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Takeuchi M, Matsuzaki K, Bando Y, Harada M. Dynamic contrast-enhanced MR imaging of uterine endometrial carcinoma with/without squamous differentiation. Abdom Radiol (NY) 2023; 48:2494-2502. [PMID: 37157002 DOI: 10.1007/s00261-023-03934-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 04/20/2023] [Accepted: 04/20/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE Endometrial carcinoma with strong enhancement on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is suggestive of high-grade type II endometrial carcinoma. However, low-grade type I endometrial carcinoma may also sometimes show strong enhancement. We hypothesized that squamous differentiation would contribute to the strong enhancement at the early phase on DCE-MRI-like uterine cervical squamous cell carcinoma and compared the DCE-MRI findings of endometrial carcinoma with and without squamous differentiation. METHODS DCE-MRI of endometrial carcinoma including 41 low-grade type I endometrial carcinomas without squamous differentiation (LG), 39 low-grade type I endometrial carcinomas with squamous differentiation (LGSD), and 20 high-grade type II endometrial carcinomas (HG) was retrospectively evaluated. RESULTS Significant difference in the time-intensity curves was found between LG and HG and LG and LGSD, whereas no significant difference was seen between HG and LGSD. Curve type 3 (initial signal rise which is steeper than that of the myometrium) was more frequent in HG (60%) and LGSD (77%) than in LG (34%). CONCLUSION It should be recognized as a pitfall that high-grade type II endometrial carcinoma and low-grade type I endometrial carcinoma with squamous differentiation may show similar early strong enhancement on DCE-MRI.
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Affiliation(s)
- Mayumi Takeuchi
- Department of Radiology, Tokushima University, 3-18-15, Kuramoto-Cho, Tokushima, 7708503, Japan.
| | - Kenji Matsuzaki
- Department of Radiological Technology, Tokushima Bunri University, 1314-1, Shido, Sanuki-City, Kagawa, 7692193, Japan
| | - Yoshimi Bando
- Division of Pathology, Tokushima University Hospital, 2-50-1, Kuramoto-Cho, Tokushima, 7708503, Japan
| | - Masafumi Harada
- Department of Radiology, Tokushima University, 3-18-15, Kuramoto-Cho, Tokushima, 7708503, Japan
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Takatsu Y, Motegi S, Miyati T, Yamamura K. [An Examination for Uterine Dynamic Study with Phase-sensitive Inversion-recovery]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2016; 72:31-41. [PMID: 26796931 DOI: 10.6009/jjrt.2016_jsrt_72.1.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The depth of myometrial invasion in patients with endometrial carcinoma is recognized as an important factor that closely correlates with prognosis. Preoperative assessment of myometrial invasion is essential for planning surgery. To enhance the contrast between myometrium and endometrium including myometrial invasion with endometrial carcinoma, we optimized the sequence parameter with phase-sensitive inversion-recovery (PSIR) in gadolinium dynamic study of uterine corpus. On a 1.5-T magnetic resonance imaging (MRI), images were acquired by three-dimensional (3D) T1 -turbo field echo (TFE) with PSIR sequence and gadolinium-diethylenetriamine pentaacetic acid( Gd-DTPA) diluted phantom (0-5 mmol/L) and myometrium model (manganese chloride tetrahydrate+agar). We calculated the null point and the contrast-to-noise ratio (CNR) at multiple TFE inversion delay times, 200 ms-maximum in each combination; flip angles (FAs), 5-35 degrees; TFE factor, 20-40; and shot interval (SI), 500-1000 ms. We assumed that dynamic scanning time was 30 seconds when the sensitivity encoding factor was 2, namely, in this study, the scanning time was 1 minute with no sensitivity encoding. In addition, we compared CNR between optimized PSIR sequence ande-Thrive. We recognized a successful CNR of the 3D PSIR parameter was TFE inversion delay times, 335 ms; FA, 25 degrees; TFE factor, 20; and SI, 500 ms. In each gadolinium-DTPA diluted phantom, the average CNR of the optimized PSIR sequence was approximately 1.7 times (maximum: 3 times) higher than e-Thrive. Optimizing sequence parameter of PSIR is applicable in gadolinium dynamic study of uterine corpus.
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Zheng L, Zheng S, Yuan X, Wang X, Zhang Z, Zhang G. Comparison of dynamic contrast-enhanced magnetic resonance imaging with T2-weighted imaging for preoperative staging of early endometrial carcinoma. Onco Targets Ther 2015; 8:1743-51. [PMID: 26229482 PMCID: PMC4514351 DOI: 10.2147/ott.s86519] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose This study aimed to compare dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) with T2-weighted imaging (T2WI) for the preoperative staging of early endometrial carcinoma. Methods This retrospective study included 22 subjects with early endometrial carcinoma who underwent 3.0 T MRI examination prior to hysterectomy. DCE-MRI and T2WI were evaluated for the preoperative staging of endometrial carcinoma. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of DCE-MRI and T2WI were assessed and compared using the revised International Federation of Gynecology and Obstetrics surgical staging guidelines (2009) as the reference standard. Results Out of the 22 cases of endometrial carcinoma, the use of the reference standard method led to the staging of 14 as IA and eight as IB. The sensitivity, specificity, PPV, NPV, and accuracy of DCE-MRI for preoperative staging were 100% (95% confidence interval: 0.73–1.0), 62.5% (95% CI: 0.26–0.90), 82.4% (95% CI: 0.56–0.95), 100% (95% CI: 0.46–1.0), and 86.4%, respectively, and these values were 85.7% (95% CI: 0.56–0.97), 75% (95% CI: 0.36–0.96), 85.7% (95% CI: 0.56–0.97), 75% (95% CI: 0.36–0.96), and 81.8%, respectively, for T2WI. Thus, the sensitivity and accuracy of DCE-MRI were greater than those of T2WI for preoperative endometrial carcinoma staging. Conclusion DCE-MRI was more sensitive but less specific than T2WI for the preoperative staging of early endometrial carcinoma. DCE-MRI may serve as a useful and reliable tool for the preoperative assessment of endometrial carcinoma.
