Keywords:
Genital / Reproductive system female, Pelvis, MR-Functional imaging, Contrast agent-intravenous, Neoplasia
Authors:
C. L. Piccolo, R. Del Vescovo, F. Giurazza, F. Pitocco, R. L. Cazzato, R. F. Grasso, B. Beomonte Zobel; Rome/IT
DOI:
10.1594/ecr2013/C-0732
Purpose
Endometrial cancer(EC) is the fourth most common tumor affecting women in developed countries,
with an incidence which is steadily rising because of increasing longevity and escalating levels of obesity.
Its prognosis depends on many factors,
such as stage,
depth of myometrial invasion,
cervical stroma and lympho-vascular invasion,
nodes status and histological grade (1).
Therefore,
preoperative information about depth of myometrial invasion and histological grade is essential in the planning of surgical approach of these patients.
Magnetic Resonance Imaging (MRI) is a very useful technique in the pre-operative staging of EC; infact it can accurately detect myometrial infiltration,
which strongly correlates with tumor grade,
nodes involvement and overall patient survival.
Together with the histological grade,
MRI allows a selections of patients for pelvic and para-aortic nodes dissection,
thus obviating the need for radical surgery treatment in patient with low-risk disease (2).
In particular,
the application of Dynamic Contrast material-Enhanced (DCE) MRI has been shown to improve T2-weighted (T2w) sequences capability in the assessment of the depth of myometrial invasion; however,
in literature there is disagreement as for as its role in staging endometrial cancer (3-5).
After gadolinium administration,
endometrial carcinoma enhances earlier than does normal endometrium,
while normal myometrium enhances intensely compared with hypointense endometrial tumors.
Therefore,
maximum contrast between hyperintense myometrium and hypointense endometrial cancer occurs 50-120 sec after contrast medium administration.(6) The purpose of our study was to compare the diagnostic performance of DCE-MRI sequences with T2 weighted ones in assessing the depth of myometrial invasion by Endometrial Cancer (EC) and lymph-nodes status.