High-grade tumors are at risk for extrauterine spread and therefore warrant full surgical staging by gynecological surgeons. The role of imaging in this subgroup may be to identify extrauterine metastases or spread, which helps Evaluation and Follow-Up of Endometrial Cancer plan the surgical approach (eg, minimally invasive surgery versus laparotomy). Laparotomy is the preferred approach when involvement of pelvic or abdominal organs are suspected. MRI Pelvis Pelvic MRI has long been established as a valuable imaging method in the preoperative staging of EC [45-49]. MRI is preferred over US or CT for pretreatment evaluation because it allows the most accurate evaluation of the extent of pelvic tumor. A meta-analysis showed that the efficacy of contrast-enhanced MRI is significantly better than that of noncontrast MRI and US, and tended toward better results than CT, in evaluating the depth of myometrial invasion in patients with EC [50]. One study found that high-frequency TVUS has similar diagnostic accuracy in the evaluation of both tumor extension into the cervix (92% for high-frequency TVUS versus 85% for MRI) and myometrial invasion (84% for high-frequency TVUS versus 82% for MRI) [51]. However, in patients with an elevated body mass index, in the presence of myomas or adenomyosis, in the setting of bulky tumors, and in the presence of a vertical or retroverted uterine corpus, evaluation of the EC is difficult with TVUS [51]. Disruption of the low signal intensity junctional zone on the T2-weighted images (T2WI) indicates the presence of myometrial invasion. Deep myometrial invasion is diagnosed when the intermediate signal intensity of the tumor involves at least 50% of the myometrial thickness on the T2WI. Dynamic contrast-enhanced MRI performs significantly better than unenhanced MRI for evaluating the depth of myometrial invasion, which is best demonstrated after 50 to 120 seconds postcontrast injection [50,52].
Pretreatment Evaluation and Follow Up of Endometrial Cancer. High-grade tumors are at risk for extrauterine spread and therefore warrant full surgical staging by gynecological surgeons. The role of imaging in this subgroup may be to identify extrauterine metastases or spread, which helps Evaluation and Follow-Up of Endometrial Cancer plan the surgical approach (eg, minimally invasive surgery versus laparotomy). Laparotomy is the preferred approach when involvement of pelvic or abdominal organs are suspected. MRI Pelvis Pelvic MRI has long been established as a valuable imaging method in the preoperative staging of EC [45-49]. MRI is preferred over US or CT for pretreatment evaluation because it allows the most accurate evaluation of the extent of pelvic tumor. A meta-analysis showed that the efficacy of contrast-enhanced MRI is significantly better than that of noncontrast MRI and US, and tended toward better results than CT, in evaluating the depth of myometrial invasion in patients with EC [50]. One study found that high-frequency TVUS has similar diagnostic accuracy in the evaluation of both tumor extension into the cervix (92% for high-frequency TVUS versus 85% for MRI) and myometrial invasion (84% for high-frequency TVUS versus 82% for MRI) [51]. However, in patients with an elevated body mass index, in the presence of myomas or adenomyosis, in the setting of bulky tumors, and in the presence of a vertical or retroverted uterine corpus, evaluation of the EC is difficult with TVUS [51]. Disruption of the low signal intensity junctional zone on the T2-weighted images (T2WI) indicates the presence of myometrial invasion. Deep myometrial invasion is diagnosed when the intermediate signal intensity of the tumor involves at least 50% of the myometrial thickness on the T2WI. Dynamic contrast-enhanced MRI performs significantly better than unenhanced MRI for evaluating the depth of myometrial invasion, which is best demonstrated after 50 to 120 seconds postcontrast injection [50,52].