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Affiliation(s)
- Linfeng Zheng
- Department of Radiology, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China ; Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Sujuan Zheng
- Department of Obstetrics and Gynecology, Dengfeng People's Hospital, Zhengzhou, People's Republic of China
| | - Xiaochun Yuan
- Department of Radiology, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Xifu Wang
- Department of Radiology, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Zhuoli Zhang
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Guixiang Zhang
- Department of Radiology, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
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Utility of tumor marker HE4 as prognostic factor in endometrial cancer: a single-center controlled study. Tumour Biol 2015; 36:4151-6. [PMID: 25577252 DOI: 10.1007/s13277-015-3049-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 01/02/2015] [Indexed: 01/01/2023] Open
Abstract
This study aims to investigate the correlation between preoperative human epididymis protein 4 (HE4) levels, endometrial cancer (EC) staging, and ideal cutoff for stage prediction. All EC patients, treated within January 2009 and February 2014 at the Division of Gynaecologic Oncology of the University Campus Bio-Medico of Rome, were considered for the study. For the first part of the study, we consider an HE4 cutoff of 70 pmol/L. Histotypes (endometrioid versus non-endometrioid), grading (G1, G2, G3), and stage were correlated with HE4 levels. In the second part of the study, the logistic regression was performed in stepwise mood to identify the ideal HE4 cutoff for stage prediction. Two hundred thirty-two patients with surgically staged EC and preoperative HE4 dosage were included in the study. We found that higher HE4 levels correlate with undifferentiated grading (p < 0.05). Moreover, we found that 42, 77, 90, 93 and 100 % of patients classified as International Federation of Gynecology and Obstetrics (FIGO) stage IA, IB, II, III, and IV, respectively, presented HE4 levels above the standard cutoff of 70 pmol/L. Based on receiver operating characteristic (ROC) curves, we found the ideal HE4 cutoff as follows: 61.3 pmol/L for FIGO stage IA (sensitivity = 82.3 % and specificity = 96 %), 89.2 pmol/L for FIGO stage IB (sensitivity = 83.3 % and specificity = 96 %), 104.3 pmol/L for FIGO stage II (sensitivity = 80.9 % and specificity = 98.6 %), 152.6 pmol/L for FIGO stage III (sensitivity = 92.5 % and specificity = 98.6 %), and 203.8 pmol/L for FIGO stage IV (sensitivity = 81.8 % and specificity = 99.3 %). Our results suggest a potential role of HE4 in EC stage prediction.
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Fukunaga T, Fujii S, Inoue C, Kato A, Chikumi J, Kaminou T, Ogawa T. Accuracy of semiquantitative dynamic contrast-enhanced MRI for differentiating type II from type I endometrial carcinoma. J Magn Reson Imaging 2014; 41:1662-8. [PMID: 25136971 DOI: 10.1002/jmri.24730] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 08/04/2014] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To investigate type II endometrial carcinoma characterization using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and evaluate the diagnostic accuracy of semiquantitative DCE-MRI in differentiating type II from type I tumors. MATERIALS AND METHODS Seventy-seven patients with endometrial carcinoma were retrospectively evaluated using 3T DCE-MRI. The maximum absolute enhancement of signal intensity (SImax), maximum relative enhancement (SIrel), wash-in rate (WIR), and the SImax/SI (piriformis) ratio were analyzed. To differentiate type I from type II tumors, optimal threshold criteria were established. The Mann-Whitney U-test was used for statistical comparison and receiver operating characteristic curve analysis was used to determine optimal cutoff values. RESULTS The SIrel (P < 0.001), WIR (P < 0.0001), and SImax/SI (piriformis) ratio (P < 0.0001), but not SImax, differed significantly between type I and type II carcinomas. Cutoff values of SIrel ≥58.8, WIR ≥37.0, and SImax/SI (piriformis) ratio ≥1.55 had sensitivities of 93%, 93%, and 67%, specificities of 60%, 60%, and 79%, accuracies of 66%, 66%, and 67%, respectively, for predicting type II endometrial carcinoma. CONCLUSION Endometrial carcinoma with strong (high level) enhancement on DCE-MRI is suggestive of type II endometrial carcinoma. Semiquantitative evaluation of DCE-MRI may be useful for differentiating type II from type I tumors.
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Affiliation(s)
- Takeru Fukunaga
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Shinya Fujii
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Chie Inoue
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Ayumi Kato
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Jun Chikumi
- Division of Reproductive-Perinatal Medicine and Gynecological Oncology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Toshio Kaminou
- Department of Radiology, National Hospital Organization Osaka Minami Medical Center, Osaka, Japan
| | - Toshihide Ogawa
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, Yonago, Japan
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Haldorsen IS, Husby JA, Werner HMJ, Magnussen IJ, Rørvik J, Helland H, Trovik J, Salvesen ØO, Espeland A, Salvesen HB. Standard 1.5-T MRI of endometrial carcinomas: modest agreement between radiologists. Eur Radiol 2012; 22:1601-11. [DOI: 10.1007/s00330-012-2400-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Revised: 12/16/2011] [Accepted: 12/22/2011] [Indexed: 10/28/2022]
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Haldorsen I, Salvesen H. Staging of endometrial carcinomas with MRI using traditional and novel MRI techniques. Clin Radiol 2012; 67:2-12. [DOI: 10.1016/j.crad.2011.02.018] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Accepted: 02/21/2011] [Indexed: 10/15/2022]
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Myometrial invasion by endometrial carcinoma: evaluation with 3.0T MR imaging. ACTA ACUST UNITED AC 2011; 36:612-8. [DOI: 10.1007/s00261-011-9719-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Vargas HA, Akin O, Zheng J, Moskowitz C, Soslow R, Abu-Rustum N, Barakat RR, Hricak H. The value of MR imaging when the site of uterine cancer origin is uncertain. Radiology 2011; 258:785-92. [PMID: 21212371 DOI: 10.1148/radiol.10101147] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To assess the value of magnetic resonance (MR) imaging in determining the site of origin of newly diagnosed uterine cancer (corpus vs cervix) when clinical and/or histologic evaluation is indeterminate. MATERIALS AND METHODS The Institutional Review Board approved and waived informed consent for this HIPAA-compliant study of 59 women (median age, 59 years; range, 28-84 years) who underwent pelvic MR imaging to determine the anatomic origin of uterine cancer. Two radiologists independently retrospectively assessed all MR imaging studies. In 48 patients who underwent hysterectomy, surgical pathologic findings were the reference standard, and overall test yields and diagnostic likelihood ratios were measured. Accuracy in detecting invasion of adjacent structures was also calculated. For the remaining patients, imaging and biopsy findings are presented descriptively. RESULTS At hysterectomy, 32 patients had uterine corpus cancer and 16 had cervical cancer. Overall test yields for reader 1 and reader 2 were 0.85 and 0.88, respectively. When a reader attributed a tumor's origin to either the uterine corpus or cervix, the odds of the tumor originating from that site were 4.80-6.35 times greater than they would have been if no other information were available. Accuracy levels in detecting invasion of the myometrium, cervical stroma, parametria and/or adnexae, and vagina, respectively, were 72%, 69%, 74%, and 85% for reader 1 and 78%, 77%, 76%, and 85% for reader 2. CONCLUSION MR imaging is useful for determining the anatomic origin of uterine cancer and provides helpful information regarding invasion of adjacent structures.
