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


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'''MR Imaging findings according to FIGO stage'''
'''MR Imaging findings according to FIGO stage'''
:* stage 1: [[tumour]] confined to [[uterus]]
::* stage 1a: tumour confined to the uterine endometrium
:::* normal or widened endometrium
:::* normal low T2 signal junctional zone
:::* complete subendometrial enhancement on T1 contrast imaging
::* stage 1b: invasion of less than half of the myometrium
:::* disruption or irregularity of the low T2 signal junctional zone
:::* 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; width: 600px" align=center
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! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Stage of endometrial cancer}}
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Stage of endometrial cancer}}
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|MRI findings}}
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|MRI findings}}
|-
|-
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Stage 1: tumor confined to uterus
Stage 1: [[tumour]] confined to [[uterus]]
 
 
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
:1a. invasion of less than half of the myometrium
:1a.
:* disruption or irregularity of the low T2 signal junctional zone
:* disruption of subendometrial early enhancement
 
:1b. 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


:* 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
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
 
Stage 2: tumor extends to cervix
stage 2: tumour extends to [[cervix]]
 
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
 
:* Widening of internal os and endocervical canal by high/isointense T2W signal tumor mass.
:* widening of internal os and endocervical canal by high/isointense T2W signal tumour mass.
:* Intact low T2W signal of normal cervical stroma
:* intact low T2W signal of normal cervical stroma
:* Disruption of low T2 signal cervical stroma
:* disruption of low T2 signal cervical stroma
 
:1. Cancer cells appears with many atypical nuclei, papillary structures, rounded cells
:2. Aggressive and often invades the myometrium and metastasizes within the peritoneum seen as omental cake or the lymphatic system.
:3. They can spread outside the uterus without invading the myometrium.
|-
|-
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Clear cell carcinoma
Stage 3: tumor extension beyond the uterus
| style="padding: 5px 5px; background: #F5F5F5;" |
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:1. Common to all clear cells visible
:3a
:2. Distinct cell membranes
:* 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
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
Mucinous carcinoma
Stage 4: bladder/rectal or distant metastasis
| style="padding: 5px 5px; background: #F5F5F5;" |  
| style="padding: 5px 5px; background: #F5F5F5;" |  
Well-differentiated columnar cells organized into glands with the characteristic mucin in the cytoplasm.
:4a
|-
:* Disruption of low T2 signal [[bladder]] or rectal wall
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
:* Intraluminal bladder mass
Mixed or undifferentiated carcinoma
| style="padding: 5px 5px; background: #F5F5F5;" |
Sheets of identical epithelial cells with no identifiable pattern
|}
|}


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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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