Radio-Imaging for Malignant Uterine Disease
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Clinical examination and ultrasound are mostly sufficient for diagnosis of gynecological diseases. Cross sectional imaging (CT and MRI) of the female pelvis is essential in those cases where a clinical examination or ultrasound may not clearly allow a definite diagnosis of uterine disease, if clarification of possible differential diagnosis of a uterine lesion is needed, or for optimal local treatment planning. An overall imaging of the body or chest is essential for complete staging in malignancy before treatment planning (Colombo et al., Ann Oncol 23(Suppl 7): 27–32, 2012; Colombo et al., Ann Oncol 24 (Suppl 6):33–38, 2013; Kinkel et al., Eur Radiol 19:1565–1574, 2009; Leitlinienprogramm, Onkologie. S3-Leitlinie Diagnostik, Therapie und Nachsorge der Patientin mit Zervixkarzinom. Kurzversion 1.0, AWMF Registernummer 032/033OL, 2014; Querleu et al., Int J Gynecol Cancer 21:945–950, 2011).
The prognosis for women with gynecologic malignancies, e.g., cervical or endometrial cancer or uterine sarcomas, not only depends on local tumor spread but also on a wide range of additional findings. These include positive lymph nodes, ascites or distant metastases. CT and MRI have increasingly been used for optimal treatment planning in gynecologic malignancies. Their staging criteria are based on the current FIGO staging system and the TNM classification system (Pecorelli, Int J Gynaecol Obstet 105:103–104, 2009; Sobin and Compton, Cancer 116:5336–5339, 2010).
Magnetic Resonance Imaging (MRI) is a perfect tool for the evaluation of the morphology of the entire female pelvis due to its high-resolution images combined with an excellent soft tissue contrast and without the application of radiation, and should be given preference for imaging of the female pelvic organs. Even without intravenous contrast media, many diagnoses could be made or even differential diagnoses could be excluded. Additionally, contrast enhanced MRI is superior to CT for differentiation of recurrent tumor and radiation fibrosis. However, patients with pacemakers, or non-MRI-safe implants, cannot be examined with MRI due to its magnetic field strength.
Computed Tomography (CT) has a lower soft tissue contrast than MRI and gives notable radiation exposure to the patient. In gynecology, CT plays an important role for radiation therapy planning and re-evaluation after treatment, as well as for the detection of distant metastases (Brocker et al., Strahlenther Onkol 187:611–618, 2011; Colombo et al., Crit Rev Oncol Hematol 60:159–179, 2011).
Positron-Emissions-Tomography (PET) is a molecular imaging technique, which commonly uses the isotope 18F-Fluordeoxyglucose (18F-FDG) for oncologic imaging to detect tissues with abnormally high glucose uptake, such as tumors (Pano et al., Radiographics 31:135–160, 2011; Grigsby, Curr Opin Oncol 21:420–424, 2009).
PET is often combined with CT, and nowadays with MRI, to combine both the molecular imaging technique and the morphological information. PET/CT has benefits in the diagnosis of tumor recurrence, in the detection of occult metastases, and in the differentiation between scar tissue and recurrence in severe cases (Brocker et al., Strahlenther Onkol 187:611–618, 2011; De Gaetano et al., Abdom Imaging 34:696–711, 2009).
KeywordsEndometrial cancer Cervical cancer Uterine sarcoma Lymphoma Recurrence
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