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Affiliation(s)
- Hebert Alberto Vargas
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room C-278, New York, NY 10065, USA.
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Rechichi G, Galimberti S, Signorelli M, Perego P, Valsecchi MG, Sironi S. Myometrial invasion in endometrial cancer: diagnostic performance of diffusion-weighted MR imaging at 1.5-T. Eur Radiol 2009; 20:754-62. [DOI: 10.1007/s00330-009-1597-x] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2009] [Revised: 05/27/2009] [Accepted: 07/06/2009] [Indexed: 11/28/2022]
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Rieck GC, Bulman J, Whitaker R, Leeson SC. A retrospective review of magnetic resonance imaging in assessing the extent of myometrial infiltration for patients with endometrial carcinoma. J OBSTET GYNAECOL 2009; 25:765-8. [PMID: 16368581 DOI: 10.1080/01443610500327951] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The surgical treatment of endometrial malignancy is based on pre-operative assessment of differentiation, myometrial and lymph node infiltration. Studies have reported the use of magnetic resonance imaging (MRI) with conflicting results. This study aims to review the pre-operative accuracy of MRI against the histology in endometrial cancer within a district hospital. A total of 112 women were identified from January 1997 to December 2004. The post-operative FIGO staging showed 76.2% Stage I, 7.6% Stage II, 14.3% Stage III and 1.7% Stage IV. A total of 57% (n = 60) had a pre-operative MRI. The myometrial infiltration was difficult to interpret in 31 MRIs. The time between hysteroscopy and MRI scan in those cases was shorter (Mean 3 weeks, SD +/- 1.5) than in reports with a clear interpretation (4.4 weeks, SD +/- 1.6). Sensitivity for MRI to detect deep myometrial infiltration was 35.7% (5/14) and specificity 50% (23/46). Accuracy was 46.6% (28/60). The presented data suggests a poor predictability of myometrial invasion by MRI but the numbers are small and MRI is a rapidly evolving modality. The conclusions must be treated with caution and cannot easily be applied to large gynaecological cancer units in general.
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Affiliation(s)
- G C Rieck
- University Hospital of Wales, Cardiff, UK.
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Sala E, Crawford R, Senior E, Shaw A, Simcock B, Vrotsou K, Palmer C, Rajan P, Joubert I, Lomas D. Added Value of Dynamic Contrast-Enhanced Magnetic Resonance Imaging in Predicting Advanced Stage Disease in Patients With Endometrial Carcinoma. Int J Gynecol Cancer 2009; 19:141-6. [DOI: 10.1111/igc.0b013e3181995fd9] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Aim:To assess the added value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in predicting advanced stage disease in patients with endometrial carcinoma.Materials and Methods:Fifty patients with endometrial carcinoma underwent preoperative MRI assessment in a single gynecological cancer center during a 2-year period. Magnetic resonance imaging examinations included high-resolution sagittal, axial, and axial-oblique T2-weighted images (T2WI) of the pelvis, and axial T1-weighted images (T1WI) of the pelvis and upper abdomen followed by DCE-MRI using a multiphase 3-dimensional gradient refocused echo T1WI sequence. The T2W images were evaluated initially, and local and overall staging was assigned according to the FIGO classification. An identical scoring system was used to evaluate the combination of DCE-MRI and T2WI. The presence of potential pitfalls in the accurate assessment of depth of myometrial invasion (leiomyoma, adenomyosis, loss of junctional zone definition, polypoid tumor, poor tumor-to-myometrium contrast, and tumor extension to uterine cornu) was also recorded. Surgical histology constituted the standard of reference.Results:The depth of myometrial invasion was correctly determined in 78% (39/50) of the cases on T2WI alone, increasing to 92% (46/50) with the addition of DCE-MRI (95% confidence interval for improvement, 4.4%-23.6%, P = 0.016). The addition of DCE-MRI led to the correct detection of deep myometrial invasion in all cases. Tumor extension to uterine cornu was the only variable significantly associated (P = 0.014) with incorrect estimation of depth of myometrial invasion.Conclusions:The addition of multiphase 3-dimensional DCE-MRI to T2WI can effectively assess the depth of myometrial invasion in endometrial carcinoma and may be a useful tool to guide the surgical approach.
