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The Evaluation of Malignant Uterine Tumors with MRI

Author: ZhaoHuiPing
Tutor: ZhaoGuoKu
School: Jilin University
Course: Clinical
Keywords: Uterine malignancies MRI Evaluate
CLC: R737.33
Type: Master's thesis
Year: 2006
Downloads: 59
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Abstract


The common malignant uterine tumor is endometrial carcinomaand cervical carcinoma. MRI is used to exam the female reproductivesystem in recent years along with the development of the MRItechnique because of it’s different direction imaging, no ionizingradiation, good soft tissue definition. This study included 53 cases of malignant uterine tumorsperformed by MRI techniques and confirmed by pathology;Threedifferent scan methods such as axial, para-sagittal and thin-sectionoblique axial images were performed to evaluate cervical invasion.The main objection of this study was to analyze the value and limit ofMRI about the malignant uterine tumors and different scan methods toevaluate cervical invasion through comparison between imaging andpathology results. Methods: MR imaging with body coils of Philips GyroscanNT-1.0T made in Holland. The scan field: the axial was from the iliaccrest to the low rim of pubic symphysis;the saggital and thethin-section oblique axial were decided by the location and the field ofthe leisions. The saggital scan was paralleled with the body of uterine,the thin-section oblique axial was perpendicular with the lesions. Thepatients laid on back and were performed by axial (spin echo): T1WI,T2WI;saggital (tubor spin echo): T2WI and fat-saturation T2WI, thelocal thin-section obique axial were performed when necessarily. Theregular scan: the slice thickness was 6mm,the slice interval was1.2mm,the thin-section scan:the slice thickness was 1-3 mm,the sliceinterval was 0.2-0.6mm,the field of view was 350mm,the Matrix was256×169mm, T1WI: TR/TE=520/15ms, T2WI: TR/TE=2100/100ms,fat-saturation T2WI: TR/TE=2100/100ms, TI=155ms.Results: 27 patients with endometrial carcinoma were confirmedby pathology examination. The MR staging was compared withpathologic results, the accuracy rate was 88.89%. 24 of 26 patientswith myometrial invasion had correct MR results, including 11 patientswith inner half myometrial invasion and 13 patients with outer halfmyometrial invasion. The overall accuracy of MR imaging for depth ofmyometrial invasion detection was 92.3%. MRI was superior to CTand sonography in differentiating the deep myometrial invasionproduced by endometrial carcinoma.24 patients with cervical carcinoma were staged by clinic andMRI according to the clinical FIGO staging system and compared withthe result of pathology. The accurate rate of clinical and the MRIstaging is 77.27% and 81.82% respectively. MRI staging was moreobjective than the clinical staging, especially in the aspect ofparametrial invasion. The accuracy rate of pre-operate stage ofmalignant uterine tumor was improved by the use of MRI.We took axial, para-sagittal and thin-section obique axial T2WIimages to evaluate the cervical invasion. The accuracy rate is 77.36%,60.38%,92.45% respectively. There was no statistically significantdifference in the accuracy in detecting the extent of cervical invasionbetween axial and para-sagittal. But there was distinct statisticallysignificant difference between axial, para-sagittal and thin-sectionoblique axial imaging.MRI plain scan was performed to evaluate lymph node metastasesin this study. There is 17 lymph nodes were diagnosed to be metastaticby MRI, their short-diameter were all longer than 1.0cm, but 6 lymphnodes were confirmed to be inflammatory by patholagy. There were 6metastatic lymph nodes that couldn’t be diagnosed by MRI, only 1lymph node’s short-diameter was longer than 1.0cm, the rest lymphnode’s short-diameter were nomal. The signal was nomal with MRIplain scan in all metastatic lymph nodes confirmed by pathology. thediagnostic criterion of matastatic lymph nodes with MRI was limitedon the size of lymph nodes because the lymph nodes involvement hadno abnormal sign in it, but there were no definitive criteria fordifferiating the metastatic from benign nodes.The results showed that:1. The MRI was the efficient and accurate imaging methods forthe pre-operation staging of malignant uterine tumor.2. The parasagittal-section was not good at estimating the extentof cervical invasion and the thin-section oblique axial was essentialand useful method in detecting it.3. MRI plain scan was only a cursory diagnostic method toevaluate lymph node metastases.

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CLC: > Medicine, health > Oncology > Genitourinary tumors > Female genital tumors > Uterine tumors
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