European Radiology

, Volume 29, Issue 2, pp 792–805 | Cite as

Endometrial Cancer MRI staging: Updated Guidelines of the European Society of Urogenital Radiology

  • Stephanie Nougaret
  • Mariana Horta
  • Evis Sala
  • Yulia Lakhman
  • Isabelle Thomassin-Naggara
  • Aki Kido
  • Gabriele Masselli
  • Nishat Bharwani
  • Elizabeth Sadowski
  • Andrea Ertmer
  • Milagros Otero-Garcia
  • Rahel A. Kubik-Huch
  • Teresa M Cunha
  • Andrea Rockall
  • Rosemarie Forstner
Magnetic Resonance



To update the 2009 ESUR endometrial cancer guidelines and propose strategies to standardize image acquisition, interpretation and reporting for endometrial cancer staging with MRI.


The published evidence-based data and the opinion of experts were combined using the RAND-UCLA Appropriateness Method and formed the basis for these consensus guidelines. The responses of the experts to 81 questions regarding the details of patient preparation, MR imaging protocol, image interpretation and reporting were collected, analysed and classified as “RECOMMENDED” versus “NOT RECOMMENDED” (if at least 80% consensus among experts) or uncertain (if less than 80% consensus among experts).


Consensus regarding patient preparation, MR image acquisition, interpretation and reporting was determined using the RAND-UCLA Appropriateness Method. A tailored MR imaging protocol and a standardized report were recommended.


These consensus recommendations should be used as a guide for endometrial cancer staging with MRI.

Key points

• MRI is recommended for initial staging of endometrial cancer.

• MR imaging protocol should be tailored based on the risk of lymph node metastases.

• Myometrial invasion is best assessed using combined axial-oblique T2WI, DWI and contrast-enhanced imaging.

• The mnemonic “Clinical and MRI Critical TEAM” summarizes key elements of the standardized report.


Magnetic resonance imaging Endometrial cancer Guideline Diffusion Uterus 



Cervical stromal invasion


Dynamic contrast-enhanced MRI


Diffusion-weighted imaging


Endometrial cancer


European Society for Medical Oncology


European Society of Urogenital Radiology


Field of view (FOV) optimized and constrained undistorted single-shot DWI


Myometrial invasion


Magnetic resonance imaging


RAND-UCLA Appropriateness Method


Signal intensity


Sentinel lymph node


Texture analysis


T2-weighted imaging



The committee would like to thank Mr Arnold Stipsits, ESUR secretary, for his help with co-ordination of the committee members. The authors would like to acknowledge the contribution of information specialist Dr. Martina Gosteli (Main library - Medicine Careum, University of Zurich) for her valuable assistance with the database searches. We would like to thank the following colleagues: Henrik Leonhardt, Celine Alt, Federico Collettini, Laure Fournier, Diomidis Botsikas, Gavin Stewart, Athina C. Tsili, Theresa Mokry, Riccardo Manfredi, Laura Bunesch Villalba, Sonya Snape, Hebert Alberto Vargas, Maryna Brochwicz-Lewinski, M. Weston, Suzan M. Goldman and Sara Belião for participating to the questionnaire on behalf of the ESUR women’s imaging group. Authors thank Joanne Chin M.F.A. for her editorial assistance with the manuscript.


Yulia Lakhman's contribution to this work was funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748.

Compliance with ethical standards


The scientific guarantor of this publication is Rosemarie Forstner

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was not required for this study because no patient data were used.

Ethical approval

Institutional review board approval was not required because no patient data were used.


• multicentre study

Supplementary material

330_2018_5515_MOESM1_ESM.docx (183 kb)
ESM 1 (DOCX 183 kb)


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Stephanie Nougaret
    • 1
    • 2
    • 3
  • Mariana Horta
    • 4
  • Evis Sala
    • 5
  • Yulia Lakhman
    • 6
  • Isabelle Thomassin-Naggara
    • 7
  • Aki Kido
    • 8
  • Gabriele Masselli
    • 9
  • Nishat Bharwani
    • 10
  • Elizabeth Sadowski
    • 11
  • Andrea Ertmer
    • 12
  • Milagros Otero-Garcia
    • 13
  • Rahel A. Kubik-Huch
    • 14
  • Teresa M Cunha
    • 15
  • Andrea Rockall
    • 16
    • 17
  • Rosemarie Forstner
    • 18
  1. 1.IRCM, Montpellier Cancer Research instituteMontpellierFrance
  2. 2.Department of Radiology, Montpellier Cancer institute, INSERM, U1194University of MontpellierMontpellierFrance
  3. 3.Service de RadiologieInstitut régional du Cancer de MontpellierMontpellierFrance
  4. 4.Department of RadiologyInstituto Português de Oncologia de Lisboa Francisco GentilLisboa CodexPortugal
  5. 5.Department of Radiology Box 218Cambridge Biomedical Campus CambridgeCambridgeUK
  6. 6.Department of RadiologyMemorial Sloan Kettering Cancer CenterNew YorkUSA
  7. 7.UPMC Univ. Paris 06, Institut Universitaire de Cancérologie, Assistance Publique – Hôpitaux de Paris (AP-HP), Hôpital TenonSorbonne UniversitésParisFrance
  8. 8.Department of Diagnostic Radiology and Nuclear MedicineKyoto University HospitalKyotoJapan
  9. 9.Radiology DepartmentSapienza UniversityRomeItaly
  10. 10.Department of Radiology, St Mary’s Hospital, Imperial College Healthcare NHS TrustLondonUK
  11. 11.Departments of Radiology, Obstetrics and GynecologyUniversity of Wisconsin SMPHMadisonUSA
  12. 12.Department of RadiologySpital BülachBülachSwitzerland
  13. 13.Complexo Hospitalario Universitario de Santiago de CompostelaSantiago de CompostelaSpain
  14. 14.Department of RadiologyKantonsspital BadenBadenSwitzerland
  15. 15.Department of RadiologyInstituto Português de Oncologia de Lisboa Francisco GentilLisboa CodexPortugal
  16. 16.The Royal Marsden Hospital NHS Foundation TrustLondonUK
  17. 17.Imperial CollegeLondonUK
  18. 18.Department of Radiology Müllner HauptstrSalzburgAustria

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