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Sala E, Wakely S, Senior E, Lomas D. RM de los tumores malignos de endometrio y cérvix. RADIOLOGIA 2008; 50:449-61. [DOI: 10.1016/s0033-8338(08)76332-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Savelli L, Ceccarini M, Ludovisi M, Fruscella E, De Iaco PA, Salizzoni E, Mabrouk M, Manfredi R, Testa AC, Ferrandina G. Preoperative local staging of endometrial cancer: transvaginal sonography vs. magnetic resonance imaging. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2008; 31:560-566. [PMID: 18398926 DOI: 10.1002/uog.5295] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVES To compare the accuracy of transvaginal sonography (TVS) and magnetic resonance imaging (MRI) in the preoperative staging of endometrial carcinoma. METHODS This was a prospective study in which 74 women consecutively diagnosed with endometrial carcinoma were examined using TVS by physicians trained in gynecological sonography and MRI by radiologists with a special interest in gynecology. All patients underwent surgical-pathological staging after removal of the uterus, adnexa and pelvic lymph nodes. Sensitivity, specificity, and positive and negative predictive values were calculated for each imaging modality with regard to detection of neoplastic invasion of the outer half of the myometrium and cervical involvement. RESULTS TVS and MRI performed equally well in the preoperative staging of endometrial cancer, with no statistically significant differences between the two techniques. The sensitivity, specificity, positive and negative predictive values, and overall diagnostic accuracy for TVS in the evaluation of myometrial infiltration were 84%, 83%, 79%, 88% and 84%, respectively. Respective values for MRI were 84%, 81%, 77%, 87% and 82%. The corresponding statistics for detection of cervical involvement were 93%, 92%, 72%, 98% and 92% for TVS; and 79%, 87%, 58%, 95% and 85% for MRI. CONCLUSIONS When carried out by expert practitioners, TVS shows good accuracy in the local staging of endometrial carcinoma. Because of its high costs, MRI should be offered only to those in whom TVS produces images of poor quality.
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Affiliation(s)
- L Savelli
- Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy.
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Ryoo UN, Choi CH, Yoon JY, Noh SK, Kang H, Kim WY, Kim BH, Kim TJ, Lee JW, Lee JH, Kim BG, Bae DS. MR imaging in endometrial carcinoma as a diagnostic tool for the prediction of myometrial invasion and lymph node metastasis. Cancer Res Treat 2007; 39:165-70. [PMID: 19746183 DOI: 10.4143/crt.2007.39.4.165] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Accepted: 11/19/2007] [Indexed: 11/21/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate the factors that are associated with the accuracy of magnetic resonance (MR) imaging for predicting myometrial invasion and lymph node metastasis in women with endometrial carcinoma. MATERIALS AND METHODS We retrospectively reviewed the medical records and preoperative MR imaging reports of 128 women who had pathologically proven endometrial carcinoma. We compared the MR imaging and the histopathology findings. RESULTS The sensitivity, specificity and accuracy for identifing any myometrial invasion (superficial or deep) were 0.81, 0.61 and 0.74, respectively; these values for deep myometrial invasion were 0.60, 0.94 and 0.86, respectively. The sensitivity, specificity and accuracy of MR imaging for detecting lymph node metastasis were 50.0%, 96.6% and 93.0%, respectively. The patients who were older, had more deliveries and a larger tumor size more frequently had incorrect prediction of deep myometrial invasion (p=0.034, p=0.044, p=0.061, respectively). A higher tumor grade, a histology other than the endometrioid type, myometrial invasion on MR findings and a larger tumor size were associated with a more frequent false-negative prediction of lymph node metastasis (p=0.018, p=0.017, p=0.002, p=0.047, respectively). A larger tumor size was also associated with more frequent false-positive results (p=0.009). CONCLUSIONS There are several factors that make accurate assessment of myometrial invasion or lymph node metastasis difficult with using MRI; therefore, the patients with these factors should have their MR findings cautiously interpreted.
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Affiliation(s)
- Ui Nam Ryoo
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Abstract
Recent developments in MR techniques have magnified the roles and potential of MRI in the female pelvis. This article reviews the techniques and clinical applications of functional MRI (fMRI) of the female pelvis, including cine MRI, diffusion-weighted MRI (DWI), and dynamic contrast-enhanced (DCE)-MRI. Cine MRI is a useful tool for evaluating uterine contractility, including sustained contraction and peristalsis, in a variety of conditions and gynecologic disorders, and for evaluating pelvic-floor weakness. DWI can demonstrate abnormal signals in pathologic foci based on differences in molecular diffusion. It also enables the quantitative evaluation of the apparent diffusion coefficient (ADC), which may be useful for distinguishing malignant from benign tissues and monitoring therapeutic outcome. DCE-MRI has the potential to improve tumor detection and local staging, and can also provide quantitative information about perfusion of the tumor, which may be useful for both monitoring therapeutic effects and predicting therapeutic outcome. Understanding the roles played by functional MR techniques in the female pelvic region is beneficial not only for determining clinical applications, but also for developing further investigations with MRI.
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Affiliation(s)
- Takashi Koyama
- Department of Radiology, Kyoto University Hospital, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
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Sala E, Wakely S, Senior E, Lomas D. MRI of malignant neoplasms of the uterine corpus and cervix. AJR Am J Roentgenol 2007; 188:1577-87. [PMID: 17515380 DOI: 10.2214/ajr.06.1196] [Citation(s) in RCA: 214] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE In this article, we review the role of MRI in the imaging of malignant neoplasms of the uterine corpus and cervix, describing its role in staging, treatment planning, and follow-up. CONCLUSION MRI is not officially incorporated in the International Federation of Gynecology and Obstetrics (FIGO) staging system, but is already widely accepted as the most reliable imaging technique for the diagnosis, staging, treatment planning, and follow-up of both endometrial and cervical cancer. MRI protocols need to be optimized to obtain the best results and avoid pitfalls.
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Affiliation(s)
- Evis Sala
- Department of Radiology, Addenbrooke's Hospital, University of Cambridge, Hills Rd., Cambridge CB2 2QQ, United Kingdom.
