Endometrial cancer MRI

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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]

Pelvic MRI

A dedicated pelvic MRI protocol is recommended for optimal assessment. 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

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