Contrast-enhanced US could be useful to diagnose the depth of myometrial invasion using the arcuate vascular plexus involvement as a marker, with the diagnostic accuracy for determining the myometrium infiltration depth was 85.3%; however, this needs further validation [31]. FDG-PET/MRI is emerging as a hybrid imaging modality that combines the functional ability of PET with the morphological high soft-tissue contrast provided by MRI. Although there is a paucity of literature on the role of FDG-PET/MRI for the initial staging and suspected recurrence in patients with EC, studies assessing local staging, lymph node involvement, and distant metastases in gynecological malignancies have found that FDG-PET/MRI is equivalent or outperforms FDG-PET/CT. Queiroz et al [32] studied 26 patients with gynecological malignancies (including four ECs) and found that PET/MRI had improved delineation compared to PET/CT for 2 of 3 ECs and 6 of 7 cervical cancers. These authors found no difference in the detection of regional lymph node involvement and abdominal metastases between the two modalities. More recently, a meta-analysis that comprised 7 studies and 216 patients with a variety of gynecological malignancies showed excellent diagnostic performance of FDG-PET/MRI to assess the primary tumor, nodal staging, and recurrence in patients with gynecological malignancies including EC [33]. In a study of 81 patients with proven recurrence of gynecological malignancy, PET/MRI achieved a lesion- based accuracy of 94% compared to 92% for PET/CT [34]. A meta-analysis (7 studies, 257 patients, 695 lesions) that evaluated the diagnostic value of FDG-PET/MRI for restaging patients with suspected recurrence of gynecological malignancies reported the pooled sensitivity and specificity on a patient-based analysis to be 0.96 and 0.95, respectively, and on a lesion-based analysis 0.99 and 0.94, respectively [35].
Pretreatment Evaluation and Follow Up of Endometrial Cancer. Contrast-enhanced US could be useful to diagnose the depth of myometrial invasion using the arcuate vascular plexus involvement as a marker, with the diagnostic accuracy for determining the myometrium infiltration depth was 85.3%; however, this needs further validation [31]. FDG-PET/MRI is emerging as a hybrid imaging modality that combines the functional ability of PET with the morphological high soft-tissue contrast provided by MRI. Although there is a paucity of literature on the role of FDG-PET/MRI for the initial staging and suspected recurrence in patients with EC, studies assessing local staging, lymph node involvement, and distant metastases in gynecological malignancies have found that FDG-PET/MRI is equivalent or outperforms FDG-PET/CT. Queiroz et al [32] studied 26 patients with gynecological malignancies (including four ECs) and found that PET/MRI had improved delineation compared to PET/CT for 2 of 3 ECs and 6 of 7 cervical cancers. These authors found no difference in the detection of regional lymph node involvement and abdominal metastases between the two modalities. More recently, a meta-analysis that comprised 7 studies and 216 patients with a variety of gynecological malignancies showed excellent diagnostic performance of FDG-PET/MRI to assess the primary tumor, nodal staging, and recurrence in patients with gynecological malignancies including EC [33]. In a study of 81 patients with proven recurrence of gynecological malignancy, PET/MRI achieved a lesion- based accuracy of 94% compared to 92% for PET/CT [34]. A meta-analysis (7 studies, 257 patients, 695 lesions) that evaluated the diagnostic value of FDG-PET/MRI for restaging patients with suspected recurrence of gynecological malignancies reported the pooled sensitivity and specificity on a patient-based analysis to be 0.96 and 0.95, respectively, and on a lesion-based analysis 0.99 and 0.94, respectively [35].