in staging of the disease.<ref name=":0" />
MRI is considered superior to CT for local staging. Contrast enhanced MRI imaging improves accuracy in detecting myometrial invasion.
* T1: hypo- to isointense to normal [[endometrium]]
* T1 C+(Gd): carcinomatous tissue will enhance less than normal endometrium
* T2: hyperintense or heterogeneous relative to normal endometrium


{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align="center"
| valign="top" |
|+
'''MR Imaging findings according to FIGO stage'''
'''MR Imaging findings according to FIGO stage'''
:* stage 1: [[tumour]] confined to [[uterus]]
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Stage of endometrial cancer}}
::* stage 1a: tumour confined to the uterine endometrium
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|MRI findings}}
:::* normal or widened endometrium
|-
:::* normal low T2 signal junctional zone
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
:::* complete subendometrial enhancement on T1 contrast imaging
Stage 1: tumor confined to uterus
::* stage 1b: invasion of less than half of the myometrium
| style="padding: 5px 5px; background: #F5F5F5;" |
:::* disruption or irregularity of the low T2 signal junctional zone
:1a.
:::* disruption of subendometrial early enhancement
::* stage 1c: invasion of outer half of myometrium
:::* disruption or irregularity of the low T2 signal junctional zone
:::* disruption of subendometrial early enhancement
:::* preservation of band of outer [[myometrium]]
:* stage 2: tumour extends to [[cervix]]
::* stage 2a
:::* widening of internal os and endocervical canal by high/isointense T2W signal tumour mass.
:::* intact low T2W signal of normal cervical stroma
::* stage 2b
:::* widening of internal os and endocervical canal by high/isointense T2W signal tumour mass
:::* disruption of low T2 signal cervical stroma
:* stage 3: tumour extension beyond the [[uterus]]
::* stage 3a
:::* irregularity to the uterine contour
:::* disruption of low T2 signal uterine serosa
::* stage 3b
:::* thickening of vaginal wall
:::* high T2 signal tumour infiltrating low signal vaginal wall
::* stage 3c
:::* pelvic/para aortic lymph node involvement
:::* short axis >/= 8 mm in pelvic nodes
:* stage 4: bladder/rectal or distant metastasis
::* stage 4a
:::* disruption of low T2 signal [[bladder]] or rectal wall
:::* intraluminal bladder mass


