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MRI of Malignant Neoplasms of the Uterine Corpus and Cervix

¹ All authors: Department of Radiology, Addenbrooke's Hospital, University of Cambridge, Hills Rd., Cambridge CB2 2QQ, United Kingdom.

View larger version (168K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —Stage IA endometrial carcinoma in 64-year-old woman. Sagittal T2-weighted fast spin-echo (A) and early phase (60 seconds) gadolinium-enhanced fat-suppressed T1-weighted (B) MR images show endometrial carcinoma (T) confined to endometrium. Zonal anatomy (arrows in A) is indistinct on T2-weighted image. However, intact band of early subendometrial enhancement seen on T1-weighted image (arrows in B) excludes myometrial invasion.

View larger version (155K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —Stage IA endometrial carcinoma in 64-year-old woman. Sagittal T2-weighted fast spin-echo (A) and early phase (60 seconds) gadolinium-enhanced fat-suppressed T1-weighted (B) MR images show endometrial carcinoma (T) confined to endometrium. Zonal anatomy (arrows in A) is indistinct on T2-weighted image. However, intact band of early subendometrial enhancement seen on T1-weighted image (arrows in B) excludes myometrial invasion.

View larger version (180K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —Stage IB endometrial carcinoma in 65-year-old woman. Sagittal T2-weighted fast spin-echo (A) and gadolinium-enhanced fat-suppressed T1-weighted (B) MR images show endometrial carcinoma (T) with superficial myometrial invasion. Note disruption of junctional zone (arrow in A). Tumor involves less than 50% of myometrium (arrow in B), which is better shown on T1-weighted image.

View larger version (170K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —Stage IB endometrial carcinoma in 65-year-old woman. Sagittal T2-weighted fast spin-echo (A) and gadolinium-enhanced fat-suppressed T1-weighted (B) MR images show endometrial carcinoma (T) with superficial myometrial invasion. Note disruption of junctional zone (arrow in A). Tumor involves less than 50% of myometrium (arrow in B), which is better shown on T1-weighted image.

View larger version (171K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —Stage IIA endometrial carcinoma in 78-year-old woman. Sagittal T2-weighted fast spin-echo (A) and gadolinium-enhanced fat-suppressed T1-weighted (B) MR images show endometrial carcinoma (T) with deep myometrial invasion and tumor extension into cervical canal (arrow in A). Note preservation of low-signal-intensity cervical stroma (asterisks). Normal enhancement of cervical mucosa (arrow in B) on enhanced images excludes cervical stroma invasion. Incidental presence of uterine leiomyoma (L) is noted.

View larger version (163K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —Stage IIA endometrial carcinoma in 78-year-old woman. Sagittal T2-weighted fast spin-echo (A) and gadolinium-enhanced fat-suppressed T1-weighted (B) MR images show endometrial carcinoma (T) with deep myometrial invasion and tumor extension into cervical canal (arrow in A). Note preservation of low-signal-intensity cervical stroma (asterisks). Normal enhancement of cervical mucosa (arrow in B) on enhanced images excludes cervical stroma invasion. Incidental presence of uterine leiomyoma (L) is noted.

View larger version (184K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —Malignant mixed müllerian tumor in 55-year-old woman. Sagittal T2-weighted fast spin-echo (FSE) (A), sagittal gadolinium-enhanced fat-suppressed T1-weighted (B), and axial oblique T2-weighted FSE (C) images show large heterogeneous mass (T) that contains areas of cystic necrosis. Tumor involves entire depth of myometrium and invades cervical stroma (asterisks in A and B). Note presence of enlarged bilateral obturator lymph nodes (N in C) and associated left-side hydronephrosis (arrow in C).

View larger version (175K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —Malignant mixed müllerian tumor in 55-year-old woman. Sagittal T2-weighted fast spin-echo (FSE) (A), sagittal gadolinium-enhanced fat-suppressed T1-weighted (B), and axial oblique T2-weighted FSE (C) images show large heterogeneous mass (T) that contains areas of cystic necrosis. Tumor involves entire depth of myometrium and invades cervical stroma (asterisks in A and B). Note presence of enlarged bilateral obturator lymph nodes (N in C) and associated left-side hydronephrosis (arrow in C).

View larger version (208K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —Malignant mixed müllerian tumor in 55-year-old woman. Sagittal T2-weighted fast spin-echo (FSE) (A), sagittal gadolinium-enhanced fat-suppressed T1-weighted (B), and axial oblique T2-weighted FSE (C) images show large heterogeneous mass (T) that contains areas of cystic necrosis. Tumor involves entire depth of myometrium and invades cervical stroma (asterisks in A and B). Note presence of enlarged bilateral obturator lymph nodes (N in C) and associated left-side hydronephrosis (arrow in C).

