Correlative imaging
of gynecological
diseases
Tina PW Lam
Radiology
QMH
* Structural imaging
* Tissue characterization
* Cancer staging
* Functional imaging

Correlative imaging
* Detail anatomy
* Accurate lesion size, location and extent
* Delineate complex anomaly

Structural imaging
Patient 1
14 year-old girl
Menarchy at 11 years old
Regular monthly cycle

Dysmenorhoea
Progressive abdominal distension
TT1W axial

T2W axial
T2W 

T2W sagittal

Uterine didelphys
Cervical atresia
Endometriotic cyst

T2W coronal
* Differentiate gas, fat, fluid, soft tissue,
blood, tumour and calcification

Tissue Characterization
Mature Teratoma
Leiolipoma

Calcified
leiomyoma
Mature teratoma

T1W

T2W



T1W FS+C
Adenomhyosis
Endometriotic
cyst
Patient 2
A 50 year-old perimenopausal lady
uterine leiomyoma for several years

2010

2012

Recent enlargement
with heter...
MRI
2012
T2W 

T1W FS +C
Red degeneration of
leiomyoma

T2W

T1W FS

T1W FS +C
US in 10/2013
Cancer staging
* 

Differentiate operable early disease (stages Ia, Ib & IIa)
from advanced disease

* 

Delineate extent of advanced dis...
Patient 3
A 16 year-old girl
Menorrhagia since menarchy



Progressive weight loss
P/E: vagina filled with tumour
Clear cell carcinoma
of cervix & vagina
Hypoplastic uterus, T-shaped
cavity – suspected DES exposure
Cancer of cervix
uteri
Cancer of cervix
uteri
* Depth of myometrial invasion correlates with tumor grade,
cervical extension, and prevalence of LN metastases

* Inciden...
Cancer of corpus
uteri
Patient 4
56 yr-old menopausal lady
Post menopausal bleeding
P/E: tumor protruded from cervix
MRI: stage IIIC2 aggressive ...
* The use of MR in evaluation of

sonographically indeterminate adnexal
lesions resulted in fewer surgical
procedures, bet...
Cancer of Ovary
Patient 5
A 49 year-old lady
Long standing endometriotic cyst
Developed vascular mural nodules
Clear cell carcinoma with omental and peritoneal deposits

PET/CT
Functional imaging
Omental &
peritoneal
deposits
No residual disease after chemotherapy

PPE

PET/CT in 4/13

PET/CT in 9/13
* PET/CT & CT alone are 100% specific
* PET/CT marginally better than CT alone
at 97% sensitivity.

* MRI is comparable to...
* Highest accuracy in LN metastasis detection (95-98%)*
* 45% endometrial cancers are grade I and not FDG-avid*
* Poor spa...
* Hybrid MRI/PET
* Functional MRI – Dynamic contrast enhanced
- Diffusion weighted imaging

* MR spectroscopy

Recent adva...
Thank you!
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Urology gynecology correlative imaging of gynecological diseases t lam

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Urology gynecology correlative imaging of gynecological diseases t lam

  1. 1. Correlative imaging of gynecological diseases Tina PW Lam Radiology QMH
  2. 2. * Structural imaging * Tissue characterization * Cancer staging * Functional imaging Correlative imaging
  3. 3. * Detail anatomy * Accurate lesion size, location and extent * Delineate complex anomaly Structural imaging
  4. 4. Patient 1 14 year-old girl Menarchy at 11 years old Regular monthly cycle Dysmenorhoea Progressive abdominal distension
  5. 5. TT1W axial T2W axial
  6. 6. T2W T2W sagittal Uterine didelphys Cervical atresia Endometriotic cyst T2W coronal
  7. 7. * Differentiate gas, fat, fluid, soft tissue, blood, tumour and calcification Tissue Characterization
  8. 8. Mature Teratoma
  9. 9. Leiolipoma Calcified leiomyoma
  10. 10. Mature teratoma T1W T2W T1W FS+C
  11. 11. Adenomhyosis Endometriotic cyst
  12. 12. Patient 2 A 50 year-old perimenopausal lady uterine leiomyoma for several years 2010 2012 Recent enlargement with heterogeneous signal 2012
  13. 13. MRI 2012 T2W T1W FS +C
  14. 14. Red degeneration of leiomyoma T2W T1W FS T1W FS +C
  15. 15. US in 10/2013
  16. 16. Cancer staging
  17. 17. *  Differentiate operable early disease (stages Ia, Ib & IIa) from advanced disease *  Delineate extent of advanced disease extent to define the radiotherapy fields *  Clinical staging inaccurate, assessment difficulties: parametrial, pelvic sidewall invasions bladder & rectal invasions endocervical tumour size lymph node & distant metastases Cancer of cervix uteri
  18. 18. Patient 3 A 16 year-old girl Menorrhagia since menarchy Progressive weight loss P/E: vagina filled with tumour
  19. 19. Clear cell carcinoma of cervix & vagina Hypoplastic uterus, T-shaped cavity – suspected DES exposure
  20. 20. Cancer of cervix uteri
  21. 21. Cancer of cervix uteri
  22. 22. * Depth of myometrial invasion correlates with tumor grade, cervical extension, and prevalence of LN metastases * Incidence of LN metastases increases from 3% with superficial myometrial invasion (stage IB) to 46% with deep myometrial invasion (stage IC) * The sensitivity and specificity of MRI for depth of myometrial invasion range from 69-94% and 64-100% respectively Berman ML, Ballon SC, Lagasse LD, Watring WG. Am J Obstet Gynecol 1980; 136:679 –688 Boronow RC, Morrow CP, Creasman WT, et al. Obstet Gynecol 1984; 63:825–832 Cancer of corpus uteri
  23. 23. Cancer of corpus uteri
  24. 24. Patient 4 56 yr-old menopausal lady Post menopausal bleeding P/E: tumor protruded from cervix MRI: stage IIIC2 aggressive tumor Histology: MMMT
  25. 25. * The use of MR in evaluation of sonographically indeterminate adnexal lesions resulted in fewer surgical procedures, better patient triage, and net cost savings Schwartz PE. Gynecologic Oncology. 1997;64(1):1–3. Cancer of ovary
  26. 26. Cancer of Ovary
  27. 27. Patient 5 A 49 year-old lady Long standing endometriotic cyst Developed vascular mural nodules
  28. 28. Clear cell carcinoma with omental and peritoneal deposits PET/CT
  29. 29. Functional imaging
  30. 30. Omental & peritoneal deposits
  31. 31. No residual disease after chemotherapy PPE PET/CT in 4/13 PET/CT in 9/13
  32. 32. * PET/CT & CT alone are 100% specific * PET/CT marginally better than CT alone at 97% sensitivity. * MRI is comparable to CT Staging & follow-up of ovarian cancer http://www.acr.org/~/media/ACR/Documents/AppCriteria/Diagnostic/StagingAndFollowUpOvarianCancer.pdf
  33. 33. * Highest accuracy in LN metastasis detection (95-98%)* * 45% endometrial cancers are grade I and not FDG-avid* * Poor spatial resolution, inefficient detection of parametrial or adjacent organs invasion in cervical cancer PET/CT in cancers of cervix & corpus uteri *Antonsen SL et al. Gynecol Oncol. 2013 Feb;128(2):300-8
  34. 34. * Hybrid MRI/PET * Functional MRI – Dynamic contrast enhanced - Diffusion weighted imaging * MR spectroscopy Recent advances
  35. 35. Thank you!
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