Tina PW Lam Radiology QMH Correlative imaging of gynecological diseases
Jan 23, 2015
Tina PW Lam Radiology
QMH
Correlative imaging of gynecological
diseases
Correlative imaging
* Structural imaging
* Tissue characterization
* Cancer staging
* Functional imaging
Structural imaging
* Detail anatomy
* Accurate lesion size, location and extent
* Delineate complex anomaly
Patient 1 14 year-old girl Menarchy at 11 years old Regular monthly cycle
Dysmenorhoea Progressive abdominal distension
TT1W axial
T2W axial
T2W
T2W sagittal
T2W coronal Uterine didelphys Cervical atresia Endometriotic cyst
Tissue Characterization
* Differentiate gas, fat, fluid, soft tissue, blood, tumour and calcification
Mature Teratoma
Leiolipoma
Calcified leiomyoma
T1W
T1W FS+C
Mature teratoma
T2W
Adenomhyosis Endometriotic cyst
2010
2012
2012
Patient 2 A 50 year-old perimenopausal lady uterine leiomyoma for several years
Recent enlargement with heterogeneous signal
MRI 2012
T2W
T1W FS +C
Red degeneration of leiomyoma
T2W
T1W FS
T1W FS +C
US in 10/2013
Cancer staging
Cancer of cervix uteri
* Differentiate operable early disease (stages Ia, Ib & IIa) from advanced disease
* Delineate extent of advanced disease extent to define the radiotherapy fields
* Clinical staging inaccurate, assessment difficulties:
parametrial, pelvic sidewall invasions
bladder & rectal invasions
endocervical tumour size
lymph node & distant metastases
Patient 3 A 16 year-old girl Menorrhagia since menarchy
Progressive weight loss P/E: vagina filled with tumour
Clear cell carcinoma of cervix & vagina
Hypoplastic uterus, T-shaped cavity – suspected DES exposure
Cancer of cervix uteri
Cancer of cervix uteri
Cancer of corpus uteri
* Depth of myometrial invasion correlates with tumor grade, cervical extension, and prevalence of LN metastases
* Incidence of LN metastases increases from 3% with superficial myometrial invasion (stage IB) to 46% with deep myometrial invasion (stage IC)
* The sensitivity and specificity of MRI for depth of myometrial invasion range from 69-94% and 64-100% respectively
Berman ML, Ballon SC, Lagasse LD, Watring WG. Am J Obstet Gynecol 1980; 136:679 –688 Boronow RC, Morrow CP, Creasman WT, et al. Obstet Gynecol 1984; 63:825–832
Cancer of corpus uteri
Patient 4 56 yr-old menopausal lady Post menopausal bleeding P/E: tumor protruded from cervix MRI: stage IIIC2 aggressive tumor Histology: MMMT
Cancer of ovary
* The use of MR in evaluation of sonographically indeterminate adnexal lesions resulted in fewer surgical procedures, better patient triage, and net cost savings
Schwartz PE. Gynecologic Oncology. 1997;64(1):1–3.
Cancer of Ovary
Patient 5 A 49 year-old lady Long standing endometriotic cyst Developed vascular mural nodules
PET/CT
PET-CT
Clear cell carcinoma with omental and peritoneal deposits
Functional imaging
Omental & peritoneal
deposits
PPE
No residual disease after chemotherapy
PET/CT in 4/13
PET/CT in 9/13
Staging & follow-up of ovarian cancer
* PET/CT & CT alone are 100% specific
* PET/CT marginally better than CT alone at 97% sensitivity.
* MRI is comparable to CT
http://www.acr.org/~/media/ACR/Documents/AppCriteria/Diagnostic/StagingAndFollowUpOvarianCancer.pdf
PET/CT in cancers of cervix & corpus uteri
* Highest accuracy in LN metastasis detection (95-98%)*
* 45% endometrial cancers are grade I and not FDG-avid*
* Poor spatial resolution, inefficient detection of parametrial or adjacent organs invasion in cervical cancer
*Antonsen SL et al. Gynecol Oncol. 2013 Feb;128(2):300-8
Recent advances
* Hybrid MRI/PET * Functional MRI – Dynamic contrast enhanced - Diffusion weighted imaging * MR spectroscopy
Thank you!