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Chung HH, Kang SB, Cho JY, Kim JW, Park NH, Song YS, Kim SH, Lee HP. Accuracy of MR imaging for the prediction of myometrial invasion of endometrial carcinoma. Gynecol Oncol 2007; 104:654-9. [PMID: 17095081 DOI: 10.1016/j.ygyno.2006.10.007] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2006] [Revised: 09/25/2006] [Accepted: 10/03/2006] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To retrospectively evaluate the accuracy of magnetic resonance (MR) imaging for the prediction of depth of myometrial invasion in the preoperative assessment of women with endometrial carcinoma. METHODS We retrospectively reviewed the medical records and MR imaging reports of 120 women with pathologically-proven endometrial carcinoma who underwent preoperative pelvic MR imaging between June 1997 and February 2006. Tumor signal intensity, the appearance of the junctional zone (JZ), the presence of large polypoid tumors and leiomyomas were analyzed. Univariate logistic-regression analysis was performed to identify associations between incorrect MR staging and the study variables. RESULTS Data from 120 patients were registered for the current study and analyzed. The sensitivity, specificity and accuracy of the MR imaging in assessment of myometrial invasion among patients with endometrial carcinoma were: 50.6%, 89.2% and 62.5% respectively. MR differentiation of deep myometrial invasion from superficial disease had an 83.3% accuracy (100 of 120 cases). Isointense JZ to myometrium (P<0.001), and the presence of polypoid tumors (P=0.037) on MR imaging were significantly associated with an underestimation of myometrial invasion by endometrial carcinoma. CONCLUSIONS Isointense JZ to myometrium and polypoid tumors are difficult to accurately evaluate for myometrial invasion of endometrial carcinoma by MR imaging.
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Affiliation(s)
- Hyun Hoon Chung
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-744, South Korea
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Rockall AG, Meroni R, Sohaib SA, Reynolds K, Alexander-Sefre F, Shepherd JH, Jacobs I, Reznek RH. Evaluation of endometrial carcinoma on magnetic resonance imaging. Int J Gynecol Cancer 2007; 17:188-96. [PMID: 17291252 DOI: 10.1111/j.1525-1438.2007.00805.x] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Our aims were to assess diagnostic performance of T2-weighted (T2W) and dynamic gadolinium-enhanced T1-weighted (T1W) magnetic resonance imaging (MRI) in the preoperative assessment of myometrial and cervical invasion by endometrial carcinoma and to identify imaging features that predict nodal metastases. Two radiologists retrospectively reviewed MR images of 96 patients with endometrial carcinoma. Tumor size, depth of myometrial and cervical invasion, and nodal enlargement were recorded and then correlated with histology. The sensitivity, specificity, positive and negative predictive values (PPV and NPV) for the identification of any myometrial invasion (superficial or deep) were 0.94, 0.50, 0.93, 0.55 on T2W and 0.92, 0.50, 0.92, 0.50 on dynamic T1W, and for deep myometrial invasion were 0.84, 0.78, 0.65, 0.91 on T2W and 0.72, 0.88, 0.72, 0.88 on dynamic T1W. The sensitivity, specificity, PPV and NPV for any cervical invasion (endocervical or stromal) were 0.65, 0.87, 0.57, 0.90 on T2W and 0.50, 0.90, 0.46, 0.92 on dynamic T1W, and for cervical stromal involvement were 0.69, 0.95, 0.69, 0.95 on T2W and 0.50, 0.96, 0.57, 0.95 on dynamic T1W. Leiomyoma or adenomyosis were seen in 73% of misdiagnosed cases. Sensitivity and specificity for the detection of nodal metastases was 66% and 73%, respectively. Fifty percent of patients with cervical invasion on MRI had nodal metastases. In conclusion, MRI has a high sensitivity for detecting myometrial invasion and a high NPV for deep invasion. MRI has a high specificity and NPV for detecting cervical invasion. Dynamic enhancement did not improve diagnostic performance. MRI may allow accurate categorization of cases into low- or high-risk groups ensuring suitable extent of surgery and adjuvant therapy
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Affiliation(s)
- A G Rockall
- Department of Radiology, St Bartholomew's Hospital, West Smithfield, 59 Bartholomew Close, West Smithfield, London, United Kingdom.
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Nakao Y, Yokoyama M, Hara K, Koyamatsu Y, Yasunaga M, Araki Y, Watanabe Y, Iwasaka T. MR imaging in endometrial carcinoma as a diagnostic tool for the absence of myometrial invasion. Gynecol Oncol 2006; 102:343-7. [PMID: 16469365 DOI: 10.1016/j.ygyno.2005.12.028] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2005] [Revised: 12/19/2005] [Accepted: 12/20/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate whether magnetic resonance imaging (MRI) is a reliable modality for verifying preoperative diagnosis of stage IA endometrial carcinoma. METHODS One hundred sixteen patients with endometrial carcinoma underwent preoperative pelvic non-contrast T2-weighted or dynamic MRI. We compared the interpretations of the MRI results with the histological findings of the resected uterus. RESULTS In assessing the depth of myometrial invasion, the accuracy of MRI was 62.1%. As to the presence of cancerous myometrial invasion, the positive predictive value was 94.4% as high as previously reported by other institutions. However, the negative predictive value, the probability of the absence of myometrial invasion, was only 42.2%. Even when dynamic study was applied to the patient, the value only improved up to 60.0%. CONCLUSION MRI has a definite advantage in evaluating deep myometrial invasion, but not the absence of invasion. We should take precautions against the risk of under-diagnosis when selecting stage IA endometrial carcinoma with use of MRI to preserve fertility or to eliminate lymphadenectomy.
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Affiliation(s)
- Yoshifumi Nakao
- Department of Obstetrics and Gynecology, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga City, Saga 849-8501, Japan.
