Staging of Early Endometrial Carcinoma: Assessment with T2-weighted and Gadolinium-enhanced T1-weighted MR Imaging1
Eun Jung Lee, MD,
Jae Young Byun, MD,
Bum-soo Kim, MD,
Sung E. Nam Koong, MD and
Kyung Sub Shinn, MD
1 From the Departments of Radiology (E.J.L., J.Y.B., B.K., K.S.S.) and Obstetrics and Gynecology (S.E.N.K.), Kangnam St Mary's Hospital, Catholic University of Korea, 505 Banpo-dong, Seocho-ku, Seoul 137-040, Korea. Presented as a scientific exhibit at the 1997 RSNA scientific assembly. Received June 10, 1998; revision requested August 24; final revision received November 10; accepted November 10. Address reprint requests to J.Y.B.
View larger version (17K):
[in a new window]
|
Figure 1. Comparison of staging accuracies for T2-weighted imaging (T2WI), gadolinium-enhanced T1-weighted imaging (Gd-T1WI), and menopausal status-dependent MR staging (MSDMS). * and ** = significantly different (P < .001 [Fisher exact test]). *** = significantly different (P < .05 [ 2 test]).
|
|
View larger version (145K):
[in a new window]
|
Figure 2a. Stage Ib endometrial carcinoma in a 26-year-old premenopausal woman. (a) Axial T2-weighted MR image (3,000/91) shows a lobulated, polypoid, isointense mass in the endometrial cavity (arrowheads) with adjacent junctional zone disruption (arrow), findings that correctly suggest stage Ib disease. (b) Axial gadolinium-enhanced T1-weighted MR image (400/11) shows an irregular endometrial mass (arrow) with no evidence of junctional zone disruption or myometrial invasion, findings that incorrectly suggest stage Ia disease.
|
|
View larger version (146K):
[in a new window]
|
Figure 2b. Stage Ib endometrial carcinoma in a 26-year-old premenopausal woman. (a) Axial T2-weighted MR image (3,000/91) shows a lobulated, polypoid, isointense mass in the endometrial cavity (arrowheads) with adjacent junctional zone disruption (arrow), findings that correctly suggest stage Ib disease. (b) Axial gadolinium-enhanced T1-weighted MR image (400/11) shows an irregular endometrial mass (arrow) with no evidence of junctional zone disruption or myometrial invasion, findings that incorrectly suggest stage Ia disease.
|
|
View larger version (152K):
[in a new window]
|
Figure 3a. Stage Ib endometrial carcinoma in a 40-year-old premenopausal woman. (a) Sagittal T2-weighted MR image (3,200/85) reveals a lobulated, polypoid, hypointense mass that widens the endometrial cavity (arrow). The junctional zone is not demonstrated, and irregularity is identified between the mass and myometrium. The extent of myometrial invasion was assessed as less than 50%, and the tumor was correctly classified as stage Ib. (b) Sagittal gadolinium-enhanced T1-weighted MR image (417/11) shows a hypointense mass confined to the endometrial cavity (arrow), findings that incorrectly suggest stage Ia disease.
|
|
View larger version (145K):
[in a new window]
|
Figure 3b. Stage Ib endometrial carcinoma in a 40-year-old premenopausal woman. (a) Sagittal T2-weighted MR image (3,200/85) reveals a lobulated, polypoid, hypointense mass that widens the endometrial cavity (arrow). The junctional zone is not demonstrated, and irregularity is identified between the mass and myometrium. The extent of myometrial invasion was assessed as less than 50%, and the tumor was correctly classified as stage Ib. (b) Sagittal gadolinium-enhanced T1-weighted MR image (417/11) shows a hypointense mass confined to the endometrial cavity (arrow), findings that incorrectly suggest stage Ia disease.
|
|
View larger version (140K):
[in a new window]
|
Figure 4a. Stage Ib endometrial carcinoma in a 54-year-old postmenopausal woman. (a) Sagittal T2-weighted MR image (3,000/85) shows a lobulated, polypoid mass (arrow) invading the myometrium to more than half of its depth, findings that incorrectly indicate stage Ic disease. (b) Sagittal gadolinium-enhanced T1-weighted MR image (600/11) shows an ovoid, hypointense mass in the endometrial cavity (arrow) and some irregularity at the interface between the mass and the inner surface of the myometrium, findings that correctly suggest stage Ib disease.
|
|
View larger version (141K):
[in a new window]
|
Figure 4b. Stage Ib endometrial carcinoma in a 54-year-old postmenopausal woman. (a) Sagittal T2-weighted MR image (3,000/85) shows a lobulated, polypoid mass (arrow) invading the myometrium to more than half of its depth, findings that incorrectly indicate stage Ic disease. (b) Sagittal gadolinium-enhanced T1-weighted MR image (600/11) shows an ovoid, hypointense mass in the endometrial cavity (arrow) and some irregularity at the interface between the mass and the inner surface of the myometrium, findings that correctly suggest stage Ib disease.
