Magnetic resonance imaging pitfalls in determining myometrial invasion in stage I endometrial cancer: a case report and literature review
Author(s)
Winarto, Hariyono
Habiburrahman, Muhammad
Siregar, Trifonia Pingkan
Nuryanto, Kartiwa Hadi
Type
Journal Article
Abstract
The degree of myometrial invasion (MI) is crucial in the preoperative diagnosis of endometrial cancer (EC) using MRI in terms of therapeutic and prognostic implications. However, several pitfalls should be kept in mind when using this modality. We report a case of EC on a 64-year-old woman, identified preoperatively without MI based on ultrasonography and MRI, implying a low risk of lymph node metastasis; surprisingly, the uterine incision showed the lesion had invaded <50% of the myometrium. Thus, a total laparoscopic hysterectomy and bilateral salpingo-oophorectomy were performed, and histopathologic analysis confirmed that the EC was on stage IA (cancer is in the endometrium only or less than halfway through the myometrium). In our case, thinning myometrium and uterine atrophy due to aging, multiple leiomyomas, previous curettage, and blood clots were all pitfalls for MRI in detecting MI. By detecting tiny or isointense tumors and depicting distinct vascularity of the malignancy in postmenopausal women, functional MRI techniques such as diffusion-weighted imaging (DWI) and dynamic contrast-enhanced MRI (DCE-MRI) can help reduce pitfalls when assessing MI. Clinicians can employ DWI preoperatively, which is more reliable and superior to DCE-MRI in determining tumor areas without contrast injection and perform a postoperative histopathological examination to confirm MI in EC.
Date Issued
2022-08
Date Acceptance
2022-05-11
Citation
Radiology Case Reports, 2022, 17 (8), pp.2680-2688
ISSN
1930-0433
Publisher
Elsevier
Start Page
2680
End Page
2688
Journal / Book Title
Radiology Case Reports
Volume
17
Issue
8
Copyright Statement
© 2022 The Authors. Published by Elsevier Inc. on behalf of University of Washington. This is an open access article under the
CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/35663819
Subjects
CT, Computed Tomography
DCE-MRI, Dynamic Contrast Enhanced-Magnetic Resonance Imaging
Diffusion-weighted MRI
DWI, Diffusion-Weighted Imaging
EC, Endometrial Cancer
eGFR, Estimated Glomerular Filtration Rate
Endometrial cancer
FIGO, The International Federation of Gynecology and Obstetrics
GdT1WI, Gadolinium-Enhanced T1WI
GRE, 3D FS Gradient-Echo
Indonesia
JZ, Junctional Zone
LNM, Lymph Node Metastasis
Magnetic resonance imaging
MI, Myometrial Invasion
MRI, Magnetic Resonance Imaging
Myometrial invasion
NPV, Negative Predictive Values
Pitfalls
PPV, Positive Predictive Values
SEE, Sub-Endometrial Enhancement
T1FS, T1-Weighted Fat-Suppressed
T1WI, T1-Weighted Imaging
T2WI, T2-Weighted Imaging
TVUS, Transvaginal Ultrasound
USG, Ultrasonography
Publication Status
Published
Coverage Spatial
Netherlands
Date Publish Online
2022-05-29