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]

Overview

Pelvic MRI may be diagnostic of endometrial cancer.

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

Stage of endometrial cancer	MRI findings
Stage 1	1. Cancer cells grow in patterns reminiscent of normal endometrium 2. Glands formed from columnar epithelium with abnormal nuclei 3. Low-grade endometrioid adenocarcinomas Well differentiated cells No invasion to the myometrium Observed alongside endometrial hyperplasia Glands without the stromal tissue that separates them.
Serous carcinoma	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.
Clear cell carcinoma	1. Common to all clear cells visible 2. Distinct cell membranes
Mucinous carcinoma	Well-differentiated columnar cells organized into glands with the characteristic mucin in the cytoplasm.
Mixed or undifferentiated carcinoma	Sheets of identical epithelial cells with no identifiable pattern