However, 3T images typically have more susceptibility and chemical shift artifacts and greater image inhomogeneity on T2WI [67,68]. US Pelvis Transvaginal In a study of 169 consecutive patients with EC, TVUS achieved a 79.5% sensitivity and a 89.6% specificity for detecting deep myometrial invasion were 82% and 81%, respectively [69]. A prospective collaborative trial comparing MRI and US, reported that the accuracy of US is comparable to that provided by MRI [51]. However, US has reported accuracies varying between 77% and 91% [50,51]. A more recent study found that MRI showed greater accuracy than 3-D TVUS or 2-D TVUS (83%, 71%, and 75%, respectively) for myometrial involvement [28]. US is limited in the setting of concomitant benign disease (eg, leiomyomas or adenomyosis) and also for large lesions because of the limited depth of penetration of TVUS. In addition, there are insufficient reports about the benefit of TVUS in predicting cervical extension, parametrical invasion, or lymphadenopathy. Studies have shown that contrast-enhanced US could be useful to diagnose the depth of myometrial invasion using the arcuate vascular plexus involvement as a marker; however, this needs further validation [31]. Variant 2: Pretreatment evaluation of endometrial cancer; assessment of lymph node and distant metastasis for low-grade tumor (Type I, grade 1, 2). Most patients with low-grade disease are at low risk of lymph node and distant metastases. In the largest series to date on grade 1 ECs, the incidence of pelvic lymph node involvement, pelvic metastasis, and distant metastasis specific to grade 1 tumors is estimated at 3.3%, 4.6%, and 2.4%, respectively [70]. CT Chest, Abdomen, and Pelvis Contrast-enhanced CT of the abdomen and pelvis may be employed preoperatively for the detection of lymph node metastases in EC. However, the reported sensitivity of contrast-enhanced CT for pelvic and para-aortic lymphadenopathy is only 29% to 52% [71,72].
Pretreatment Evaluation and Follow Up of Endometrial Cancer. However, 3T images typically have more susceptibility and chemical shift artifacts and greater image inhomogeneity on T2WI [67,68]. US Pelvis Transvaginal In a study of 169 consecutive patients with EC, TVUS achieved a 79.5% sensitivity and a 89.6% specificity for detecting deep myometrial invasion were 82% and 81%, respectively [69]. A prospective collaborative trial comparing MRI and US, reported that the accuracy of US is comparable to that provided by MRI [51]. However, US has reported accuracies varying between 77% and 91% [50,51]. A more recent study found that MRI showed greater accuracy than 3-D TVUS or 2-D TVUS (83%, 71%, and 75%, respectively) for myometrial involvement [28]. US is limited in the setting of concomitant benign disease (eg, leiomyomas or adenomyosis) and also for large lesions because of the limited depth of penetration of TVUS. In addition, there are insufficient reports about the benefit of TVUS in predicting cervical extension, parametrical invasion, or lymphadenopathy. Studies have shown that contrast-enhanced US could be useful to diagnose the depth of myometrial invasion using the arcuate vascular plexus involvement as a marker; however, this needs further validation [31]. Variant 2: Pretreatment evaluation of endometrial cancer; assessment of lymph node and distant metastasis for low-grade tumor (Type I, grade 1, 2). Most patients with low-grade disease are at low risk of lymph node and distant metastases. In the largest series to date on grade 1 ECs, the incidence of pelvic lymph node involvement, pelvic metastasis, and distant metastasis specific to grade 1 tumors is estimated at 3.3%, 4.6%, and 2.4%, respectively [70]. CT Chest, Abdomen, and Pelvis Contrast-enhanced CT of the abdomen and pelvis may be employed preoperatively for the detection of lymph node metastases in EC. However, the reported sensitivity of contrast-enhanced CT for pelvic and para-aortic lymphadenopathy is only 29% to 52% [71,72].