Skip to main content

Advertisement

SpringerLink
Log in

PET/MR imaging in gynecologic cancer: tips for differentiating normal gynecologic anatomy and benign pathology versus cancer

  • Special Section: Quantitative Imaging
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Positron emission tomography/magnetic resonance imaging (PET/MR) is used in the pre-treatment and surveillance settings to evaluate women with gynecologic malignancies, including uterine, cervical, vaginal and vulvar cancers. PET/MR combines the excellent spatial and contrast resolution of MR imaging for gynecologic tissues, with the functional metabolic information of PET, to aid in a more accurate assessment of local disease extent and distant metastatic disease. In this review, the optimal protocol and utility of whole-body PET/MR imaging in patients with gynecologic malignancies will be discussed, with an emphasis on the advantages of PET/MR over PET/CT and how to differentiate normal or benign gynecologic tissues from cancer in the pelvis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10

Similar content being viewed by others

References

  1. Khan S.R., Arshad M., Wallitt K., Stewart V., Bharwani N., Barwick T.D. What's New in Imaging for Gynecologic Cancer? Curr Oncol Rep, 19 (2017) 85.

    Article  PubMed  Google Scholar 

  2. Kusmirek J., Robbins J., Allen H., Barroilhet L., Anderson B., Sadowski E.A. PET/CT and MRI in the imaging assessment of cervical cancer. Abdom Imaging, 40 (2015) 2486-2511.

    Article  PubMed  Google Scholar 

  3. Lai C.H., Lin G., Yen T.C., Liu F.Y. Molecular imaging in the management of gynecologic malignancies. Gynecol Oncol, 135 (2014) 156-162.

    Article  PubMed  Google Scholar 

  4. Lee S.I., Catalano O.A., Dehdashti F. Evaluation of gynecologic cancer with MR imaging, 18F-FDG PET/CT, and PET/MR imaging. J Nucl Med, 56 (2015) 436-443.

    Article  PubMed  Google Scholar 

  5. Lin G., Lai C.H., Yen T.C. Emerging Molecular Imaging Techniques in Gynecologic Oncology. PET Clin, 13 (2018) 289-299.

    Article  PubMed  Google Scholar 

  6. Lin M.Y., Dobrotwir A., McNally O., Abu-Rustum N.R., Narayan K. Role of imaging in the routine management of endometrial cancer. Int J Gynaecol Obstet, 143 Suppl 2 (2018) 109-117.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Mansoori B., Khatri G., Rivera-Colón G., Albuquerque K., Lea J., Pinho D.F. Multimodality Imaging of Uterine Cervical Malignancies. AJR Am J Roentgenol, 215 (2020) 292-304.

    Article  PubMed  Google Scholar 

  8. Nougaret S., Horta M., Sala E. et al. Endometrial Cancer MRI staging: Updated Guidelines of the European Society of Urogenital Radiology. Eur Radiol, 29 (2019) 792-805.

    Article  PubMed  Google Scholar 

  9. Grueneisen J., Schaarschmidt B.M., Heubner M. et al. Integrated PET/MRI for whole-body staging of patients with primary cervical cancer: preliminary results. Eur J Nucl Med Mol Imaging, 42 (2015) 1814-1824.

    Article  PubMed  Google Scholar 

  10. Ohliger M.A., Hope T.A., Chapman J.S., Chen L.M., Behr S.C., Poder L. PET/MR Imaging in Gynecologic Oncology. Magn Reson Imaging Clin N Am, 25 (2017) 667-684.

    Article  PubMed  Google Scholar 

  11. Sotoudeh H., Sharma A., Fowler K.J., McConathy J., Dehdashti F. Clinical application of PET/MRI in oncology. J Magn Reson Imaging, 44 (2016) 265-276.

    Article  PubMed  Google Scholar 

  12. Fowler K.J., McConathy J., Narra V.R. Whole-body simultaneous positron emission tomography (PET)-MR: optimization and adaptation of MRI sequences. J Magn Reson Imaging, 39 (2014) 259-268.

    Article  PubMed  Google Scholar 

  13. Hirsch F.W., Sattler B., Sorge I. et al. PET/MR in children. Initial clinical experience in paediatric oncology using an integrated PET/MR scanner. Pediatr Radiol, 43 (2013) 860–875.

  14. Melsaether A.N., Raad R.A., Pujara A.C. et al. Comparison of Whole-Body (18)F FDG PET/MR Imaging and Whole-Body (18)F FDG PET/CT in Terms of Lesion Detection and Radiation Dose in Patients with Breast Cancer. Radiology, 281 (2016) 193-202.

