EURORAD ESR

Case 14476

Pelvic endometrial carcinoma recurrence: MRI including diffusion-weighted imaging

Author(s)
Tonolini Massimo, MD.

"Luigi Sacco" University Hospital,
Radiology Department;
Via G.B. Grassi 74
20157 Milan, Italy;
Email:mtonolini@sirm.org
 
Patient
female, 58 year(s)
 
 
  • Figure 1
    Initial, presurgical contrast-enhanced CT (MRI unavailable at another facility)
     

    Multiplanar post-contrast images (a...c) showed uterine body with well-demarcated, mildly heterogeneous hypointense endometrial mass (arrowheads), measuring approximately 3x2.5x1.5 cm, which did not appear to involve...

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    Multiplanar post-contrast images (a...c) showed uterine body with well-demarcated, mildly heterogeneous hypointense endometrial mass (arrowheads), measuring approximately 3x2.5x1.5 cm, which did not extend beyond the...

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    Multiplanar post-contrast images (a...c) showed uterine body with well-demarcated, mildly heterogeneous hypointense endometrial mass (arrowheads), which invaded over 50% of myometrium but not full-thickness or beyond...

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    Oblique-axial image from additional excretory-phase CT acquisition after colonic water enema confirmed hypointense endometrial mass (arrowheads) invading over 50% of myometrium but not full-thickness or beyond the...

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Neoplasia;
     
     
  • Figure 2
    Contrast-enhanced abdominal CT obtained for oncologic follow-up 2 years after Fig.1
     

    Axial (a...c in craniocaudal order) and coronal (d) images showed development of left-sided hydronephrosis (thick arrows) with delayed nephrogram, caused by ipsilateral pelvic mass (arrows).

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    Axial (a...c in craniocaudal order) and coronal (d) images showed development of left-sided hydronephrosis (thick arrows) with delayed nephrogram, caused by ipsilateral pelvic mass (arrows).

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    The left lateral pelvic mass (arrows) measured approximately 3x2.5x1.5 cm and showed peripheral contrast enhancement. No ascites, adenopathies and solid organ lesions.

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    The left lateral pelvic mass (arrows) measured approximately 3x2.5x1.5 cm and showed peripheral contrast enhancement. Note ipsilateral hydronephrosis (thick arrows) with delayed nephrogram.

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Neoplasia;
     
     
  • Figure 3
    Unenhanced and post-gadolinium MRI a week after Fig.2
     

    Multiplanar T2-weighted images (a...c) confirmed ovoid-shaped lobulated left pelvic mass (arrows), with tumour-like solid signal intensity, closely adherent to sigmoid colon (*), causing infiltration of the...

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    Multiplanar T2-weighted images (a...c) confirmed ovoid-shaped lobulated left pelvic mass (arrows), with tumour-like solid signal intensity, abutting the surgical clips indicated by ferromagnetic artefacts (arrowhead)...

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    Multiplanar T2-weighted images (a...c) confirmed ovoid-shaped lobulated left pelvic mass (arrows), with tumour-like solid signal intensity, closely adherent to sigmoid colon (*) and mesorectal fascia (thick arrow).

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    On precontrast T1-weighted images the ovoid-shaped lobulated left pelvic mass (arrows) showed intermediate solid signal intensity, was closely adherent to sigmoid colon (*) and mesorectal fascia (thick arrow).

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    High (800) b-value diffusion-weighted image (DWI, e) showed strong hyperintense signal at the left lateral pelvic mass (arrows), with corresponding low apparent diffusion coefficient (ADC value 0.85x10-3 mm2/s, f).

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    High (800) b-value diffusion-weighted image (DWI, e) showed strong hyperintense signal at the left lateral pelvic mass (arrows), with corresponding low apparent diffusion coefficient (ADC value 0.85x10-3 mm2/s, f).

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    Additionally, midsagittal T2-weighted image showed normal postoperative appearance of the vagina without signs of recurrence at the usual vault site indicated by thin arrow.

