1. Correlative imaging
of gynecological
diseases
Tina PW Lam
Radiology
QMH

2. * Structural imaging
* Tissue characterization
* Cancer staging
* Functional imaging
Correlative imaging

3. * Detail anatomy
* Accurate lesion size, location and extent
* Delineate complex anomaly
Structural imaging

4. Patient 1
14 year-old girl
Menarchy at 11 years old
Regular monthly cycle
Dysmenorhoea
Progressive abdominal distension

5. TT1W axial
T2W axial

6. T2W
T2W sagittal
Uterine didelphys
Cervical atresia
Endometriotic cyst
T2W coronal

7. * Differentiate gas, fat, fluid, soft tissue,
blood, tumour and calcification
Tissue Characterization

8. Mature Teratoma

9. Leiolipoma
Calcified
leiomyoma

10. Mature teratoma
T1W
T2W
T1W FS+C

11. Adenomhyosis
Endometriotic
cyst

12. Patient 2
A 50 year-old perimenopausal lady
uterine leiomyoma for several years
2010
2012
Recent enlargement
with heterogeneous signal
2012

13. MRI
2012
T2W
T1W FS +C

14. Red degeneration of
leiomyoma
T2W
T1W FS
T1W FS +C

15. US in 10/2013

16. Cancer staging

17. *
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
Cancer of cervix uteri

18. Patient 3
A 16 year-old girl
Menorrhagia since menarchy
Progressive weight loss
P/E: vagina filled with tumour

19. Clear cell carcinoma
of cervix & vagina
Hypoplastic uterus, T-shaped
cavity – suspected DES exposure

20. Cancer of cervix
uteri

21. Cancer of cervix
uteri

22. * 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
Cancer of corpus
uteri

23. Cancer of corpus
uteri

24. Patient 4
56 yr-old menopausal lady
Post menopausal bleeding
P/E: tumor protruded from cervix
MRI: stage IIIC2 aggressive tumor
Histology: MMMT

25. * 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.
Cancer of ovary

26. Cancer of Ovary

27. Patient 5
A 49 year-old lady
Long standing endometriotic cyst
Developed vascular mural nodules

28. Clear cell carcinoma with omental and peritoneal deposits
PET/CT

29. Functional imaging

30. Omental &
peritoneal
deposits

31. No residual disease after chemotherapy
PPE
PET/CT in 4/13
PET/CT in 9/13

32. * PET/CT & CT alone are 100% specific
* PET/CT marginally better than CT alone
at 97% sensitivity.
* MRI is comparable to CT
Staging & follow-up of
ovarian cancer
http://www.acr.org/~/media/ACR/Documents/AppCriteria/Diagnostic/StagingAndFollowUpOvarianCancer.pdf

33. * 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
PET/CT in cancers of
cervix & corpus uteri
*Antonsen
SL et al. Gynecol Oncol. 2013 Feb;128(2):300-8

34. * Hybrid MRI/PET
* Functional MRI – Dynamic contrast enhanced
- Diffusion weighted imaging
* MR spectroscopy
Recent advances

35. Thank you!