urology gynecology correlative imaging of gynecological diseases t lam
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Tina PW Lam Radiology
QMH
Correlative imaging of gynecological
diseases
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Correlative imaging
* Structural imaging
* Tissue characterization
* Cancer staging
* Functional imaging
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Structural imaging
* Detail anatomy
* Accurate lesion size, location and extent
* Delineate complex anomaly
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Patient 1 14 year-old girl Menarchy at 11 years old Regular monthly cycle
Dysmenorhoea Progressive abdominal distension
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TT1W axial
T2W axial
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T2W
T2W sagittal
T2W coronal Uterine didelphys Cervical atresia Endometriotic cyst
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Tissue Characterization
* Differentiate gas, fat, fluid, soft tissue, blood, tumour and calcification
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Mature Teratoma
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Leiolipoma
Calcified leiomyoma
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T1W
T1W FS+C
Mature teratoma
T2W
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Adenomhyosis Endometriotic cyst
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2010
2012
2012
Patient 2 A 50 year-old perimenopausal lady uterine leiomyoma for several years
Recent enlargement with heterogeneous signal
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MRI 2012
T2W
T1W FS +C
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Red degeneration of leiomyoma
T2W
T1W FS
T1W FS +C
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US in 10/2013
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Cancer staging
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Cancer of cervix uteri
* Differentiate operable early disease (stages Ia, Ib & IIa) from advanced disease
* Delineate extent of advanced disease extent to define the radiotherapy fields
* Clinical staging inaccurate, assessment difficulties:
parametrial, pelvic sidewall invasions
bladder & rectal invasions
endocervical tumour size
lymph node & distant metastases
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Patient 3 A 16 year-old girl Menorrhagia since menarchy
Progressive weight loss P/E: vagina filled with tumour
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Clear cell carcinoma of cervix & vagina
Hypoplastic uterus, T-shaped cavity – suspected DES exposure
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Cancer of cervix uteri
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Cancer of cervix uteri
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Cancer of corpus uteri
* Depth of myometrial invasion correlates with tumor grade, cervical extension, and prevalence of LN metastases
* Incidence of LN metastases increases from 3% with superficial myometrial invasion (stage IB) to 46% with deep myometrial invasion (stage IC)
* The sensitivity and specificity of MRI for depth of myometrial invasion range from 69-94% and 64-100% respectively
Berman ML, Ballon SC, Lagasse LD, Watring WG. Am J Obstet Gynecol 1980; 136:679 –688 Boronow RC, Morrow CP, Creasman WT, et al. Obstet Gynecol 1984; 63:825–832
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Cancer of corpus uteri
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Patient 4 56 yr-old menopausal lady Post menopausal bleeding P/E: tumor protruded from cervix MRI: stage IIIC2 aggressive tumor Histology: MMMT
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Cancer of ovary
* The use of MR in evaluation of sonographically indeterminate adnexal lesions resulted in fewer surgical procedures, better patient triage, and net cost savings
Schwartz PE. Gynecologic Oncology. 1997;64(1):1–3.
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Cancer of Ovary
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Patient 5 A 49 year-old lady Long standing endometriotic cyst Developed vascular mural nodules
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PET/CT
PET-CT
Clear cell carcinoma with omental and peritoneal deposits
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Functional imaging
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Omental & peritoneal
deposits
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PPE
No residual disease after chemotherapy
PET/CT in 4/13
PET/CT in 9/13
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Staging & follow-up of ovarian cancer
* PET/CT & CT alone are 100% specific
* PET/CT marginally better than CT alone at 97% sensitivity.
* MRI is comparable to CT
http://www.acr.org/~/media/ACR/Documents/AppCriteria/Diagnostic/StagingAndFollowUpOvarianCancer.pdf
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PET/CT in cancers of cervix & corpus uteri
* Highest accuracy in LN metastasis detection (95-98%)*
* 45% endometrial cancers are grade I and not FDG-avid*
* Poor spatial resolution, inefficient detection of parametrial or adjacent organs invasion in cervical cancer
*Antonsen SL et al. Gynecol Oncol. 2013 Feb;128(2):300-8
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Recent advances
* Hybrid MRI/PET * Functional MRI – Dynamic contrast enhanced - Diffusion weighted imaging * MR spectroscopy
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Thank you!