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    Fat-suppressed T1-weighted images after iv gadolinium contrast showed positive, minimally inhomogeneous contrast enhancement at the left pelvic mass (arrows), closely adherent to the sigmoid colon (*).

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    Fat-suppressed T1-weighted images after iv gadolinium contrast showed positive, minimally inhomogeneous contrast enhancement at the left pelvic mass (arrows), abutting the surgical clips indicated by ferromagnetic...

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Neoplasia;
     
     
  • Figure 4
    [18F]-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT)
     

    FDG-PET/CT showed strong tracer uptake in the left lateral pelvic mass (arrows). Note radiotracer in the urinary cavities and bladder, asymmetric increased thyroid uptake attributed to chronic lymphocytic thyroiditis.

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: SPECT; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    FDG-PET/CT showed strong tracer uptake in the left lateral pelvic mass (arrows) with corresponding maximum standardized uptake value (SUV) 15.4. No other pathological uptake representing nodal or distant relapse sites.

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: SPECT-CT; Procedure: Diagnostic procedure; Special Focus: Neoplasia;
     
     
  • Figure 5
    Repeated MRI following chemotherapy, 6 months after Fig.3
     

    Compared to Fig.3, multiplanar T2-weighted images (a...c) showed decreased size and development of hypointense signal at the lateral pelvic recurrence (arrows) consistent with post-treatment fibrosis. Note...

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    Compared to Fig.3, multiplanar T2-weighted images (a...c) showed decreased size and development of hypointense signal at the lateral pelvic recurrence (arrows) consistent with post-treatment fibrosis. Note...

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    Compared to Fig.3, multiplanar T2-weighted images (a...c) showed decreased size and development of hypointense signal at the lateral pelvic recurrence (arrows) consistent with post-treatment fibrosis. Note...

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    Fat-saturated post-gadolinium images showed minimal residual contrast enhancement at the lateral pelvic recurrence (arrow).

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    Compared to Fig.3, high (800) b-value DWI and corresponding ADC map showed disappearance of abnormal diffusion restriction at the lateral pelvic recurrence (arrows).

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    Compared to Fig.3, high (800) b-value DWI and corresponding ADC map showed disappearance of abnormal diffusion restriction at the lateral pelvic recurrence (arrows).

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Neoplasia;
     
     
Multiplanar post-contrast images (a...c) showed uterine body with well-demarcated, mildly heterogeneous hypointense endometrial mass (arrowheads), measuring approximately 3x2.5x1.5 cm, which did not appear to involve the cervix. No ascites and lymphadenopathies.
 
Multiplanar post-contrast images (a...c) showed uterine body with well-demarcated, mildly heterogeneous hypointense endometrial mass (arrowheads), measuring approximately 3x2.5x1.5 cm, which did not extend beyond the uterus. No adnexal enlargement and lymphadenopathies.
 
Multiplanar post-contrast images (a...c) showed uterine body with well-demarcated, mildly heterogeneous hypointense endometrial mass (arrowheads), which invaded over 50% of myometrium but not full-thickness or beyond the uterus. No adnexal enlargement and lymphadenopathies.
 
Oblique-axial image from additional excretory-phase CT acquisition after colonic water enema confirmed hypointense endometrial mass (arrowheads) invading over 50% of myometrium but not full-thickness or beyond the uterus.
 
Axial (a...c in craniocaudal order) and coronal (d) images showed development of left-sided hydronephrosis (thick arrows) with delayed nephrogram, caused by ipsilateral pelvic mass (arrows).
 
Axial (a...c in craniocaudal order) and coronal (d) images showed development of left-sided hydronephrosis (thick arrows) with delayed nephrogram, caused by ipsilateral pelvic mass (arrows).
 
The left lateral pelvic mass (arrows) measured approximately 3x2.5x1.5 cm and showed peripheral contrast enhancement. No ascites, adenopathies and solid organ lesions.
 
