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. The MRI findings of endometrial cancer vary according to the stage of the disease and may include presence of localized tumor, invasion to surrounding structures, large pelvic nodes in nodal involvement, and tumors of distant metastasis.

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 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