Abstract
Objectives
To update the 2009 ESUR endometrial cancer guidelines and propose strategies to standardize image acquisition, interpretation and reporting for endometrial cancer staging with MRI.
Methods
The published evidence-based data and the opinion of experts were combined using the RAND-UCLA Appropriateness Method and formed the basis for these consensus guidelines. The responses of the experts to 81 questions regarding the details of patient preparation, MR imaging protocol, image interpretation and reporting were collected, analysed and classified as “RECOMMENDED” versus “NOT RECOMMENDED” (if at least 80% consensus among experts) or uncertain (if less than 80% consensus among experts).
Results
Consensus regarding patient preparation, MR image acquisition, interpretation and reporting was determined using the RAND-UCLA Appropriateness Method. A tailored MR imaging protocol and a standardized report were recommended.
Conclusions
These consensus recommendations should be used as a guide for endometrial cancer staging with MRI.
Key points
• MRI is recommended for initial staging of endometrial cancer.
• MR imaging protocol should be tailored based on the risk of lymph node metastases.
• Myometrial invasion is best assessed using combined axial-oblique T2WI, DWI and contrast-enhanced imaging.
• The mnemonic “Clinical and MRI Critical TEAM” summarizes key elements of the standardized report.
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Abbreviations
- CSI:
-
Cervical stromal invasion
- DCE-MRI:
-
Dynamic contrast-enhanced MRI
- DWI:
-
Diffusion-weighted imaging
- EC:
-
Endometrial cancer
- ESMO:
-
European Society for Medical Oncology
- ESUR:
-
European Society of Urogenital Radiology
- FOCUS:
-
Field of view (FOV) optimized and constrained undistorted single-shot DWI
- MI:
-
Myometrial invasion
- MRI:
-
Magnetic resonance imaging
- RAM:
-
RAND-UCLA Appropriateness Method
- SI:
-
Signal intensity
- SLN:
-
Sentinel lymph node
- TA:
-
Texture analysis
- T2WI:
-
T2-weighted imaging
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Acknowledgements
The committee would like to thank Mr Arnold Stipsits, ESUR secretary, for his help with co-ordination of the committee members. The authors would like to acknowledge the contribution of information specialist Dr. Martina Gosteli (Main library - Medicine Careum, University of Zurich) for her valuable assistance with the database searches. We would like to thank the following colleagues: Henrik Leonhardt, Celine Alt, Federico Collettini, Laure Fournier, Diomidis Botsikas, Gavin Stewart, Athina C. Tsili, Theresa Mokry, Riccardo Manfredi, Laura Bunesch Villalba, Sonya Snape, Hebert Alberto Vargas, Maryna Brochwicz-Lewinski, M. Weston, Suzan M. Goldman and Sara Belião for participating to the questionnaire on behalf of the ESUR women’s imaging group. Authors thank Joanne Chin M.F.A. for her editorial assistance with the manuscript.
Funding
Yulia Lakhman's contribution to this work was funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748.
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The scientific guarantor of this publication is Rosemarie Forstner
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Nougaret, S., Horta, M., Sala, E. et al. Endometrial Cancer MRI staging: Updated Guidelines of the European Society of Urogenital Radiology. Eur Radiol 29, 792–805 (2019). https://doi.org/10.1007/s00330-018-5515-y
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DOI: https://doi.org/10.1007/s00330-018-5515-y