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Barwick TD, Rockall AG, Barton DP, Sohaib SA. Imaging of endometrial adenocarcinoma. Clin Radiol 2006; 61:545-55. [PMID: 16784939 DOI: 10.1016/j.crad.2006.03.011] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2005] [Revised: 03/06/2006] [Accepted: 03/15/2006] [Indexed: 10/24/2022]
Abstract
Endometrial cancer is the most common gynaecological malignancy and the incidence rising. Prognosis depends on age of patient, histological grade, depth of myometrial invasion and cervical invasion and lymph node metastases. Myometrial invasion and accurate cervical involvement cannot be predicted clinically. Pre-treatment knowledge of these criteria is advantageous in order to plan treatment. The clinical challenge is to effectively select patients at risk of relapse for more radical treatment whilst avoiding over treating low risk cases. This is important as endometrial cancer predominately occurs in postmenopausal women with co-morbidities. Modern imaging provides important tools in the accurate pre-treatment assessment of endometrial cancer and may optimize treatment planning. However, there is little consensus to date on imaging in the routine preoperative assessment of endometrial carcinoma and practice varies amongst many gynaecologists. Transvaginal ultrasound is often the initial imaging examination for women with uterine bleeding. However, once the diagnosis of endometrial cancer has been made, contrast-enhanced magnetic resonance imaging (MRI) provides the best assessment of the disease. The results of contrast-enhanced MRI may identify patients who need more aggressive therapy and referral to a cancer centre. In this article we review the role of imaging in the diagnosis and staging/preoperative assessment of endometrial carcinoma.
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Affiliation(s)
- T D Barwick
- Department of Radiology, St Bartholomew's Hospital, West Smithfield, London, UK
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Takeuchi M, Matsuzaki K, Uehara H, Yoshida S, Nishitani H, Shimazu H. Pathologies of the uterine endometrial cavity: usual and unusual manifestations and pitfalls on magnetic resonance imaging. Eur Radiol 2005; 15:2244-55. [PMID: 16228215 DOI: 10.1007/s00330-005-2814-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2004] [Revised: 04/19/2005] [Accepted: 05/03/2005] [Indexed: 12/01/2022]
Abstract
The endometrial cavity may demonstrate various imaging manifestations such as normal, reactive, inflammatory, and benign and malignant neoplasms. We evaluated usual and unusual magnetic resonance imaging (MRI) findings of the uterine endometrial cavity, and described the diagnostic clues to differential diagnoses. Surgically proven pathologies of the uterine endometrial cavity were evaluated retrospectively with pathologic correlation. The pathologies included benign endometrial neoplasms such as endometrial hyperplasia and polyp, malignant endometrial neoplasms such as endometrial carcinoma and carcinosarcoma, endometrial-myometrial neoplasm such as endometrial stromal sarcoma, pregnancy-related lesions in the endometrial cavity such as gestational trophoblastic diseases (hydatidiform mole, invasive mole and choriocarcinoma) and placental polyp, myometrial lesions simulating endometrial lesions such as submucosal leiomyoma and some adenomyosis, endometrial neoplasms simulating myometrial lesions such as adenomyomatous polyp and endometrial lesions arising in the hemicavity of a septate/bicornate uterus, and fluid collections in the uterine cavity (hydro/hemato/pyometra). It is important to recognize various imaging findings in these diseases, in order to make a correct preoperative diagnosis.
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Affiliation(s)
- Mayumi Takeuchi
- Department of Radiology, University of Tokushima, 3-18-15, Kuramoto-cho, Tokushima, Japan.
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Akaeda T, Isaka K, Takayama M, Kakizaki D, Abe K. Myometrial invasion and cervical invasion by endometrial carcinoma: Evaluation by CO2-volumetric interpolated breathhold examination (VIBE). J Magn Reson Imaging 2005; 21:166-71. [PMID: 15666399 DOI: 10.1002/jmri.20243] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To assess myometrial invasion and cervical invasion by endometrial carcinoma, using CO2-volumetric interpolated breathhold examination (VIBE) enabling more precise evaluation of depth of tumor invasion. MATERIALS AND METHODS CO2-VIBE was performed in 21 cases of endometrial carcinoma (Stage Ia-IIb) prior to treatment. The images were interpreted by performing multiplanar reconstruction (MPR), and the findings obtained from the images (degree of myometrial invasion and presence or absence of cervical invasion) were assessed in comparison with the histopathological diagnosis. RESULTS The sites of the endometrial carcinoma lesions were clearly visualized by the CO2-VIBE method. Evaluation of the degree of myometrial invasion enabled a high correct diagnosis rate of 90.5%, and evaluation for the presence of cervical invasion also allowed a high correct diagnosis rate of 90.5%. CONCLUSION VIBE permits evaluation of any plane desired by means of thin slices, and it is a truly revolutionary method for preoperative evaluation of depth of invasion of endometrial carcinoma that enables highly accurate determination of the extent of lesion sites and degree of invasion before treatment.
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Affiliation(s)
- Tomoyoshi Akaeda
- Department of Obstetrics and Gynecology, Tokyo Medical University Hospital, Tokyo, Japan.
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Affiliation(s)
- Revathy Lyer
- Department of Radiology, M.D. Anderson Cancer Center, Houston, TX 77030-4009, USA
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Chaudhry S, Reinhold C, Guermazi A, Khalili I, Maheshwari S. Benign and malignant diseases of the endometrium. Top Magn Reson Imaging 2003; 14:339-57. [PMID: 14578778 DOI: 10.1097/00002142-200308000-00006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Affiliation(s)
- Sidhartha Chaudhry
- Department of Radiology, McGill University Health Center, Montreal, Canada
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Iha T, Shen H, Kanazawa K. Hysteroscopy to detect Stage IA well-differentiated endometrioid adenocarcinoma of the endometrium. Acta Obstet Gynecol Scand 2003; 82:378-84. [PMID: 12716324 DOI: 10.1034/j.1600-0412.2003.00035.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Well-differentiated Stage IA endometrial carcinoma may be managed conservatively with progestin treatment. However, even advanced imaging methods cannot overcome limitations in the correct determination of the absence of early microscopic myometrial invasion by endometrial carcinoma. Hysteroscopy has not yet been investigated as a tool for this purpose. METHODS Of 97 patients with well-differentiated endometrioid adenocarcinoma, 87 whose tumors were clinically confined to the uterine corpus were enrolled for inclusion in this study. The preoperative hysteroscopic appearance was correlated with the histological findings of the hysterectomy specimen. RESULTS Post-surgical FIGO stage was Stage IA in 36 cases, IB in 29, IC in 16, IIA in one, and Stage IIIA/C in five cases. Before surgery, the growth pattern of the disease was hysteroscopically diagnosed as pedunculated in 69.0% and sessile nodular in 31.0%. Surface ulceration was observed in 23.3% of the pedunculated tumors and in 74.1% of the sessile tumors ( p < 0.0001), and in 39.1% of all tumors. The incidence of absent myometrial invasion was significantly higher in the pedunculated tumors (56.3%) than in the sessile tumors (3.7%) ( p < 0.0001) and was higher in the nonulcerated tumors (64.2%) than in the ulcerated tumors (5.9%) ( p < 0.0001). When the statistical parameters were calculated in combination with the tumor growth pattern and the absence or presence of ulceration, the nonulcerated pedunculated growth pattern had a sensitivity of 92% and a positive predictive value of 72% for correct selection of Stage IA disease with no myometrial invasion. CONCLUSION Well-differentiated endometrioid adenocarcinoma was categorized by hysteroscopy into two growth patterns of pedunculated or sessile and with or without surface ulceration. This provided useful pretreatment diagnosis of Stage IA disease confined to the endometrium.
