Abdominal Imaging

, Volume 30, Issue 5, pp 626–636

Endometrial cancer: magnetic resonance imaging

  • R. Manfredi
  • B. Gui
  • G. Maresca
  • F. Fanfani
  • L. Bonomo


Carcinoma of the endometrium is the most common invasive gynecologic malignancy of the female genital tract. Clinically, patients with endometrial carcinoma present with abnormal uterine bleeding. The role of magnetic resonance imaging (MRI) in endometrial carcinoma is disease staging and treatment planning. MRI has been shown to be the most valuable imaging mod-ality in this task, compared with endovaginal ultrasound and computed tomography, because of its intrinsic contrast resolution and multiplanar capability. MRI protocol includes axial T1-weighted images; axial, sagittal, and coronal T2-weighted images; and dynamic gadolinium-enhanced T1-weighted imaging. MR examination is usually performed in the supine position with a phased array multicoil using a four-coil configuration. Endometrial carcinoma is isointense with the normal endometrium and myometrium on noncontrast T1-weighted images and has a variable appearance on T2-weighted images demonstrating heterogeneous signal intensity. The appearance of noninvasive endometrial carcinoma on MRI is characterized by a normal or thickened endometrium, with an intact junctional zone and a sharp tumor-myometrium interface. Invasive endometrial carcinoma is characterized disruption or irregularity of the junctional zone by intermediate signal intensity mass on T2-weighted images. Invasion of the cervical stroma is diagnosed when the low signal intensity cervical stroma is disrupted by the higher signal intensity endometrial carcinoma. MRI in endometrial carcinoma performs better than other imaging modalities in disease staging and treatment planning. Further, the accuracy and the cost of MRI are equivalent to those of surgical staging.


Uterine neoplasms MR Uterus endometrium Uterus  MR 


  1. 1.
    Creasman, WT 2003

    Malignant tumors of the uterine corpus

    Rock, JAJones, HW eds. Operative gynecology9thLippincott Williams & WilkinsPhiladelphia14451486
    Google Scholar
  2. 2.
    Ascher, SM, Reinhold, C 2002Imaging of cancer endometriumRadiol Clin North Am40563576CrossRefPubMedGoogle Scholar
  3. 3.
    Barakat, RR, Grigsby, PW, Zaino, SP 2000

