Chapter 13 - MRI of malignant uterine tumors

Abstract

Endometrial carcinoma is the most common gynecologic malignancy in the United States and other developed countries. It is a malignancy of the perimenopausal and postmenopausal women with approximately 25% presenting before menopause. Surgery is the primary treatment and surgical staging had been the standard of care. Transvaginal ultrasonography is used to the evaluate the endometrium in women with abnormal uterine bleeding prior to endometrial biopsy. Preoperative imaging with magnetic resonance imaging (MRI) is useful to assess the extent of the disease including depth of myometrial invasion and extrauterine invasion and is important to optimize treatment decision making. The role of MRI and its advantages in preoperative staging are reviewed in this manuscript. Role of contrast enhanced computed tomography (CT) and FDG PET (Fluorodeoxyglucose (FDG)-positron emission tomography(PET))./CT/MRI for detection of lymph nodal and distant metastases for complete staging are also discussed. Nonepithelial malignancies comprising different types of sarcomas represent 10% of uterine malignancies. The imaging features of these sarcomas which overlap with benign leiomyoma and endometrial carcinoma are also illustrated. Proper interpretation of the MR imaging findings using a standardized reporting template is emphasized.