The left lateral pelvic mass (arrows) measured approximately 3x2.5x1.5 cm and showed peripheral contrast enhancement. Note ipsilateral hydronephrosis (thick arrows) with delayed nephrogram.
 
Multiplanar T2-weighted images (a...c) confirmed ovoid-shaped lobulated left pelvic mass (arrows), with tumour-like solid signal intensity, closely adherent to sigmoid colon (*), causing infiltration of the ipsilateral ureter (thick arrow) and upstream hydronephrosis.
 
Multiplanar T2-weighted images (a...c) confirmed ovoid-shaped lobulated left pelvic mass (arrows), with tumour-like solid signal intensity, abutting the surgical clips indicated by ferromagnetic artefacts (arrowhead) and closely adherent to sigmoid colon (*).
 
Multiplanar T2-weighted images (a...c) confirmed ovoid-shaped lobulated left pelvic mass (arrows), with tumour-like solid signal intensity, closely adherent to sigmoid colon (*) and mesorectal fascia (thick arrow).
 
On precontrast T1-weighted images the ovoid-shaped lobulated left pelvic mass (arrows) showed intermediate solid signal intensity, was closely adherent to sigmoid colon (*) and mesorectal fascia (thick arrow).
 
High (800) b-value diffusion-weighted image (DWI, e) showed strong hyperintense signal at the left lateral pelvic mass (arrows), with corresponding low apparent diffusion coefficient (ADC value 0.85x10-3 mm2/s, f).
 
High (800) b-value diffusion-weighted image (DWI, e) showed strong hyperintense signal at the left lateral pelvic mass (arrows), with corresponding low apparent diffusion coefficient (ADC value 0.85x10-3 mm2/s, f).
 
Additionally, midsagittal T2-weighted image showed normal postoperative appearance of the vagina without signs of recurrence at the usual vault site indicated by thin arrow.
 
Fat-suppressed T1-weighted images after iv gadolinium contrast showed positive, minimally inhomogeneous contrast enhancement at the left pelvic mass (arrows), closely adherent to the sigmoid colon (*).
 
Fat-suppressed T1-weighted images after iv gadolinium contrast showed positive, minimally inhomogeneous contrast enhancement at the left pelvic mass (arrows), abutting the surgical clips indicated by ferromagnetic artefacts (arrowhead) and closely adherent to sigmoid colon (*).
 
FDG-PET/CT showed strong tracer uptake in the left lateral pelvic mass (arrows). Note radiotracer in the urinary cavities and bladder, asymmetric increased thyroid uptake attributed to chronic lymphocytic thyroiditis.
 
FDG-PET/CT showed strong tracer uptake in the left lateral pelvic mass (arrows) with corresponding maximum standardized uptake value (SUV) 15.4. No other pathological uptake representing nodal or distant relapse sites.
 
Compared to Fig.3, multiplanar T2-weighted images (a...c) showed decreased size and development of hypointense signal at the lateral pelvic recurrence (arrows) consistent with post-treatment fibrosis. Note disappearance of hydronephrosis.
 
Compared to Fig.3, multiplanar T2-weighted images (a...c) showed decreased size and development of hypointense signal at the lateral pelvic recurrence (arrows) consistent with post-treatment fibrosis. Note disappearance of hydronephrosis.
 
Compared to Fig.3, multiplanar T2-weighted images (a...c) showed decreased size and development of hypointense signal at the lateral pelvic recurrence (arrows) consistent with post-treatment fibrosis. Note disappearance of hydronephrosis.
 
Fat-saturated post-gadolinium images showed minimal residual contrast enhancement at the lateral pelvic recurrence (arrow).
 
Compared to Fig.3, high (800) b-value DWI and corresponding ADC map showed disappearance of abnormal diffusion restriction at the lateral pelvic recurrence (arrows).
 
Compared to Fig.3, high (800) b-value DWI and corresponding ADC map showed disappearance of abnormal diffusion restriction at the lateral pelvic recurrence (arrows).
 
 
 
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