    Corpus epithelial tumors

    Hoskins, WJPerez, CAYoung, RC eds. Principles and practice of gynecologic oncology3rdLippincott Williams & WilkinsPhiladelphia919959
    Google Scholar
  4. 4.
    Frei, KA, Kinkel, K 2001Staging endometrial cancer: role of magnetic resonance imagingJ Magn Reson Imaging13850855CrossRefPubMedGoogle Scholar
  5. 5.
    Rose, PG 1996Endometrial carcinomaN Engl J Med335640649CrossRefPubMedGoogle Scholar
  6. 6.
    Reinhold C, Gallix BP, Ascher SM (1997) Uterus, cervix. In: Semelka R, Ascher SM, Reinhold C, eds. MRI of the abdomen and pelvis. New York: Wiley-Liss, pp 585–660Google Scholar
  7. 7.
    Goodman A (1994) Premalignant and malignant disorders of the uterine corpus. In: Decherney AH, Pernoll ML, eds. Current obstetric and gynecologic diagnosis and treatment, 8th ed. Norwalk, CT: Appleton & Lange, pp 937–953Google Scholar
  8. 8.
    Boronow, RC, Morrow, CP, Creaseman, WT,  et al. 1984Surgical staging in endometrial carcinoma: clinical-pathological findings of a prospective studyObstet Gynecol63825832PubMedGoogle Scholar
  9. 9.
    Faught, W, Krepart, GV, Lotocki, R, Heywood, M 1994Should selective para-aortic lymphadenectomy be part of surgical staging for endometrial cancer?Gynecol Oncol555155CrossRefPubMedGoogle Scholar
  10. 10.
    Piver, MS, Lele, SB, Barlow, JJ, Blumenson, L 1982Paraortic lymph node evaluation in stage I endometrial carcinomaObstet Gynecol5997100PubMedGoogle Scholar
  11. 11.
    Shepherd, JH 1989Revised FIGO staging for gynecological cancerBr J Obstet Gynaecol96889892PubMedGoogle Scholar
  12. 12.
    Hardesty, LA, Sumkin, JH, Nath, ME,  et al. 2000Use of preoperative MR imaging in the management of endometrial carcinoma: cost analysisRadiology2154549PubMedGoogle Scholar
  13. 13.
    Hricak, H, Rubinstein, LV, Gherman, CM, Karstaedt, N 1991MR imaging evaluation of endometrial carcinoma: results of an NCI cooperative studyRadiology179829832PubMedGoogle Scholar
  14. 14.
    Manfredi, R, Mirk, P, Maresca, G,  et al. 2004Local-regional staging of endometrial carcinoma: role of MR imaging in surgical planningRadiology231372378PubMedGoogle Scholar
  15. 15.
    Kinkel, K, Yu, KK, Kaji, Y,  et al. 1999Radiological staging in patients with endometrial cancer: a meta-analysisRadiology212711718PubMedGoogle Scholar
  16. 16.
    Yamashita, Y, Harada, M, Sawada, T,  et al. 1993Normal uterus and FIGO stage I endometrial carcinoma: dynamic gadolinium-enhanced MR imagingRadiology186495501PubMedGoogle Scholar
  17. 17.
    Seki, H, Takano, T, Sakai, K 2000Value of dynamic MR imaging in assessing endometrial carcinoma involvement of the cervixAJR175171176PubMedGoogle Scholar
  18. 18.
    McCarthy S, Hricak H (1997) The uterus and vagina. In: Higgins CB, Hricak H, Helms CA eds. Magnetic resonance imaging of the body, 3rd ed. Philadelphia: Lippincott-Raven, :761–814Google Scholar
  19. 19.
    Lee, EJ, Byun, JY, Kim, B,  et al. 1999Staging of early endometrial carcinoma: assessment with T2-weighted and gadolinium-enhanced T1-weighted imagingRadiographics19937945PubMedGoogle Scholar
  20. 20.
    Smith-Bindman, R, Kerlikowske, K, Feldstein, VA,  et al. 1998Endovaginal ultrasound to exclude endometrial cancer and other endometrial abnormalitiesJAMA28015101517CrossRefPubMedGoogle Scholar
  21. 21.
    Sahakian, V, Syrop, C, Turner, D 1991Endometrial carcinoma: transvaginal ultrasonography prediction of deep myometrial invasionGynecol Oncol43217219CrossRefPubMedGoogle Scholar
  22. 22.
    Hasumi, K, Mutsuzawa, M, Chen, HG,  et al. 1982Computed tomography in the evaluation and treatment of endometrial carcinomaCancer50904908PubMedGoogle Scholar
  23. 23.
    Hirano, Y, Kubo, K, Hirai, Y,  et al. 1992Preliminary experience with gadolinium-enhanced dynamic MR imaging for uterine neoplasmRadiographics12243256PubMedGoogle Scholar
  24. 24.
    Lien, HH, Blomlie, V, Trope, C,  et al. 1991Cancer of the endometrium: value of MR imaging in determining depth of invasion into the myometriumAJR15712211223PubMedGoogle Scholar
  25. 25.
    Hricak, H, Hamm, B, Semelka, R,  et al. 1991Carcinoma of the uterus: use of gadopentetate dimeglumine in MR imagingRadiology18195106PubMedGoogle Scholar
  26. 26.
    Sironi, S, Colombo, E, Villa, G,  et al. 1992Myometrial invasion by endometrial carcinoma: assessment with plain and gadolinium-enhanced MR imagingRadiology185207212PubMedGoogle Scholar
  27. 27.
    Chen, SS, Rumancik, WM, Spiegel, C 1990Magnetic resonance imaging in stage I endometrial carcinomaObstet Gynecol75274277PubMedGoogle Scholar
  28. 28.
    Maschio, A, Vanzulli, A, Sironi, S,  et al. 1993Estimating the depth of myometrial involvement by endometrial carcinoma: efficacy of transvaginal sonography vs MR imagingAJR160533538PubMedGoogle Scholar
  29. 29.
    Saez, F, Urresola, A, Larena, JA,  et al. 2000Endometrial carcinoma: assessment of myometrial invasion with plain and gadolinium-enhanced MR imagingJ Magn Reson Med12460466CrossRefGoogle Scholar
  30. 30.
    Seki, H, Kimura, M, Sakai, K 1997Myometrial invasion of endometrial carcinoma: assessment with dynamic MR and contrast-enhanced T1-weighted imagesClin Radiol521823CrossRefPubMedGoogle Scholar
  31. 31.
    Chen, SS, Rumancik, WM, Spiegel, C 1990Magnetic resonance imaging in stage I endometrial carcinomaObstet Gynecol75274277PubMedGoogle Scholar
  32. 32.
    Mazzon I, Corrado G, Morricone D, Scambia G (2005) Reproductive preservation for treatment of stage IA endometrial cancer in a young woman: hysteroscopic resection. Int J Gynecol Cancer in pressGoogle Scholar
  33. 33.
    Scoutt, LM, McCarthy, SM, Flynn, SD,  et al. 1995Clinical stage I endometrial carcinoma: pitfalls in preoperative assessment with MR imagingWork in progress. Radiology194567572Google Scholar
  34. 34.
    Yang, WT, Lam, WWM, Yu, MY,  et al. 2000Comparison of dynamic helical CT and dynamic MR imaging in the valuation of pelvic lymph nodes in cervical carcinomaAJR175 759766PubMedGoogle Scholar
  35. 35.
    Hirisinghami, MG, Barentsz, J, Hahn, PF,  et al. 2003Noninvasive detection of clinically occult lymph node metastases in prostate cancerN Engl J Med34824912499CrossRefPubMedGoogle Scholar
  36. 36.
    Fagotti, A, Ferrandina, G, Longo, R,  et al. 2002Minilaparotomy in early endometrial cancer: an alternative to standard and laparoscopic treatmentGynecol Oncol86177183CrossRefPubMedGoogle Scholar
  37. 37.
    Eltabbakh, GH, Shamonki, MI, Moody, JM, Garafano, LL 2001Laparoscopy as the primary modality for the treatment of women with endometrial carcinomaCancer91378387CrossRefPubMedGoogle Scholar
  38. 38.
    Massi, G, Savino, L, Susini, T 1996Vaginal hysterectomy versus abdominal hysterectomy for the treatment of stage I endometrial adenocarcinomaAm J Obstet Gynecol17413201326PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2005

Authors and Affiliations

  • R. Manfredi
    • 1
  • B. Gui
    • 1
  • G. Maresca
    • 1
  • F. Fanfani
    • 2
  • L. Bonomo
    • 1
  1. 1.Department of Radiology“A. Gemelli” University HospitalRomeItaly
  2. 2.Department of GynecologyCentro di Ricerca e Formazione ad Alta Technologia nelle Scienze BiomedicheCampobassoItaly

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