Purpose
Endometrial cancer (EC) is the most common gynecologic lesion in developed countries,
occurring mainly in postmenopausal women.
Various factors can influence its prognosis,
such as the histological subtype,
grade and tumor stage,
especially the depth of myometrial invasion(1).
Deep myometrial infiltration (>50%) is the most important morphologic prognostic factor,
correlating with tumor grade,
presence of nodes metastases and overall patient survival; moreover it is an indication for pelvic and lomboaortic dissection,
hysterectomy and annessectomy (2-3).
Therefore,
preoperative information about depth of myometrial invasion and histological...
Methods and Materials
Between August 2012 and November 2012 12 patients affected by hystologically proved EC were enrolled in our prospective study.
MR examination was performed on a 1,5T scanner (Symphony,
Siemens) equipped with high-performing gradients (amplitude 30 mT/m),
with patient in supine position; before exam beginning,
20 mg of N-butile-scopolamine were injected i.v.
to reduce bowel movements artifacts.
Then we started with TSE T2-weighted sequences on multiple planes (FOV:220X220,slice thickness:4mm,effective matrix:384x75,
FA:180°,
TR:4400,
TE:104 both for sagittal and coronal planes; slice thickness:3mm,
effective matrix:320x75,
FA:180°,
FOV:280x280,
TR:5452,...
Results
Among the 12 patients enrolled in our study,
two of them were excluded because the histolgical result was atypical hyperplasia,
which is not detectable on MR images.
Therefore,
10 women in post-menopausal age were included in our study,
with a mean age of 63 yrs (range 50-76).
All the patients underwent surgery: in 3 cases hysteroannessectomy was performed,
in 9 cases hysteroanessectomy with pelvic and lomboaortic nodes dissection was performed; among these,
in one case it was performed hysteroannessectomy with nodes sampling; the histological subtypes...
Conclusion
MR imaging is very accurate in the assessment of endometrial cancer,
delineating its local extent and its involvement of myometrial thickness; in particular,
on DWI,
EC shows impeded diffusion compared with surrounding tissue,
showing high signal intensity and low signal intensity on ADC map,
providing a quantitative measure of water diffusion.
DWI should always be reviewed with its ADC maps to avoid pitfalls such as T2 shine-through effect.
(5-7)
The added value of DWI in assessing EC local extend is not yet well established such...
References
1- Beddy P.,
0’Neill A,
Yamamoto A,
et al.
FIGO staging system for endometrial cancer: added benefits of MR imaging.
Radiographics.
2012 June; 32:241-254.
2- Larson DM,
Connor GP,
Broste SK,
et al.
Prognostic significance of gross myometrial invasion with endometrial cancer.
Obstet.
Gynecol. 1996;88 (3):394-398.
3- Berman ML,
Ballon SC,
Lagasse LD,
et al.
Prognosis and treatment of endometrial cancer.
Am J Obstet Gynecol. 1980; 136(5):679-688.
4- Qayyum A.
Diffusion weighted imaging in the abdomen and pelvis: concepts and applications.
Radiographics 2009;29:1797-1810.
5- Tamai...