|
|
View larger version (145K):
[in a new window]
|
Figure 5a. Stage Ib endometrial carcinoma in a 57-year-old postmenopausal woman. (a) Sagittal T2-weighted MR image (3,000/85) shows no definite endometrial mass, a finding that incorrectly suggests stage Ia disease. (b) Sagittal gadolinium-enhanced T1-weighted MR image (450/11) shows a discrete hypointense mass (arrow) with invasion of the myometrium to less than half of its depth, findings that correctly suggest stage Ib disease. The histopathologic result corresponded to that of gadolinium-enhanced T1-weighted imaging.
|
|
View larger version (133K):
[in a new window]
|
Figure 5b. Stage Ib endometrial carcinoma in a 57-year-old postmenopausal woman. (a) Sagittal T2-weighted MR image (3,000/85) shows no definite endometrial mass, a finding that incorrectly suggests stage Ia disease. (b) Sagittal gadolinium-enhanced T1-weighted MR image (450/11) shows a discrete hypointense mass (arrow) with invasion of the myometrium to less than half of its depth, findings that correctly suggest stage Ib disease. The histopathologic result corresponded to that of gadolinium-enhanced T1-weighted imaging.
|
|
View larger version (168K):
[in a new window]
|
Figure 6a. Stage Ib endometrial carcinoma in a 60-year-old postmenopausal woman. (a) Sagittal T2-weighted MR image (3,200/99) shows an indistinct junctional zone. There is a slightly hyperintense lesion (arrowheads) in the posterior part of the endometrium with possible focal myometrial invasion (arrow). (b) Sagittal gadolinium-enhanced T1-weighted MR image (600/14) shows a discrete hypointense mass with some marginal irregularity (arrow), which is better demonstrated than on the T2-weighted image (a).
|
|
View larger version (169K):
[in a new window]
|
Figure 6b. Stage Ib endometrial carcinoma in a 60-year-old postmenopausal woman. (a) Sagittal T2-weighted MR image (3,200/99) shows an indistinct junctional zone. There is a slightly hyperintense lesion (arrowheads) in the posterior part of the endometrium with possible focal myometrial invasion (arrow). (b) Sagittal gadolinium-enhanced T1-weighted MR image (600/14) shows a discrete hypointense mass with some marginal irregularity (arrow), which is better demonstrated than on the T2-weighted image (a).
|
|
View larger version (131K):
[in a new window]
|
Figure 7a. Stage Ib endometrial carcinoma in a 35-year-old premenopausal woman. (a) Sagittal T2-weighted MR image (2,000/90) shows focal disruption of the junctional zone (arrow) at the lower anterior wall. The well-defined junctional zone shows the exact extent of disease. (b) Sagittal gadolinium-enhanced T1-weighted MR image (500/11) shows an irregular interface between the myometrium and the endometrial mass. Focal deep invasion of the myometrium (arrow) indicates stage Ic disease. The histopathologic result was consistent with the stage at T2-weighted imaging. Gadolinium enhancement obliterated the distinction between the junctional zone and the outer myometrium and thus led to overstaging.
|
|
View larger version (152K):
[in a new window]
|
Figure 7b. Stage Ib endometrial carcinoma in a 35-year-old premenopausal woman. (a) Sagittal T2-weighted MR image (2,000/90) shows focal disruption of the junctional zone (arrow) at the lower anterior wall. The well-defined junctional zone shows the exact extent of disease. (b) Sagittal gadolinium-enhanced T1-weighted MR image (500/11) shows an irregular interface between the myometrium and the endometrial mass. Focal deep invasion of the myometrium (arrow) indicates stage Ic disease. The histopathologic result was consistent with the stage at T2-weighted imaging. Gadolinium enhancement obliterated the distinction between the junctional zone and the outer myometrium and thus led to overstaging.
|
|
View larger version (147K):
[in a new window]
|
Figure 8a. Stage Ic endometrial carcinoma in a 61-year-old postmenopausal woman. (a) Axial T2-weighted MR image (3,000/85) shows a slightly hyperintense mass in the endometrial cavity (black arrowheads). The junctional zone is disrupted at the anterior aspect (white arrowheads), but the tumor margin is indistinct. An ill-defined hypointense area is noted at the anterior wall of the uterus (arrows). At histopathologic analysis, this area proved to be underlying adenomyosis. (b) Axial gadolinium-enhanced T1-weighted MR image (500/11) shows adenomyosis (arrows), which is better differentiated from the endometrial carcinoma (arrowheads) than on the T2-weighted image (a).
|
|
View larger version (149K):
[in a new window]
|
Figure 8b. Stage Ic endometrial carcinoma in a 61-year-old postmenopausal woman. (a) Axial T2-weighted MR image (3,000/85) shows a slightly hyperintense mass in the endometrial cavity (black arrowheads). The junctional zone is disrupted at the anterior aspect (white arrowheads), but the tumor margin is indistinct. An ill-defined hypointense area is noted at the anterior wall of the uterus (arrows). At histopathologic analysis, this area proved to be underlying adenomyosis. (b) Axial gadolinium-enhanced T1-weighted MR image (500/11) shows adenomyosis (arrows), which is better differentiated from the endometrial carcinoma (arrowheads) than on the T2-weighted image (a).
|
|
Copyright © 1999 by the Radiological Society of North America.
