Introduction

Abstract

Early detection and accurate characterization of the extent of recurrent disease are important in identifying patients who might be candidates for local resection, pelvic exenteration, or radiotherapy for nonresectable disease. CT and MRI can demonstrate the site and extent of recurrence after surgery. CT is widely available, but the superior soft tissue contrast of MRI allows for a better assessment of the local extent of recurrent tumor. To evaluate widespread recurrence, CT is preferred. It is important to distinguish postradiation changes from recurrent tumor and CT remains limited in this regard. MRI has high sensitivity but low specificity for recurrent disease, because benign conditions such as edema, inflammation, and necrosis also may cause an increased T2 signal mimicking residual tumor. Functional imaging using dynamic multiphase contrast-enhanced MRI (DCE-MRI) and diffusion-weighted MRI (DW-MRI) help increase the reader’s confidence for detecting recurrent disease in uterine malignancies. In detecting recurrent lesions and evaluating treatment responses, FDG-PET, used in conjunction with anatomic information from CT or MRI, showed a better diagnostic ability than conventional imaging and tumor markers. FDG-PET also can be useful in women who present with elevated markers but negative conventional imaging. Imaging has become an important adjunct to the assessment of uterine malignancy. Imaging findings of these modalities may be the first sign of recurrent disease and they can be used to recommend suitable candidates for exenteration, additional radiation therapy, or chemotherapy.