    Article  PubMed  Google Scholar 

  15. Al-Nabhani K.Z., Syed R., Michopoulou S. et al. Qualitative and quantitative comparison of PET/CT and PET/MR imaging in clinical practice. J Nucl Med, 55 (2014) 88-94.

    Article  CAS  PubMed  Google Scholar 

  16. Beiderwellen K., Grueneisen J., Ruhlmann V. et al. [(18)F]FDG PET/MRI vs. PET/CT for whole-body staging in patients with recurrent malignancies of the female pelvis: initial results. Eur J Nucl Med Mol Imaging, 42 (2015) 56–65.

  17. Botsikas D., Bagetakos I., Picarra M. et al. What is the diagnostic performance of 18-FDG-PET/MR compared to PET/CT for the N- and M- staging of breast cancer? Eur Radiol, 29 (2019) 1787-1798.

    Article  PubMed  Google Scholar 

  18. Drzezga A., Souvatzoglou M., Eiber M. et al. First clinical experience with integrated whole-body PET/MR: comparison to PET/CT in patients with oncologic diagnoses. J Nucl Med, 53 (2012) 845-855.

    Article  PubMed  Google Scholar 

  19. Kim S.K., Choi H.J., Park S.Y. et al. Additional value of MR/PET fusion compared with PET/CT in the detection of lymph node metastases in cervical cancer patients. Eur J Cancer, 45 (2009) 2103-2109.

    Article  PubMed  Google Scholar 

  20. Kitajima K., Suenaga Y., Ueno Y. et al. Value of fusion of PET and MRI for staging of endometrial cancer: comparison with 18F-FDG contrast-enhanced PET/CT and dynamic contrast-enhanced pelvic MRI. Eur J Radiol, 82 (2013) 1672-1676.

    Article  PubMed  Google Scholar 

  21. Nakajo K., Tatsumi M., Inoue A. et al. Diagnostic performance of fluorodeoxyglucose positron emission tomography/magnetic resonance imaging fusion images of gynecological malignant tumors: comparison with positron emission tomography/computed tomography. Jpn J Radiol, 28 (2010) 95-100.

    Article  PubMed  Google Scholar 

  22. Queiroz M.A., Kubik-Huch R.A., Hauser N. et al. PET/MRI and PET/CT in advanced gynaecological tumours: initial experience and comparison. Eur Radiol, 25 (2015) 2222-2230.

    Article  PubMed  Google Scholar 

  23. Riola-Parada C., García-Cañamaque L., Pérez-Dueñas V., Garcerant-Tafur M., Carreras-Delgado J.L. Simultaneous PET/MRI vs PET/CT in oncology. A systematic review. Rev Esp Med Nucl Imagen Mol, 35 (2016) 306–312.

  24. Sawicki L.M., Grueneisen J., Buchbender C. et al. Comparative Performance of (1)(8)F-FDG PET/MRI and (1)(8)F-FDG PET/CT in Detection and Characterization of Pulmonary Lesions in 121 Oncologic Patients. J Nucl Med, 57 (2016) 582-586.

    Article  CAS  PubMed  Google Scholar 

  25. Singnurkar A., Poon R., Metser U. Comparison of 18F-FDG-PET/CT and 18F-FDG-PET/MR imaging in oncology: a systematic review. Ann Nucl Med, 31 (2017) 366-378.

    Article  PubMed  Google Scholar 

  26. Stolzmann P., Veit-Haibach P., Chuck N. et al. Detection rate, location, and size of pulmonary nodules in trimodality PET/CT-MR: comparison of low-dose CT and Dixon-based MR imaging. Invest Radiol, 48 (2013) 241-246.

    Article  PubMed  Google Scholar 

  27. Kusmirek J., Cho S., Ibrahim N., McMillan A., Sadowski E. Detection of Lung Nodules: Low-dose CT versus Fast Spoiled Gradient Echo MR images acquired during PET/MR. ARRS Annual Meeting, Virtual,(April 2021)

  28. Buchbender C., Hartung-Knemeyer V., Beiderwellen K. et al. Diffusion-weighted imaging as part of hybrid PET/MRI protocols for whole-body cancer staging: does it benefit lesion detection? Eur J Radiol, 82 (2013) 877-882.

    Article  PubMed  Google Scholar 

  29. Grueneisen J., Schaarschmidt B.M., Beiderwellen K. et al. Diagnostic value of diffusion-weighted imaging in simultaneous 18F-FDG PET/MR imaging for whole-body staging of women with pelvic malignancies. J Nucl Med, 55 (2014) 1930-1935.

