Caroline Reinhold MD, Presenter: Nothing to Disclose

1) To understand the role of diagnostic imaging in the pre- and postoperative evaluation of patients with a malignancy of the uterine corpus. 2) To compare the diagnostic accuracy, advantages and limitations of cross-sectional imaging techniques in diagnosing and staging patients with uterine malignancies. 3) To be familiar with the common imaging appearances of malignancies of the uterine corpus. 4) To accurately stage malignancies of the uterine corpus and avoid commonly encountered pitfalls.

A number of imaging modalities have been advocated in the pretreatment evaluation of malignancies of the uterine corpus. Although CT is useful in identifying extrauterine spread of disease, it cannot accurately predict the degree of myometrial invasion or the presence of cervical extension. CT is comparable to non SPIO enhanced MR imaging in detecting the presence of lymphadenopathy. Several studies have investigated the use of EVS in predicting the depth of myometrial invasion. However, overestimating the degree of myometrial invasion occurs frequently in the setting of a large intraluminal tumor, adenomyosis or uterine leiomyomas. In addition, EVS is not accurate in predicting cervical extension, parametrial invasion, or the presence of lymphadenopathy. EVS, on the other hand, is the modality of choice for detecting endometrial carcinoma. EVS is highly accurate for patients at low risk for endometrial disease obviating the need for endometrial sampling in this subgroup of patients. The excellent contrast resolution of MR imaging renders it invaluable in staging patients with malignancies of the uterine corpus. MR imaging is indicated in patients in whom advanced disease is suspected on clinical grounds and in patients with histologic subtypes that signify a worse prognosis. In addition, MR imaging can be performed in cases where EVS is technically limited or indeterminate. T2-weighted sequences are used to identify and stage endometrial carcinoma because they provide optimal depiction of the uterine zonal anatomy. In addition to standard sagittal and transverse imaging planes, short-axis views of the uterine corpus are helpful for assessing myometrial invasion. We routinely perform dynamic gadolinium-enhanced imaging, using fat-suppression. Gadolinium-enhanced T1-weighted sequences have been shown to improve the detection of endometrial carcinoma and to facilitate differentiation of tumor from debris when compared with T2-weighted sequences.

www.medims.muhc.mcgill.ca/MedImS1.htm

Reinhold, C, Endometrial Carcinoma.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4405027.html