View larger version (160K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —Stage IIB cervical cancer in 47-year-old woman. Sagittal fast spin-echo (A) and axial fat-suppressed (B) T2-weighted images show small cervical cancer (T) involving anterior lip of cervix. Tumor invades fibrocervical stroma on left as shown by focal disruption of low-signal-intensity ring (arrow in B). Pathology showed full-depth stromal invasion with tumor extending 2 mm into left parametrium.

View larger version (196K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —Stage IIB cervical cancer in 47-year-old woman. Sagittal fast spin-echo (A) and axial fat-suppressed (B) T2-weighted images show small cervical cancer (T) involving anterior lip of cervix. Tumor invades fibrocervical stroma on left as shown by focal disruption of low-signal-intensity ring (arrow in B). Pathology showed full-depth stromal invasion with tumor extending 2 mm into left parametrium.

View larger version (187K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —Stage IIB cervical cancer in 42-year-old woman. Sagittal fast spin-echo (A), axial oblique (B), and coronal oblique (C) T2-weighted images show cervical cancer (T) involving both anterior and posterior lips of cervix. Tumor invades fibrocervical stroma bilaterally, as shown by loss of low-signal-intensity ring, and extends to both parametria (arrows in B). Coronal oblique image shows bilateral parametrial invasion (arrows in C) and enlarged lymph nodes (N in C).

View larger version (189K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —Stage IIB cervical cancer in 42-year-old woman. Sagittal fast spin-echo (A), axial oblique (B), and coronal oblique (C) T2-weighted images show cervical cancer (T) involving both anterior and posterior lips of cervix. Tumor invades fibrocervical stroma bilaterally, as shown by loss of low-signal-intensity ring, and extends to both parametria (arrows in B). Coronal oblique image shows bilateral parametrial invasion (arrows in C) and enlarged lymph nodes (N in C).

View larger version (184K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6C —Stage IIB cervical cancer in 42-year-old woman. Sagittal fast spin-echo (A), axial oblique (B), and coronal oblique (C) T2-weighted images show cervical cancer (T) involving both anterior and posterior lips of cervix. Tumor invades fibrocervical stroma bilaterally, as shown by loss of low-signal-intensity ring, and extends to both parametria (arrows in B). Coronal oblique image shows bilateral parametrial invasion (arrows in C) and enlarged lymph nodes (N in C).

View larger version (180K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7A —Stage IVB cervical cancer in 39-year-old woman. Sagittal fast spin-echo (A) and axial fat-suppressed (B and C) T2-weighted images show large cervical cancer (T in A and B) involving anterior lip of cervix. Tumor also invades posterior wall of bladder, entire vagina, and urethra (asterisk in C).

View larger version (150K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7B —Stage IVB cervical cancer in 39-year-old woman. Sagittal fast spin-echo (A) and axial fat-suppressed (B and C) T2-weighted images show large cervical cancer (T in A and B) involving anterior lip of cervix. Tumor also invades posterior wall of bladder, entire vagina, and urethra (asterisk in C).

View larger version (157K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7C —Stage IVB cervical cancer in 39-year-old woman. Sagittal fast spin-echo (A) and axial fat-suppressed (B and C) T2-weighted images show large cervical cancer (T in A and B) involving anterior lip of cervix. Tumor also invades posterior wall of bladder, entire vagina, and urethra (asterisk in C).

View larger version (157K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8A —Tumor recurrence in 45-year-old woman who had undergone hysterectomy for cervical carcinoma. Sagittal fast spin-echo (A) and axial fat-suppressed (B) T2-weighted images show intermediate-signal-intensity mass at vaginal vault (T), which is consistent with tumor recurrence.

View larger version (155K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8B —Tumor recurrence in 45-year-old woman who had undergone hysterectomy for cervical carcinoma. Sagittal fast spin-echo (A) and axial fat-suppressed (B) T2-weighted images show intermediate-signal-intensity mass at vaginal vault (T), which is consistent with tumor recurrence.

View larger version (184K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9A —Tumor recurrence in 67-year-old woman who had undergone radiochemotherapy for cervical carcinoma. Sagittal fast spin-echo (A) and axial fat-suppressed (B) T2-weighted images show heterogeneous mass involving uterine corpus (T), which is consistent with tumor recurrence. Note presence of enlarged right external iliac lymph node (N in B).

View larger version (179K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9B —Tumor recurrence in 67-year-old woman who had undergone radiochemotherapy for cervical carcinoma. Sagittal fast spin-echo (A) and axial fat-suppressed (B) T2-weighted images show heterogeneous mass involving uterine corpus (T), which is consistent with tumor recurrence. Note presence of enlarged right external iliac lymph node (N in B).

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