    Article  CAS  PubMed  Google Scholar 

  30. Choi J., Kim H.J., Jeong Y.H. et al. The Role of (18) F-FDG PET/CT in Assessing Therapy Response in Cervix Cancer after Concurrent Chemoradiation Therapy. Nucl Med Mol Imaging, 48 (2014) 130-136.

    Article  CAS  PubMed  Google Scholar 

  31. Soret M., Bacharach S.L., Buvat I. Partial-volume effect in PET tumor imaging. J Nucl Med, 48 (2007) 932-945.

    Article  PubMed  Google Scholar 

  32. Weber W.A. Use of PET for monitoring cancer therapy and for predicting outcome. J Nucl Med, 46 (2005) 983-995.

    CAS  PubMed  Google Scholar 

  33. Ehman E.C., Johnson G.B., Villanueva-Meyer J.E. et al. PET/MRI: Where might it replace PET/CT? J Magn Reson Imaging, 46 (2017) 1247-1262.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Fraum T.J., Fowler K.J., McConathy J. PET/MRI: Emerging Clinical Applications in Oncology. Acad Radiol, 23 (2016) 220-236.

    Article  PubMed  Google Scholar 

  35. Nensa F., Beiderwellen K., Heusch P., Wetter A. Clinical applications of PET/MRI: current status and future perspectives. Diagn Interv Radiol, 20 (2014) 438-447.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Torigian D.A., Zaidi H., Kwee T.C. et al. PET/MR imaging: technical aspects and potential clinical applications. Radiology, 267 (2013) 26-44.

    Article  PubMed  Google Scholar 

  37. Grueneisen J., Beiderwellen K., Heusch P. et al. Simultaneous positron emission tomography/magnetic resonance imaging for whole-body staging in patients with recurrent gynecological malignancies of the pelvis: a comparison to whole-body magnetic resonance imaging alone. Invest Radiol, 49 (2014) 808-815.

    Article  PubMed  Google Scholar 

  38. Reinhold C., Rockall A., Sadowski E.A. et al. Ovarian-Adnexal Reporting Lexicon for MRI: A White Paper of the ACR Ovarian-Adnexal Reporting and Data Systems MRI Committee. J Am Coll Radiol. https://doi.org/10.1016/j.jacr.2020.12.022(2021)

  39. Sadowski E.A., Robbins J.B., Rockall A.G., Thomassin-Naggara I. A systematic approach to adnexal masses discovered on ultrasound: the ADNEx MR scoring system. Abdom Radiol (NY), 43 (2018) 679-695.

    Article  Google Scholar 

  40. Dejanovic D., Hansen N.L., Loft A. PET/CT Variants and Pitfalls in Gynecological Cancers. Semin Nucl Med. https://doi.org/10.1053/j.semnuclmed.2021.06.006(2021)

  41. Subhas N., Patel P.V., Pannu H.K., Jacene H.A., Fishman E.K., Wahl R.L. Imaging of pelvic malignancies with in-line FDG PET-CT: case examples and common pitfalls of FDG PET. Radiographics, 25 (2005) 1031-1043.

    Article  PubMed  Google Scholar 

  42. Uglietti A., Buggio L., Farella M. et al. The risk of malignancy in uterine polyps: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol, 237 (2019) 48-56.

    Article  PubMed  Google Scholar 

  43. Murase E., Siegelman E.S., Outwater E.K., Perez-Jaffe L.A., Tureck R.W. Uterine leiomyomas: histopathologic features, MR imaging findings, differential diagnosis, and treatment. Radiographics, 19 (1999) 1179-1197.

    Article  CAS  PubMed  Google Scholar 

  44. Abdel Wahab C., Jannot A.S., Bonaffini P.A. et al. Diagnostic Algorithm to Differentiate Benign Atypical Leiomyomas from Malignant Uterine Sarcomas with Diffusion-weighted MRI. Radiology, 297 (2020) 361-371.

    Article  Google Scholar 

  45. Ascher S.M., Jha R.C., Reinhold C. Benign myometrial conditions: leiomyomas and adenomyosis. Top Magn Reson Imaging, 14 (2003) 281-304.

    Article  PubMed  Google Scholar 

  46. Reinhold C., Tafazoli F., Mehio A. et al. Uterine adenomyosis: endovaginal US and MR imaging features with histopathologic correlation. Radiographics, 19 Spec No (1999) S147–160.

  47. Sadowski E.A., Robbins J.B., Guite K. et al. Preoperative Pelvic MRI and Serum Cancer Antigen-125: Selecting Women With Grade 1 Endometrial Cancer for Lymphadenectomy. AJR Am J Roentgenol, 205 (2015) W556-564.

