Role of MRI in staging and follow-up of endometrial and cervical cancer: pitfalls and mimickers

María Milagros Otero-García, Alicia Mesa-Álvarez, Olivera Nikolic, Patricia Blanco-Lobato, Marijana Basta-Nikolic, Rafael Menéndez de Llano-Ortega, Laura Paredes-Velázquez, Nikola Nikolic, Magda Szewczyk-Bieda

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    MRI plays important roles in endometrial and cervical cancer assessment, from detection to recurrent disease evaluation. Endometrial cancer (EC) is the most common malignant tumor of the female genital tract in Western countries. EC patients are divided into risk categories based on histopathological tumor type, grade, and myometrial invasion depth. EC is surgically staged using the International Federation of Gynecology and Obstetrics (FIGO) system. Since FIGO (2009) stage correlates with prognosis, preoperative staging is essential for tailored treatment. MRI reveals myometrial invasion depth, which correlates with tumor grade and lymph node metastases, and thus correlates with prognosis. Cervical cancer (CC) is the second most common cancer, and the third leading cause of cancer-related death among females in developing countries. The FIGO Gynecologic Oncology Committee recently revised its CC staging guidelines, allowing staging based on imaging and pathological findings when available. The revised FIGO (2018) staging includes node involvement and thus enables both therapy selection and evaluation, prognosis estimation, and calculation of end results. MRI can accurately assess prognostic indicators, e.g., tumor size, parametrial invasion, pelvic sidewall, and lymph node invasion. Despite these important roles of MRI, radiologists still face challenges due to the technical and interpretation pitfalls of MRI during all phases of endometrial and cervical cancer evaluation. Awareness of mimics that can simulate both cancers is critical. With careful application, functional MRI with DWI and DCE sequences can help establish a correct diagnosis, although it is sometimes necessary to perform biopsy and histopathological analysis.

    Original languageEnglish
    Article number19
    Pages (from-to)1-22
    Number of pages22
    JournalInsights into Imaging
    Issue number1
    Early online date13 Feb 2019
    Publication statusPublished - 13 Feb 2019


    • Cervical cancer
    • Diffusion
    • Endometrial cancer
    • Lymph nodes
    • Magnetic resonance

    ASJC Scopus subject areas

    • Radiology Nuclear Medicine and imaging


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