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Affiliation(s)
- Tadashi Iha
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
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Szklaruk J, Tamm EP, Choi H, Varavithya V. MR imaging of common and uncommon large pelvic masses. Radiographics 2003; 23:403-24. [PMID: 12640156 DOI: 10.1148/rg.232025089] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Magnetic resonance (MR) imaging is often used in the detection and staging of large pelvic masses. Many large masses in the female pelvis arise from the reproductive organs (eg, uterus, cervix, ovaries, fallopian tubes). In addition, these masses may arise from the gastrointestinal system, urinary system, adjacent soft tissues, peritoneum, or retroperitoneum or from metastases. The majority of large masses in the female pelvis represent such commonly encountered entities as uterine fibroid tumor, dermoid tumor, ovarian cyst, and ovarian cancer. However, uncommon pelvic masses such as mesothelioma, adenocarcinoma, carcinosarcoma, leiomyosarcoma, and desmoid tumor may also be seen. Thus, the differential diagnosis for female pelvic masses is extensive. However, the site of origin, MR imaging characteristics, and clinical history may all help narrow the differential diagnosis. Although with large tumors it may not always be possible to determine the site of origin or distinguish between various tumors at radiology, familiarity with the clinicopathologic and MR imaging features of common and uncommon pelvic masses is important for diagnosis and treatment.
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Affiliation(s)
- Janio Szklaruk
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA.
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Akaeda T, Isaka K, Kakizaki D, Abe K, Takayama M. Evaluation of endometrial cancer with 3D-VIBE (volume interpolated breath-hold examination) using intrauterine CO2 gas. Magn Reson Imaging 2002; 20:551-6. [PMID: 12413601 DOI: 10.1016/s0730-725x(02)00530-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To evaluate the myometrial infiltration of the endometrial cancer prior to aggressive treatment, dynamic MRI (magnetic resonance imaging) has attracted attention. However, it has also been found that in a number of cases, MRI exhibits inconsistent results with regards to the extent of the infiltration into this component of the uterine body. To overcome this limitation, the authors designed a method to delineate the tumor morphology more clearly by injecting CO2 gas into the uterine cavity. This procedure was combined with VIBE (volumetric interpolated breath-hold examination) to determine more precisely the depth of the tumor invasion. From our clinical results, the efficacy of the method was evaluated. On four patients with endometrial cancers (stage Ia-Ic), CO2 was injected to dilate the intra-uterine space through a catheter equipped with a balloon that had been introduced into the uterine cavity, after which VIBE was conducted. The images were interpreted by MPR (multiplanar reconstruction) and the findings from these images were compared against the histopathological findings. By employing this method, it was possible to delineate clearly the tumorous lesion in the uterine body, and three-dimensional images of the tumor invasion was acquired. The site and extent of tumor invasion in the myometrium were generally consistent with the histopathological findings. This method allows one to observe multiple planes by using thin slices. By dilating the uterine cavity, the site of involvement and the extent of invasion can be more precisely defined before treatment. It is truly a revolutionary procedure for determining-prior to surgery-the depth of invasion of a cancer located in the uterine body.
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Affiliation(s)
- Tomoyoshi Akaeda
- Department of Obstetrics and Gynecology, Tokyo Medical University Hospital, Tokyo, Japan
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Frei KA, Kinkel K. Staging endometrial cancer: role of magnetic resonance imaging. J Magn Reson Imaging 2001; 13:850-5. [PMID: 11382943 DOI: 10.1002/jmri.1121] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
This review article summarizes and comments the role of magnetic resonance imaging (MRI) in the management of endometrial cancer. The MRI technique, appearance, and diagnostic criteria of endometrial carcinoma are discussed. The value of MRI in the preoperative staging of endometrial cancer is compared to alternative strategies. Contrast-enhanced MRI performs best in the pretreatment evaluation of myometrial or cervical invasion, compared to ultrasonography (US), computed tomography (CT), or nonenhanced MRI. The overall costs and accuracy are similar to those of the current methods of staging, including intraoperative gross dissection of the uterus. In addition, results of MRI might decrease the number of unnecessary lymph node dissections. J. Magn. Reson. Imaging 2001;13:850-855.
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Affiliation(s)
- K A Frei
- Department of Obstetrics and Gynecology, Kantonales Frauenspital Fontana, Lürlibadstr. 118, 7000 Chur, Switzerland.
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Hardesty LA, Sumkin JH, Hakim C, Johns C, Nath M. The ability of helical CT to preoperatively stage endometrial carcinoma. AJR Am J Roentgenol 2001; 176:603-6. [PMID: 11222188 DOI: 10.2214/ajr.176.3.1760603] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study evaluated helical CT as an imaging modality for preoperative staging of endometrial carcinoma. MATERIALS AND METHODS Three radiologists retrospectively and independently reviewed the preoperative helical CT scans of 25 consecutive patients with endometrial carcinoma. The presence or absence of deep myometrial invasion and the presence or absence of cervical involvement were evaluated on helical CT and compared with pathologic findings at hysterectomy. RESULTS Helical CT has a sensitivity of 83% and a specificity of 42% for the detection of deep myometrial invasion (stage IC). Helical CT has a sensitivity of 25% and a specificity of 70% for the detection of cervical involvement (state II). These results compare poorly with those of MR imaging (sensitivity 92%, specificity 90% for the detection of deep myometrial invasion; sensitivity 86%, specificity 97% for the detection of cervical involvement). CONCLUSION Helical CT is insensitive and nonspecific compared with MR imaging for the preoperative staging of endometrial carcinoma. MR imaging remains the imaging modality of choice.