    Article  PubMed  Google Scholar 

  48. Khalifa M.A., Atri M., Klein M.E., Ghatak S., Murugan P. Adenomyosis As a Confounder to Accurate Endometrial Cancer Staging. Semin Ultrasound CT MR, 40 (2019) 358-363.

    Article  PubMed  Google Scholar 

  49. Takeuchi M., Matsuzaki K., Harada M. Evaluating Myometrial Invasion in Endometrial Cancer: Comparison of Reduced Field-of-view Diffusion-weighted Imaging and Dynamic Contrast-enhanced MR Imaging. Magn Reson Med Sci, 17 (2018) 28-34.

    Article  CAS  PubMed  Google Scholar 

  50. Balcacer P., Cooper K.A., Huber S., Spektor M., Pahade J.K., Israel G.M. Magnetic Resonance Imaging Features of Endometrial Polyps: Frequency of Occurrence and Interobserver Reliability. J Comput Assist Tomogr, 42 (2018) 721-726.

    Article  PubMed  Google Scholar 

  51. Grasel R.P., Outwater E.K., Siegelman E.S., Capuzzi D., Parker L., Hussain S.M. Endometrial polyps: MR imaging features and distinction from endometrial carcinoma. Radiology, 214 (2000) 47-52.

    Article  CAS  PubMed  Google Scholar 

  52. Lacey J.V., Jr., Chia V.M. Endometrial hyperplasia and the risk of progression to carcinoma. Maturitas, 63 (2009) 39-44.

    Article  PubMed  Google Scholar 

  53. Ulaner G.A., Lyall A. Identifying and distinguishing treatment effects and complications from malignancy at FDG PET/CT. Radiographics, 33 (2013) 1817-1834.

    Article  PubMed  Google Scholar 

  54. Long N.M., Smith C.S. Causes and imaging features of false positives and false negatives on F-PET/CT in oncologic imaging. Insights Imaging, 2 (2011) 679-698.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Viswanathan A.N., Lee L.J., Eswara J.R. et al. Complications of pelvic radiation in patients treated for gynecologic malignancies. Cancer, 120 (2014) 3870-3883.

    Article  PubMed  Google Scholar 

  56. Moore K.N., Gold M.A., McMeekin D.S., Zorn K.K. Vesicovaginal fistula formation in patients with Stage IVA cervical carcinoma. Gynecol Oncol, 106 (2007) 498-501.

    Article  PubMed  Google Scholar 

  57. Salavati A., Shah V., Wang Z.J., Yeh B.M., Costouros N.G., Coakley F.V. F-18 FDG PET/CT findings in postradiation pelvic insufficiency fracture. Clin Imaging, 35 (2011) 139-142.

    Article  PubMed  Google Scholar 

  58. Zhong X., Li J., Zhang L. et al. Characterization of Insufficiency Fracture and Bone Metastasis After Radiotherapy in Patients With Cervical Cancer Detected by Bone Scan: Role of Magnetic Resonance Imaging. Front Oncol, 9 (2019) 183.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372, Madison, WI, 53792-3252, USA

    Elizabeth A. Sadowski

  2. Department of Radiology and Medical Physics, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, WIMR II, 2423, Madison, WI, 53705, USA

    Ali Pirasteh

  3. Department of Radiology, 1111 Highland Avenue, Rm 1139, Madison, WI, 53705, USA

    Alan B. McMillan

  4. Department of Radiology, University of California San Diego, 200 W Arbor Drive, # 8756, San Diego, CA, 92103, USA

    Kathryn J. Fowler

  5. Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372, Madison, WI, 53792-3252, USA

    Joanna E. Kusmirek

Authors
  1. Elizabeth A. Sadowski
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ali Pirasteh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alan B. McMillan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kathryn J. Fowler
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Joanna E. Kusmirek
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Elizabeth A. Sadowski.

Ethics declarations

Conflict of interest

Ali Pirasteh has Institutional research support from GE Healthcare. Elizabeth A. Sadowski, Alan B. McMillan, Kathryn J. Fowler and Joanna E. Kusmirek have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sadowski, E.A., Pirasteh, A., McMillan, A.B. et al. PET/MR imaging in gynecologic cancer: tips for differentiating normal gynecologic anatomy and benign pathology versus cancer. Abdom Radiol 47, 3189–3204 (2022). https://doi.org/10.1007/s00261-021-03264-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-021-03264-9

Keywords

Search

Navigation