PET/CT and cross sectional imaging of gynecologic malignancy

Abstract

Gynecologic cancers are a common cause of morbidity and mortality in women of all ages. While many gynecologic cancers are staged clinically using the International Federation of Gynecology and Obstetrics (FIGO) staging system, imaging can be a useful adjunct to clinical staging. Cross sectional imaging techniques such as ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) have been used to detect and follow patients with gynecologic cancer. These imaging modalities can show anatomic detail and morphologic changes in the female genitourinary tract to good advantage. Positron emission tomography (PET) differs in that it shows functional information that is not easily obtained by the other cross sectional imaging techniques. The fusion of PET with CT allows anatomic localization of functional abnormalities in the female genital tract and thereby allows the detection of gross disease in many malignant conditions both within and outside the confines of the female pelvis. The utility and limitations of imaging common gynecologic tumors such as cervical, ovarian and endometrial cancer are discussed with particular emphasis on PET/CT imaging.

Figure 1

A 37-year-old female with newly diagnosed squamous cell carcinoma of the cervix. (a) Sagittal T2-weighted MRI of the pelvis shows cervical tumor (arrowhead); (b) coronal fused PET/CT shows FDG avid primary tumor and adenopathy in the pelvis as well as uptake adjacent to the right hip (arrowheads), subsequently proven soft tissue metastasis; (c) axial fused PET/CT shows FDG avid adenopathy in the left supraclavicular fossa (arrowhead); (d) axial fused PET/CT also shows another FDG avid soft tissue metastasis in the right periscapular region (arrowhead).

Figure 2

A 56-year-old female with recurrent ovarian cancer. (a) Coronal PET image shows multiple sites of FDG recurrent disease in the chest, abdomen and pelvis (arrowheads); (b) axial fused PET/CT localizes one site of FDG uptake to the sigmoid colon which proved to be metastatic ovarian cancer involving the colon.

Figure 3

A 74-year-old female with endometrial cancer. (a) CT shows small retroperitoneal nodes that measure less than 1 cm; (b) axial PET/CT shows FDG uptake in these nodes, subsequently proven metastases.