Pitfalls in staging uterine neoplasm with imaging: a review |
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Authors: | K Kinkel |
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Institution: | (1) Institut de Radiologie, Clinique et fondation des Grangettes, 7, chemin des Grangettes, Chêne-Bougeries, Geneva, CH-1224, Switzerland |
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Abstract: | This review analyzes current pitfalls in pretreatment staging of endometrial and cervical carcinoma with magnetic resonance
imaging (MRI) based on a critical review of the literature. Technical, patient, and tumor-related characteristics were analyzed
to improve further staging of uterine neoplasm with MRI. For endometrial carcinoma staging, contrast-enhanced dynamic imaging
appears essential to avoid false-positive findings for deep myometrial invasion by better delineating tumor from normal myometrium.
However, leiomyomas, adenomyosis, and grade 3 tumors provide difficulties in staging for pathologists and radiologists. Slice
orientation perpendicular to the long axis of the cervical channel might improve false-negative findings for deep stromal
invasion on T2-weighted images in endometrial and cervical cancer. Contrast-enhanced sequences do not improve diagnosis of
parametrial or vaginal invasion in cervical cancer. Assessment of lymph node invasion by any imaging modality has limited
sensitivity in detecting lymph node metastasis smaller than 5 mm. Knowledge of diagnostic criteria is critical to avoid false-negative
findings for bladder wall invasion. Higher spatial resolution with dedicated multichannel pelvic phase array coils, smaller
fields of view and section thickness, and careful comparison of T2-weighted and contrast-enhanced sequences are strategies
that might avoid misinterpretation of pelvic MRI in staging uterine neoplasm. |
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Keywords: | Uterine Neoplasm Endometrial carcinoma Cervical carcinoma Magnetic resonance imaging Staging |
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