CT Head Although a head CT is acceptable as a means to document brain metastases (FIGO), the formalized consensus of the EOTTD favors MRI over CT in the detection of brain metastases [6]. Because GTN metastases are typically vascular, IV contrast enhancement is necessary to improve lesion detection. CT Abdomen and Pelvis CT abdomen and pelvis is useful to exclude disseminated disease in patients with high-risk or recurrent GTN who are being considered for salvage hysterectomy [16] or to evaluate for recurrence of tumors after surgical resection. In the specific context of oligometastatic disease to lung with potential for pulmonary wedge resection, CT abdomen and pelvis has particular utility for exclusion of additional disease sites [16,18]. Because GTN metastases are typically vascular, IV contrast enhancement is necessary to improve lesion detection. FDG-PET/CT Skull Base to Mid-Thigh The role of FDG-PET/CT in the evaluation of patients with refractory or recurrent GTN is incompletely defined and evolving, given the uncommon nature of the disease. FDG-PET/CT may help to identify the site of active or occult disease and facilitate planning for surgical resection and potential cure [10,66,67,69,72]. However, the evidence basis is small and retrospective. Variant 4: Assessment of complications: GTD and GTN. Patients with GTD can present with complications related to invasive mole or metastatic lesions, in large part because of the highly vascular nature of this disease process. Some of these complications can be severe and life- threatening. Hemorrhage is the most common complication and can result from tumor invading the uterus or from other sites of metastatic tumor involvement, including lungs, brain, vagina, and liver [2,16,50,73]. Selective angiographic localization and embolization can be used to identify and treat lesions with active hemorrhage as well as post-treatment sequelae, such as arteriovenous malformation [18].
Gestational Trophoblastic Disease. CT Head Although a head CT is acceptable as a means to document brain metastases (FIGO), the formalized consensus of the EOTTD favors MRI over CT in the detection of brain metastases [6]. Because GTN metastases are typically vascular, IV contrast enhancement is necessary to improve lesion detection. CT Abdomen and Pelvis CT abdomen and pelvis is useful to exclude disseminated disease in patients with high-risk or recurrent GTN who are being considered for salvage hysterectomy [16] or to evaluate for recurrence of tumors after surgical resection. In the specific context of oligometastatic disease to lung with potential for pulmonary wedge resection, CT abdomen and pelvis has particular utility for exclusion of additional disease sites [16,18]. Because GTN metastases are typically vascular, IV contrast enhancement is necessary to improve lesion detection. FDG-PET/CT Skull Base to Mid-Thigh The role of FDG-PET/CT in the evaluation of patients with refractory or recurrent GTN is incompletely defined and evolving, given the uncommon nature of the disease. FDG-PET/CT may help to identify the site of active or occult disease and facilitate planning for surgical resection and potential cure [10,66,67,69,72]. However, the evidence basis is small and retrospective. Variant 4: Assessment of complications: GTD and GTN. Patients with GTD can present with complications related to invasive mole or metastatic lesions, in large part because of the highly vascular nature of this disease process. Some of these complications can be severe and life- threatening. Hemorrhage is the most common complication and can result from tumor invading the uterus or from other sites of metastatic tumor involvement, including lungs, brain, vagina, and liver [2,16,50,73]. Selective angiographic localization and embolization can be used to identify and treat lesions with active hemorrhage as well as post-treatment sequelae, such as arteriovenous malformation [18].