Imaging
Uterine Cancer
- Preliminary Diagnosis: Uterine cancer
-
I. What imaging technique is first-line for this diagnosis
- II. Describe the advantages and disadvantages of this technique for diagnosis of uterine cancer.
-
III. What are the contraindications for the first-line imaging technique?
-
IV. What alternative imaging techniques are available?
- V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of uterine cancer.
- VI. What are the contraindications for the alternative imaging techniques?
Preliminary Diagnosis: Uterine cancer
I. What imaging technique is first-line for this diagnosis
Ultrasound (US) of the pelvis with transabdominal and transvaginal imaging.
For a known diagnosis of uterine cancer: Magnetic resonance imaging of the pelvis with intravenous gadolinium for preoperative assessment, staging, or post-therapy response.
II. Describe the advantages and disadvantages of this technique for diagnosis of uterine cancer.
Advantages
Allows for evaluation of endometrial thickness and the myometrium.
Relatively quick examination
Does not utilize ionizing radiation.
Can allow for assessment of vascular flow to endometrial lesions.
Cost-effective imaging modality.
Can be diagnostic of other causes of postmenopausal bleeding such as polyps, fibroids, and atrophy
Disadvantages
Very operator-dependent, and relies heavily on the skill of the technologist or physician performing the exam.
Image quality can be significantly degraded by patient body habitus and bowel gas content.
Transvaginal ultrasound, while more sensitive, is uncomfortable to many patients.
III. What are the contraindications for the first-line imaging technique?
There are no significant contraindications to transabdominal US examination of the pelvis.
Transvaginal US is much more sensitive, but may be declined by a subset of patients.
IV. What alternative imaging techniques are available?
Hysterosonogram: Ultrasound examination of the uterus following catheter instillation of saline into the endometrial cavity.
Magnetic resonance imaging with intravenous gadolinium contrast.
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of uterine cancer.
Hysterosonogram
Advantages
Allows for distention of the endometrial cavity, which allows for better evaluation of the endometrium and lesions within the endometrial cavity.
Does not utilize ionizing radiation.
3D ultrasound imaging can be utilized if intracavitary finding is suspected.
Cost-effective.
Disadvantages
Semi-invasive procedure that requires catheterization of the cervical canal and the instillation of saline, which can result in cramping and patient discomfort.
Image quality can be significantly degraded by patient body habitus and bowel gas content.
Operator-dependent.
Magnetic resonance Imaging (MRI) with contrast
Advantages
Allows for high resolution evaluation of the endometrial cavity and myometrium in multiple planes.
Allows for reliable assessment of other causes of bleeding such as fibroids, polyps, cervical and ovarian pathology.
Does not use ionizing radiation.
In a known diagnosis of uterine cancer, MRI reliably allows for assessment of myometrial and parametrial invasion.
Disadvantages
Expensive
Time-consuming
Requires significant patient cooperation to minimize motion artifact
Cannot be performed in a select number of patients with pacemakers and other metallic non-titanium hardware or medical devices.
Gadolinium contrast has been implicated in nephrogenic systemic fibrosis and should not be administered with a GFR<30. Department policies vary for GFR 30-60 and often require a reduced dose.
VI. What are the contraindications for the alternative imaging techniques?
Hysterosonogram
Severe cervical stenosis.
Examination should be performed only if the patient has a negative pregnancy test and is preferred on day 7-14 of the menstrual cycle.
MRI with contrast
Patients with embedded metallic devices not made of titanium such as cardiac pacers, stents, and other non-MR approved metallic devices may not enter the magnet for imaging.
Patients with GFR <30 cannot receive gadolinium intravenous contrast.
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