{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
:* Disruption or irregularity of the low T2 signal junctional zone
|+
:* Disruption of subendometrial early enhancement
! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Stage}}
:1b.
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|MRI Findings}}
:* Disruption or irregularity of the low T2 signal junctional zone
|-
:* Disruption of subendometrial early enhancement
| style="padding: 5px 5px; background: #DCDCDC;" | '''Stage I'''
:* Preservation of band of outer myometrium
| style="padding: 5px 5px; background: #F5F5F5;" | Tumor confined to the corpus uteri
|-
|  rowspan=4 style="padding: 5px 5px; background: #DCDCDC;" | '''IA'''
| style="padding: 5px 5px; background: #F5F5F5;" | No or less than half myometrial invasion
|-
| style="padding: 5px 5px; background: #F5F5F5;" | normal or widened endometrium
|-
| style="padding: 5px 5px; background: #F5F5F5;" | normal low T2 signal junctional zone
|-
| style="padding: 5px 5px; background: #F5F5F5;" | complete subendometrial enhancement on T1 contrast imaging
|-
|  rowspan=3 style="padding: 5px 5px; background: #DCDCDC;" | '''IB'''
| style="padding: 5px 5px; background: #F5F5F5;" | Invasion equal to or more than half of the [[myometrium]]|-
| style="padding: 5px 5px; background: #F5F5F5;" | normal or widened endometrium
|-
| style="padding: 5px 5px; background: #F5F5F5;" | normal low T2 signal junctional zone
|-
| style="padding: 5px 5px; background: #F5F5F5;" | complete subendometrial enhancement on T1 contrast imaging
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''Stage II'''
| style="padding: 5px 5px; background: #F5F5F5;" | Tumor invades cervical stroma but does not extend beyond the [[uterus]]
|-
| style="padding: 5px 5px; background: #F5F5F5;" | normal or widened endometrium
|-
| style="padding: 5px 5px; background: #F5F5F5;" | normal low T2 signal junctional zone
|-
| style="padding: 5px 5px; background: #F5F5F5;" | complete subendometrial enhancement on T1 contrast imaging
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''Stage III'''
| style="padding: 5px 5px; background: #F5F5F5;" | Local and/or regional spread of the tumor
|-
| style="padding: 5px 5px; background: #F5F5F5;" | normal or widened endometrium
|-
| style="padding: 5px 5px; background: #F5F5F5;" | normal low T2 signal junctional zone
|-
| style="padding: 5px 5px; background: #F5F5F5;" | complete subendometrial enhancement on T1 contrast imaging
|-
|style="padding: 5px 5px; background: #DCDCDC;" |'''IIIA'''
| style="padding: 5px 5px; background: #F5F5F5;" | Tumor invades the serosa of the corpus uteri and/or adnexae
|-
| style="padding: 5px 5px; background: #F5F5F5;" | normal or widened endometrium
|-
| style="padding: 5px 5px; background: #F5F5F5;" | normal low T2 signal junctional zone
|-
| style="padding: 5px 5px; background: #F5F5F5;" | complete subendometrial enhancement on T1 contrast imaging
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''IIIB'''
| style="padding: 5px 5px; background: #F5F5F5;" | Vaginal involvement and/or parametrial involvement
|-
| style="padding: 5px 5px; background: #F5F5F5;" | normal or widened endometrium
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" | normal low T2 signal junctional zone
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
Stage 2: tumor extends to cervix
| style="padding: 5px 5px; background: #F5F5F5;" |
:* Widening of internal os and endocervical canal by high/isointense T2W signal tumor mass.
:* Intact low T2W signal of normal cervical stroma
:* Disruption of low T2 signal cervical stroma
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" | complete subendometrial enhancement on T1 contrast imaging
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
|-
Stage 3: tumor extension beyond the uterus
| rowspan=3 style="padding: 5px 5px; background: #DCDCDC;" | '''III C'''
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" | Metastases to pelvic and/or para-aortic lymph nodes
:3a
|-
:* Irregularity to the uterine contour
| style="padding: 5px 5px; background: #F5F5F5;" | (i) Positive pelvic nodes
:* Disruption of low T2 signal uterine serosa
|-
:3b
| style="padding: 5px 5px; background: #F5F5F5;" | (ii) Positive para-aortic nodes with or without positive pelvic [[lymph nodes]]
:* Thickening of vaginal wall
|-
:* High T2 signal tumor infiltrating low signal vaginal wall
| style="padding: 5px 5px; background: #DCDCDC;" | '''Stage IV'''
:3c
| style="padding: 5px 5px; background: #F5F5F5;" | Tumor invades bladder and/or bowel mucosa, and/or distant metastases
:* Pelvic/para aortic lymph node involvement
|-
:* Short axis ≥ 8 mm in pelvic nodes
| style="padding: 5px 5px; background: #DCDCDC;" | '''IVA'''
| style="padding: 5px 5px; background: #F5F5F5;" | Tumor invasion of [[bladder]] and/or bowel mucosa
|-
| style="padding: 5px 5px; background: #F5F5F5;" | normal or widened endometrium
|-
| style="padding: 5px 5px; background: #F5F5F5;" | normal low T2 signal junctional zone
|-
| style="padding: 5px 5px; background: #F5F5F5;" | complete subendometrial enhancement on T1 contrast imaging
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''IVB'''
| style="padding: 5px 5px; background: #F5F5F5;" | Distant metastasis, including intra-abdominal [[metastases]] and/or inguinal nodes
|-
| style="padding: 5px 5px; background: #F5F5F5;" | normal or widened endometrium
|-
| style="padding: 5px 5px; background: #F5F5F5;" | normal low T2 signal junctional zone
|-
| style="padding: 5px 5px; background: #F5F5F5;" | complete subendometrial enhancement on T1 contrast imaging
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
Stage 4: bladder/rectal or distant metastasis
| style="padding: 5px 5px; background: #F5F5F5;" |
:4a
:* Disruption of low T2 signal [[bladder]] or rectal wall
:* Intraluminal bladder mass
|}
|}


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Latest revision as of 14:42, 29 November 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Monalisa Dmello, M.B,B.S., M.D. [2]

Overview

The MRI is not needed for the diagnosis of endometrial cancer. However, an MRI may be helpful in staging of the disease.[1]

Pelvic MRI

The MRI is not needed for the diagnosis of endometrial cancer. However, an MRI may be helpful in staging of the disease.[1]

MR Imaging findings according to FIGO stage
Stage of endometrial cancer MRI findings

Stage 1: tumor confined to uterus

1a.
  • Disruption or irregularity of the low T2 signal junctional zone
  • Disruption of subendometrial early enhancement
1b.
  • Disruption or irregularity of the low T2 signal junctional zone
  • Disruption of subendometrial early enhancement
  • Preservation of band of outer myometrium

Stage 2: tumor extends to cervix

  • Widening of internal os and endocervical canal by high/isointense T2W signal tumor mass.
  • Intact low T2W signal of normal cervical stroma
  • Disruption of low T2 signal cervical stroma

Stage 3: tumor extension beyond the uterus

3a
  • Irregularity to the uterine contour
  • Disruption of low T2 signal uterine serosa
3b
  • Thickening of vaginal wall
  • High T2 signal tumor infiltrating low signal vaginal wall
3c
  • Pelvic/para aortic lymph node involvement
  • Short axis ≥ 8 mm in pelvic nodes

Stage 4: bladder/rectal or distant metastasis

4a
  • Disruption of low T2 signal bladder or rectal wall
  • Intraluminal bladder mass

References

  1. ↑ 1.0 1.1 "endometrial cancer MRI".


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