Magnetic Resonance Imaging of Uterine Malignancies

Abstract

Magnetic Resonance Imaging (MRI) is the criterion standard in the assessment and staging of uterine cancer because of the high tissue contrast between glandular lining and inner and outer muscle layers of the uterine corpus and cervix on T2-weighted scans. It is also an essential tool in monitoring treatment response and in assessing disease recurrence in these patients. The key to a successful examination lies in good patient preparation, use of antiperistaltic agents, and a meticulous scanning technique. Endometrial carcinomas are the most common uterine malignancy, occurring in a primarily postmenopausal population. Dynamic contrast-enhanced scans may be required in addition to T2-weighted images to assess the presence of myometrial invasion in this age group. Cervical cancers occur in a younger population and are readily assessed with T2-weighted imaging. Use of an endovaginal receiver coil allows high spatial resolution imaging of the cervix, which is particularly useful when assessing patients for fertility-sparing procedures such as trachelectomy. Uterine sarcomas are 1% to 3% of all uterine malignancies and usually arise from a mixture of homologous and heterologous elements. Rarely, lymphoma, small cell carcinoma and metastatic deposits involve the uterus. This review summarizes the optimal scanning techniques for demonstrating uterine malignancy and discusses the role of imaging and the MRI appearances of uterine tumors.

Diffusion-weighted magnetic resonance imaging of endometrial cancer: differentiation from benign endometrial lesions and preoperative assessment of myometrial invasion

“…In our series, DWI clearly demonstrated the boundary between high-intensity endometrial cancer and low-intensity myometrium. Because endometrial cancer showed intermediate to slightly high signal intensity on T2-weighted images, similar to that of the outer myometrium in relatively younger patients and that of postmenopausal myometrium, it was often difficult to evaluate the depth of myometrial invasion (16). The boundaries between the tumor and myometrium were not clear on gadolinium-enhanced T1-weighted images in the patients with coexisting adenomyosis or with infiltrative myometrial invasion, and DWI could demonstrate the tumor margins clearly.…”

Evaluating Myometrial Invasion in Endometrial Cancer: Comparison of Reduced Field-of-view Diffusion-weighted Imaging and Dynamic Contrast-enhanced MR Imaging

“…On T 2 -weighted imaging, the tumor showed intermediate signal intensity similar to that of the outer myometrium in younger patients and that of postmenopausal myometrium, so it was difficult to evaluate the depth of myometrial invasion in eight of nine patients with deep myometrial invasion. 23 In two patients with coexisting adenomyosis, the tumor margins adjacent to ademonyosis were not clear on both T 2 -weighted and contrast-enhanced T 1 -weighted imaging due to heterogeneous signal intensity and heterogeneous contrast enhancement respectively, and only reduced FOV DW imaging could demonstrate the tumor margins clearly. However typical adenomyosis appears as a low signal intensity area on T 2 -weighted images, some adenomyosis may show heterogeneous signal intensity with high intensity areas corresponding to islands of ectopic endometrial tissue and cystic dilatation of glands resulting in the unclear boundaries between the tumor and myometrium.…”

Magnetic Resonance Imaging of Benign and Malignant Uterine Neoplasms

“…74,77,78 Typically, the lesion has a low to intermediate T1 signal and high T2 signal intensity. [74][75][76][77][78] Though no imaging findings have been described on DWI in uterine lymphoma, lymphomas in general show restricted diffusion because of hypercellularity and little extracellular space. 79 The tumor typically enhances homogenously, though it can be heterogeneous.…”

“…79 The tumor typically enhances homogenously, though it can be heterogeneous. 74,77,78 Differentiating lymphoma from other pelvic malignancies is crucial to prevent unnecessary surgery. Standard treatment is with chemotherapy or radiation therapy.…”