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Affiliation(s)
- L A Hardesty
- Department of Radiology, Magee Women's Hospital, University of Pittsburgh, 300 Halket St., Pittsburgh, PA 15213, USA
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Frei KA, Kinkel K, Bonél HM, Lu Y, Zaloudek C, Hricak H. Prediction of deep myometrial invasion in patients with endometrial cancer: clinical utility of contrast-enhanced MR imaging-a meta-analysis and Bayesian analysis. Radiology 2000; 216:444-9. [PMID: 10924568 DOI: 10.1148/radiology.216.2.r00au17444] [Citation(s) in RCA: 169] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine if, in a patient with an endometrial cancer, in addition to the knowledge of tumor grade, preoperative magnetic resonance (MR) imaging findings contribute to treatment stratification and specialist referral. MATERIALS AND METHODS By using a MEDLINE literature search and institutional pathology reports, pretest probabilities for myometrial invasion were correlated with tumor grade. Likelihood ratios (LRs) were obtained through summary receiver operating characteristics. RESULTS The mean pretest probabilities of deep myometrial invasion were derived from seven articles (1,875 patients) and from 125 institutional pathology reports. LRs for the prediction of myometrial invasion with contrast-enhanced MR imaging were derived from nine studies (742 patients); positive and negative LRs were 10.11 and 0.1, respectively. The mean weighted pretest probabilities of deep myometrial invasion in patients with tumor grades 1, 2, or 3 were 13%, 35%, or 54%, respectively. Posttest probabilities of deep myometrial invasion for grades 1, 2, or 3 increased to 60%, 84%, or 92%, respectively, for positive and decreased to 1%, 5%, or 10%, respectively, for negative MR imaging findings. CONCLUSION Use of contrast-enhanced MR imaging significantly affects the posttest probability of deep myometrial invasion in patients with all grades of endometrial cancer and could be used to select patients for specialist referral.
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Affiliation(s)
- K A Frei
- Departments of Radiology, The University of California, San Francisco, CA, USA
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Seki H, Takano T, Sakai K. Value of dynamic MR imaging in assessing endometrial carcinoma involvement of the cervix. AJR Am J Roentgenol 2000; 175:171-6. [PMID: 10882269 DOI: 10.2214/ajr.175.1.1750171] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate endometrial carcinoma involvement of the cervix using dynamic MR imaging compared with T2-weighted and contrast-enhanced T1-weighted MR imaging. SUBJECTS AND METHODS In 42 patients with endometrial carcinoma, T2-weighted MR imaging using rapid acquisition with relaxation enhancement, dynamic MR imaging using gradient-echo sequences, and contrast-enhanced T1-weighted MR imaging using spin-echo sequences were performed before treatment. We evaluated patterns of enhancement in the cervix and tumor. In 39 of the 42 patients who underwent surgical treatment, we compared MR imaging findings with histologic results concerning cervical involvement. RESULTS Enhancement of the cervical epithelium was greater than that of the tumor and cervical stroma on dynamic MR imaging in most patients. In assessing cervical involvement, the accuracy of T2-weighted, dynamic, and contrast-enhanced T1-weighted MR imaging was 85%, 95%, and 90%, respectively; no statistically significant difference was observed. False-positive cases on T2-weighted MR imaging were correctly identified as having no cervical involvement on dynamic MR imaging using the finding of continuous enhancement of the cervical epithelium. We found this finding to be reliable in assessing tumor involvement of the cervix. CONCLUSION We believe that, in combination with T2-weighted MR imaging sequences, dynamic MR imaging is useful in assessing endometrial carcinoma involvement of the cervix.
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Affiliation(s)
- H Seki
- Department of Radiology, Niigata University School of Medicine, Japan
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Kinkel K, Kaji Y, Yu KK, Segal MR, Lu Y, Powell CB, Hricak H. Radiologic staging in patients with endometrial cancer: a meta-analysis. Radiology 1999; 212:711-8. [PMID: 10478237 DOI: 10.1148/radiology.212.3.r99au29711] [Citation(s) in RCA: 345] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To apply a meta-analysis to compare the utility of computed tomography (CT), ultrasonography (US), and magnetic resonance (MR) imaging in staging endometrial cancer. MATERIALS AND METHODS Data were obtained from a MEDLINE literature search and from manual reviews of article bibliographies. Articles were selected that included results in patients with proved endometrial cancer and imaging-histopathologic correlation and that presented data that allowed calculation of contingency tables. Data for the imaging evaluation of myometrial and cervical invasion were abstracted independently by two authors. Data on year of publication, International Federation of Gynecology and Obstetrics (FIGO) stage distribution, and methodologic quality were also collected. A subgroup analysis was performed to compare contrast medium-enhanced MR imaging with nonenhanced MR imaging, US, and CT. RESULTS Six studies met the inclusion criteria for CT; 16, for US; and 25, for MR imaging. Summary receiver operating characteristic analysis showed no significant differences in the overall performance of CT, US, and MR imaging. In the assessment of myometrial invasion, however, contrast-enhanced MR imaging performed significantly better than did nonenhanced MR imaging or US (P < .002) and demonstrated a trend toward better results, as compared with CT. The lack of data on the assessment of cervical invasion at CT or US prevented meta-analytic comparison with data obtained at MR imaging. Results were not influenced by year of publication, FIGO stage distribution, or methodologic quality. CONCLUSION Although US, CT, or MR imaging can be used in the pretreatment evaluation of endometrial cancer, contrast-enhanced MR imaging offers "one-stop" examination with the highest efficacy.
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Affiliation(s)
- K Kinkel
- Department of Radiology, University of California-San Francisco 94143-0628, USA.
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