Korean J Radiol.  2019 Jan;20(1):18-33. 10.3348/kjr.2018.0090.

Current Status of Magnetic Resonance Imaging in Patients with Malignant Uterine Neoplasms: A Review

• Huang YT
• Huang YL
• Ng KK
• Lin G

• KMID: 2429917
• DOI: http://doi.org/10.3348/kjr.2018.0090

Abstract

In this study, we summarize the clinical role of magnetic resonance imaging (MRI) in the diagnosis of patients with malignant uterine neoplasms, including leiomyosarcoma, endometrial stromal sarcoma, adenosarcoma, uterine carcinosarcoma, and endometrial cancer, with emphasis on the challenges and disadvantages. MRI plays an essential role in patients with uterine malignancy, for the purpose of tumor detection, primary staging, and treatment planning. MRI has advanced in scope beyond the visualization of the many aspects of anatomical structures, including diffusion-weighted imaging, dynamic contrast enhancement-MRI, and magnetic resonance spectroscopy. Emerging technologies coupled with the use of artificial intelligence in MRI are expected to lead to progressive improvement in case management of malignant uterine neoplasms.

Keyword

Uterine neoplasm; Magnetic resonance imaging; Endometrial cancer; Sarcoma

MeSH Terms

Adenosarcoma
Artificial Intelligence
Carcinosarcoma
Case Management
Diagnosis
Endometrial Neoplasms
Female
Humans
Leiomyosarcoma
Magnetic Resonance Imaging*
Magnetic Resonance Spectroscopy
Sarcoma
Sarcoma, Endometrial Stromal
Uterine Neoplasms*

Figure

• 

  Fig. 1 Characteristic MRI features of LMS.47-year-old female patient with 19.9-cm LMS at posterior wall of uterus.A. Sagittal T2WI shows intralesional heterogeneous high signal intensity with distorted inner lining of tumor. B. Post-contrast fat-saturated T1WI shows typical central non-enhancement (asterisk) with hypervascularity of tumor. Diffusion restriction and low signal are observed at periphery of tumor on DWI (C) and ADC map (D) respectively, with ADC value of 1.06 x 10−3 mm2/s. ADC = apparent diffusion coefficient, DWI = diffusion-weighted imaging, LMS = leiomyosarcoma, MRI = magnetic resonance imaging, T1WI = T1-weighted images, T2WI = T2-weighted images

• 

  Fig. 2 MRI finding in representative case of high-grade ESS.88-year-old female patient with 9.0-cm high-grade ESS involving both endometrial cavity and myometrium.A. Axial T2WI shows tumor signal higher than adjacent myometrium, with scattered intratumoral T2 hypointense bands and marginal nodularity. B. Post-contrast fat-saturated T1WI shows feather-like enhancement (arrowheads). Tumor demonstrates water restriction on DWI (C) and ADC value of 1.01 × 10−3 mm2/s on ADC map (D). ESS = endometrial stromal sarcoma

• 

  Fig. 3 MRI finding in representative case of AS.31-year-old woman with 5.6-cm AS located within endometrial cavity (arrows), with superficial myometrial invasion and protrusion into uterine cervix.A. Axial T2WI shows heterogeneous hyperintensity of tumor with small cyst. B. Post-contrast fat-saturated T1WI shows homogeneous and equal enhancement relative to myometrium with faint lattice-like pattern. Solid component of tumor demonstrates diffusion restriction on DWI (C) and low signal intensity on ADC map (D). ADC value of tumor is 1.19 × 10−3 mm2/s. AS = adenosarcoma

• 

  Fig. 4 MRI finding in representative case of uterine carcinosarcoma.56-year-old woman with 10-cm carcinosarcoma causing distension of uterine cavity.A. Axial T2WI shows bulky tumor in endometrial cavity with protrusion toward cervical canal, i.e., myoma delivery-like (arrow). Cystic or necrotic portion on right aspect of tumor is observed. B. Post-contrast fat-saturated T1WI and (C) DWI show focal irregular tumor/myometrial interface on right side (arrowheads), corresponding to presence of myometrial invasion based on histopathology. Tumor demonstrates water restriction on DWI and (D) ADC map. ADC value of tumor is 0.97 × 10−3 mm2/s.

• 

  Fig. 5 MRI finding in representative case of EC with cervical stromal invasion.44-year-old woman with 10.6-cm tumor with cervical stromal invasion.(A) Sagittal T2WI (B) post-contrast fat-saturated T1WI (C) DWI in b = 1000 s/mm2 (D) ADC map shows tumor with myometrial invasion and cervical stromal invasion (arrows). Satellite lesion at upper vaginal wall (arrowheads) with similar signal intensity as that of primary tumor is confirmed as metastasis. ADC value of tumor is 0.69 × 10−3 mm2/s. Based on histopathology, diagnosis was poorly differentiated endometrioid carcinoma. EC = endometrial cancer

• 

  Fig. 6 MRI finding in representative case of EC with pelvic lymph node metastasis.64-year-old woman with 9.5-cm endometrioid carcinoma with 93% myometrial invasion.(A) Axial T2WI, (B) DWI in b = 1000 s/mm2, (C) T1WI and (D) contrast-enhanced fat-saturated T1WI show enlarged bilateral external iliac lymph nodes (arrows) with diffusion-restriction. Right hydrosalpinx (arrowheads) with focal high signal intensity on DWI and hyperintensity on T1WI, representing hemorrhage. Bilateral pelvic lymph node metastasis and right ovarian metastasis was confirmed based on final pathology result. ADC value of tumor is 0.71 Å~ 10−3 mm2/s.

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