Uterine Carcinoma

Uterine Carcinoma

Todd M. Blodgett, MD

Alex Ryan, MD

Sanjay Paidisetty, BS

Graphic shows a representation of uterine body carcinoma image.

Axial fused PET/CT shows an enlarged uterus with circumferential FDG activity image and central necrosis image in this patient with uterine leiomyosarcoma.


Abbreviations and Synonyms

  • Endometrial carcinoma, uterine sarcoma, uterine carcinosarcoma, leiomyosarcoma


  • Malignancy of uterine endometrium or uterine body

    • Most common type is endometrioid adenocarcinoma


General Features

  • Best diagnostic clue

    • Primary endometrial cancer

      • Thickened endometrium on CT

      • Intense FDG activity on PET corresponding to lesion

    • FDG uptake in metastatic sites

      • Lymphadenopathy

      • Abdominal and distant metastases

  • Location

    • Usually glandular component of superior endometrium

      • May spread within endo-/myometrium and from fundus toward isthmus and cervix

      • May arise within an endometrial polyp

Imaging Recommendations

  • Best imaging tool

    • CT/MR

      • Evaluate disease extension

      • Provide information for treatment planning

      • Detect lymph node metastases; 18-66% sensitivity and 73-99% specificity

      • Limited in recurrent disease due to anatomic distortion 2° surgery and radiation

    • FDG PET

      • For staging, restaging, early detection, and evaluating response to therapy

      • Incorporation of FDG PET into post-therapy surveillance shown to influence treatment in up to 20% of patients

      • Particularly useful for asymptomatic disease

    • PET/CT useful for anatomic and functional localization of sites of recurrence

  • Protocol advice

    • Oral contrast agent for CT

      • Helps better delineate normal bowel activity

      • Demonstrates pathologic intra-abdominal activity (peritoneal implants)

    • IV contrast

      • Differentiates small lymph nodes from vessels, intestine, or the ureter

      • Correctly detects small liver metastases, small peritoneal dissemination, and local recurrence at the vagina

CT Findings

  • Inconsistent depiction of endometrium and endometrial thickness

  • Findings associated with endometrial carcinoma are nonspecific and similar to other conditions

  • Uterine cancer and normal endometrium are often indistinguishable on nonenhanced CT

    • May see diffuse thickening, discrete mass, or polypoid mass within endometrial cavity

    • Cavity may be expanded with fluid

    • Mass may be of uniform or heterogeneous attenuation

    • Usually poorly enhancing relative to myometrium

      • Variable areas of contrast enhancement

  • IV contrast also aids in evaluating local invasion by increasing conspicuity of tumor

  • Invasion of myometrium suggested by irregular tumor-myometrium border

    • CT limited in ability to delineate deep myometrial invasion and cervical involvement

  • CT reasonably sensitive for lymphadenopathy and distant metastases

    • Size cutoff for suspicion of malignancy > 8-10 mm in short axis

MR Findings

  • T1WI

    • Endometrium and myometrium have similar signal intensity and cannot readily be distinguished

  • T2WI

    • Endometrium appears as central zone of high signal intensity

  • Myometrium depicted as zone of low signal intensity at its inner aspect and a wider zone of intermediate signal intensity at its outer aspect

  • Endometrial thickness varies in menstruating women from 4 mm in early proliferative phase to 13 mm in late secretory phase

Nuclear Medicine Findings

Sep 22, 2016 | Posted by in MAGNETIC RESONANCE IMAGING | Comments Off on Uterine Carcinoma

Full access? Get Clinical Tree

Get Clinical Tree app for offline access