Endometrial cancer MRI
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Endometrial cancer Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Endometrial cancer MRI On the Web |
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American Roentgen Ray Society Images of Endometrial cancer MRI |
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Risk calculators and risk factors for Endometrial cancer MRI |
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.[1] 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
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- 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 | MRI Findings | |
|---|---|---|
| Stage I | Tumor confined to the corpus uteri | |
| IA | No or less than half myometrial invasion | |
| normal or widened endometrium | ||
| normal low T2 signal junctional zone | ||
| complete subendometrial enhancement on T1 contrast imaging | ||
| IB | Invasion equal to or more than half of the myometrium|- | normal or widened endometrium |
| normal low T2 signal junctional zone | ||
| complete subendometrial enhancement on T1 contrast imaging | ||
| Stage II | Tumor invades cervical stroma but does not extend beyond the uterus | |
| normal or widened endometrium | ||
| normal low T2 signal junctional zone | ||
| complete subendometrial enhancement on T1 contrast imaging | ||
| Stage III | Local and/or regional spread of the tumor | |
| normal or widened endometrium | ||
| normal low T2 signal junctional zone | ||
| complete subendometrial enhancement on T1 contrast imaging | ||
| IIIA | Tumor invades the serosa of the corpus uteri and/or adnexae | |
| normal or widened endometrium | ||
| normal low T2 signal junctional zone | ||
| complete subendometrial enhancement on T1 contrast imaging | ||
| IIIB | Vaginal involvement and/or parametrial involvement | |
| normal or widened endometrium | ||
| normal low T2 signal junctional zone | ||
| complete subendometrial enhancement on T1 contrast imaging | ||
| III C | Metastases to pelvic and/or para-aortic lymph nodes | |
| (i) Positive pelvic nodes | ||
| (ii) Positive para-aortic nodes with or without positive pelvic lymph nodes | ||
| Stage IV | Tumor invades bladder and/or bowel mucosa, and/or distant metastases | |
| IVA | Tumor invasion of bladder and/or bowel mucosa | |
| normal or widened endometrium | ||
| normal low T2 signal junctional zone | ||
| complete subendometrial enhancement on T1 contrast imaging | ||
| IVB | Distant metastasis, including intra-abdominal metastases and/or inguinal nodes | |
| normal or widened endometrium | ||
| normal low T2 signal junctional zone | ||
| complete subendometrial enhancement on T1 contrast imaging |
References