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Staging of endometrial cancer with MRI: Guidelines of the European Society of Urogenital Imaging

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Abstract

The purpose of this study was to define guidelines for endometrial cancer staging with MRI. The technique included critical review and expert consensus of MRI protocols by the female imaging subcommittee of the European Society of Urogenital Radiology, from ten European institutions, and published literature between 1999 and 2008. The results indicated that high field MRI should include at least two T2-weighted sequences in sagittal, axial oblique or coronal oblique orientation (short and long axis of the uterine body) of the pelvic content. High-resolution post-contrast images acquired at 2 min ± 30 s after intravenous contrast injection are suggested to be optimal for the diagnosis of myometrial invasion. If cervical invasion is suspected, additional slice orientation perpendicular to the axis of the endocervical channel is recommended. Due to the limited sensitivity of MRI to detect lymph node metastasis without lymph node-specific contrast agents, retroperitoneal lymph node screening with pre-contrast sequences up to the level of the kidneys is optional. The likelihood of lymph node invasion and the need for staging lymphadenectomy are also indicated by high-grade histology at endometrial tissue sampling and by deep myometrial or cervical invasion detected by MRI. In conclusion, expert consensus and literature review lead to an optimized MRI protocol to stage endometrial cancer.

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Authors and Affiliations

  1. Clinique des Grangettes, Geneva University Hospital and Institut de Radiologie, 7, Chemin des Grangettes, CH1224, Chêne-Bougeries/Geneva, Switzerland

    K. Kinkel

  2. Zentralröntgeninstitut, LandesklinikenSalzburg, Mullner Hauptstr. 48, A-5020, Salzburg, Austria

    R. Forstner

  3. Dipartimento di Bioimmagini e scienze radiologiche, Università Cattolica del S. Cuore, 8, largo A. Gemelli, 00168, Rome, Italy

    F. M. Danza

  4. Radiology Department, Hospital Clinic, C/Villaroel 170, Barcelona, 08036, Spain

    L. Oleaga

  5. Department of Radiology, Instituto Português de Oncologia de Lisboa Francisco Gentil, R. Prof. Lima Basto, 1099-023, Lisboa Codex, Portugal

    T. M. Cunha

  6. Department of Radiology, Uppsala University Hospital, SE-751 85, Uppsala, Sweden

    A. Bergman

  7. Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands

    J. O. Barentsz

  8. Department of Radiology, Institut de Cancérologie Gustave Roussy, 39, rue Camille Desmoulins, 94805, Villejuif Cedex, France

    C. Balleyguier

  9. Department of Diagnostic and Interventional Radiology, University Hospital “Dubrava”, Avenija G.Suska 6, Zagreb, Croatia

    B. Brkljacic

  10. Medical School, University of Zagreb, 10000, Zagreb, Croatia

    B. Brkljacic

  11. Department of Clinical Radiology, St James’s Institute of Oncology, Leeds, LS9 7TF, UK

    J. A. Spencer

  12. Institut de radiologie, Clinique des Grangettes, 7, chemin des Grangettes, CH 1223, Chêne-Bougerie/Geneva, Switzerland

    K. Kinkel

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  1. K. Kinkel
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Correspondence to K. Kinkel.

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Kinkel, K., Forstner, R., Danza, F.M. et al. Staging of endometrial cancer with MRI: Guidelines of the European Society of Urogenital Imaging. Eur Radiol 19, 1565–1574 (2009). https://doi.org/10.1007/s00330-009-1309-6

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  • DOI: https://doi.org/10.1007/s00330-009-1309-6

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