Molecular Imaging in Gynecology: Beyond Cancer

Abstract

Gynecological pathologies account for approximately 4.5% of the overall global disease burden. Although cancers of the female reproductive system have understandably been the focus of a great deal of research, benign gynecological conditions-such as endometriosis, polycystic ovary syndrome, and uterine fibroids-have remained stubbornly understudied despite their astonishing ubiquity and grave morbidity. This historical inattention has frequently become manifested in flawed diagnostic and treatment paradigms. Molecular imaging could be instrumental in improving patient care on both fronts. In this Focus on Molecular Imaging review, we will examine recent advances in the use of PET, SPECT, MRI, and fluorescence imaging for the diagnosis and management of benign gynecological conditions, with particular emphasis on recent clinical reports, areas of need, and opportunities for growth.

Keywords: MRI; PET; SPECT; fluorescence imaging; intraoperative imaging; molecular imaging.

FIGURE 1.

Studies cited for diagnosis and management of conditions.

FIGURE 2.

[¹⁸F]FDG PET/CT of 47-y-old woman with sarcomatous lung cancer and 11-y history of endometriosis at time of imaging. (A) Intense [¹⁸F]FDG uptake can be seen in primary lung cancer lesions as well as lymph node and pleural metastases. (B–G) Two foci of increased [¹⁸F]FDG avidity can be seen in endometriosis lesions in uterine wall via PET (B and E) and PET/CT (D and G) (arrows) but are not clearly visualized by CT alone (C and F). No [¹⁸F]FDG uptake was observed in known right ovarian endometrioma (arrowhead). (Reprinted with permission of (17).)

FIGURE 3.

[³F]FDG and [¹⁸F]FES PET of 75-y-old woman with leiomyosarcoma (A and B, arrows) and 52-y-old woman with uncomplicated benign leiomyoma (C and D, arrows). In former, primary tumor in uterus accumulated [¹⁸F]FDG (A) but was negative for [¹⁸F]FES (B), and postoperative histopathologic results confirmed leiomyosarcoma. In latter, lesions were avid for both [¹⁸F]FDG (C) and [¹⁸F]FES (D), and postoperative histopathologic results confirmed uncomplicated leiomyoma and adenomyosis. (Reprinted with permission of (35).)

FIGURE 4.

Typical T2-weighted images (T2WI), T1-weighted images (T1WI), apparent diffusion coefficient (ADC) maps, and amide proton transfer maps (APT) (overlaid on T2WI) of serous cystadenoma (SCA) (top), mucinous cystadenoma (MCA) (middle), and functional cyst (FC) (bottom). All 3 cystic lesions showed similar signal intensities in T1WI and T2WI as well as similar ADC values. However, amide proton transfer values were clearly different among trio of cysts: low in serous cystadenoma (2.25%), moderate in mucinous cystadenoma (5.03%), and very high in functional cyst (7.38%). Color bar indicates amide proton transfer signal (%). (Reprinted with permission of (44).)