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Value of Dynamic MR Imaging in Assessing Endometrial Carcinoma Involvement of the Cervix

Hiroshi Seki1, Tooru Takano and Kunio Sakai

1 All authors: Department of Radiology, Niigata University School of Medicine, 757, 1-Bancho, Asahimachi-dori, Niigata 951-8510, Japan.



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  		Fig. 1. —Graph shows enhancement ratio on dynamic MR imaging. Ranges indicate standard deviation of mean. In most patients, enhancement of cervical epithelium ({blacksquare}) exceeded that of cervical stroma ([UNK]) and endometrial carcinoma ({blacktriangleup}), which was especially significant in phase 2 (80-160 sec) or phase 3 (160-240 sec).

 


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  		Fig. 2A. —Endometrial carcinoma involvement of cervix in 59-year-old woman. T2-weighted MR image shows tumor (arrows) extending into widened cervical canal.

 


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  		Fig. 2B. —Endometrial carcinoma involvement of cervix in 59-year-old woman. Dynamic MR images in phase 1 (B) and phase 2 (C) show disruption of enhancement of cervical epithelium (arrows). Enhancement of cervical epithelium (arrowheads) exceeds that of cervical stroma and tumor.

 


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  		Fig. 2C. —Endometrial carcinoma involvement of cervix in 59-year-old woman. Dynamic MR images in phase 1 (B) and phase 2 (C) show disruption of enhancement of cervical epithelium (arrows). Enhancement of cervical epithelium (arrowheads) exceeds that of cervical stroma and tumor.

 


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  		Fig. 2D. —Endometrial carcinoma involvement of cervix in 59-year-old woman. Contrast-enhanced T1-weighted MR image reveals disruption of enhancement of cervical epithelium (arrows). Tumor-cervical epithelial contrast is inferior to that seen in B and C.

 


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  		Fig. 3A. —Endometrial carcinoma extending near internal cervical os without cervical involvement in 54-year-old woman. T2-weighted MR image shows widening of cervical canal (arrows), which led to false-positive diagnosis of cervical involvement.

 


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  		Fig. 3B. —Endometrial carcinoma extending near internal cervical os without cervical involvement in 54-year-old woman. Enhancement of cervical epithelium is greater in phase 3 (C) than in phase 1 (B) on dynamic MR imaging. Dynamic MR image in phase 3 (C) shows continuous enhancement of cervical epithelium (arrows, C), which indicates no cervical involvement.

 


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  		Fig. 3C. —Endometrial carcinoma extending near internal cervical os without cervical involvement in 54-year-old woman. Enhancement of cervical epithelium is greater in phase 3 (C) than in phase 1 (B) on dynamic MR imaging. Dynamic MR image in phase 3 (C) shows continuous enhancement of cervical epithelium (arrows, C), which indicates no cervical involvement.

 


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  		Fig. 3D. —Endometrial carcinoma extending near internal cervical os without cervical involvement in 54-year-old woman. Contrast-enhanced T1-weighted MR image reveals poor tumor-cervical epithelial contrast (arrows), resulting in a false-positive diagnosis of cervical involvement.

 


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  		Fig. 4A. —Endometrial carcinoma involvement of cervical stroma in 51-year-old woman. T2-weighted MR image shows tumor extending into cervical stroma (arrows), with widening of cervical canal.

 


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  		Fig. 4B. —Endometrial carcinoma involvement of cervical stroma in 51-year-old woman. Dynamic MR image in phase 2 shows less-enhanced tumor replacing cervical stroma (arrows), which is significantly enhanced.

 


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  		Fig. 5. —Graph shows contrast between tumor and cervical epithelium with each pulse sequence. Dynamic MR imaging (dynamic phase 1, 2, and 3) had significant contrast compared with T2-weighted MR imaging (p < 0.0001) and contrast-enhanced T1-weighted spin-echo MR imaging (p < 0.001).

 


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  		Fig. 6. —Graph shows contrast between tumor and cervical stroma with each pulse sequence. T2-weighted MR imaging had excellent contrast compared with dynamic MR imaging (dynamic phase 1, 2, and 3) (p < 0.01) and contrast-enhanced T1-weighted spin-echo MR imaging (p < 0.000001).

 

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