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...to have a role in the staging and evaluation of lymph node involvement in patients with cervical cancer. PET has shown some promise in detecting lymph node metastases in the pelvis and retroperitoneum=-=[8,9]-=-. Sironi et al.[10] found that PET/CT proved to be valuable for lymph node staging in patients with early-stage cervical cancer with short-axis diameter greater than 0.5 cm being the size threshold fo...

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...2 October 2007 S131 Lymphangiography, CT, and MRI have been shown to perform similarly in the detection of lymph node metastasis from cervical cancer with an overall accuracy estimated to be about 85%=-=[7]-=-. Since FDG PET can demonstrate metabolically active sites of tumor spread, it has been shown to have a role in the staging and evaluation of lymph node involvement in patients with cervical cancer. P...

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...ctional imaging modalities primarily rely on morphologic changes such as nodal size and therefore have difficulty detecting metastatic disease in normal sized lymph nodes (short axis diameter 51 cm)=-=[4,5]-=-. Other criteria such as inherent tissue contrast and contrast enhancement are also unreliable[6]. Table 1 Cervix cancer FIGO staging Stage 0 Carcinoma in situ, CIN Stage I Invasive carcinoma confined...

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...r studies. In subsequent studies, the sensitivities and specificities of FDG PET in the diagnosis of ovarian cancer has been between 58 and 86% and 54 and 86% respectively in women with adnexal masses=-=[26,27]-=-. In a study by Kawahara et al.[28], a total of 38 patients were evaluated. PET imaging showed a sensitivity of 78% and a specificity of 87% compared with 91% and 87% respectively for MRI. False posit...

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...th MRI. False positive results in benign cystadenomas and endometriosis were noted in this study with false negative results in the case of borderline tumors of the ovary. In a study of Fenchel et al.=-=[30]-=-, false negative PET findings were obtained in cystadenocarcinoma and ovarian tumors with low malignant potential, and false positive PET results were obtained in acute inflammatory processes, benign ...

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...lse positive results were seen for cystadenomas and dermoid tumors and false negative results were seen in borderline ovarian tumors and mucinous adenocarcinoma of the ovary. In a study by Grab et al.=-=[29]-=-, 101 asymptomatic adnexal masses were evaluated by ultrasound, MRI and PET. The sensitivity and specificity of PET was 58% and 80% compared with 90% and 60% with ultrasound and 83% and 84% with MRI. ...

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...mphadenopathy are based mostly on size criteria. PET imaging has been shown to be more accurate in identifying metastatic lymph nodes, particularly in nodes considered normal by size criteria (Fig. 3)=-=[45,46]-=-. Like most neoplasms, endometrial carcinoma does demonstrate an increased rate of glycolysis and takes up FDG[47]. There have been case reports of endometrial cancer diagnosed incidentally by PET[48,...

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...e staging and evaluation of lymph node involvement in patients with cervical cancer. PET has shown some promise in detecting lymph node metastases in the pelvis and retroperitoneum[8,9]. Sironi et al.=-=[10]-=- found that PET/CT proved to be valuable for lymph node staging in patients with early-stage cervical cancer with short-axis diameter greater than 0.5 cm being the size threshold for accurate depictio...

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...MR imaging. MRI is useful in the diagnosis of benign lesions, such as mature cystic teratomas (containing fat), endometriomas (containing blood products), and non-degenerative leiomyomas in the adnexa=-=[24,25]-=-. The findings most predictive of malignancy on MRI are papillary projections, necrosis in a solid tumor, and septations, which can be readily detected on contrast-enhanced MRI. Table 2 Ovarian cancer...

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...ing surgery is extremely important. Imaging and staging There are few studies evaluating the additional role of PET imaging to CT imaging in the pre-operative staging of ovarian cancer. Yoshida et al.=-=[33]-=- evaluated 15 patients who underwent PET in addition to CT to detect tumor spread. The sensitivity and specificity of CT alone was 72% and 81% compared with 76% and 82% with the addition of PET. The a...

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...to CT imaging. Picchio et al.[37] showed increase in sensitivity from 70 to 83% and increase in specificity from 83 to 92% with the addition of PET to CT compared with CT imaging alone. Bristow et al.=-=[38]-=- evaluated combined PET/CT in the detection of tumor recurrence. The sensitivity and accuracy was 83% and 82% respectively. There is a definite role for PET imaging in patients with elevated tumor mar...

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...atic lymph nodes, particularly in nodes considered normal by size criteria (Fig. 3)[45,46]. Like most neoplasms, endometrial carcinoma does demonstrate an increased rate of glycolysis and takes up FDG=-=[47]-=-. There have been case reports of endometrial cancer diagnosed incidentally by PET[48,49]. Malignant uptake in the endometrium has been shown to have a mean SUV of 18.8 9[45]. Non-malignant, physiolo...

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...ave difficulty detecting metastatic disease in normal sized lymph nodes (short axis diameter 51 cm)[4,5]. Other criteria such as inherent tissue contrast and contrast enhancement are also unreliable=-=[6]-=-. Table 1 Cervix cancer FIGO staging Stage 0 Carcinoma in situ, CIN Stage I Invasive carcinoma confined to the cervix Stage I Diagnosed only by microscopy IA1 Micro-invasive carcinoma with stromal inv...

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...absence of parametrial invasion by tumor is important in determining if the patient may be a surgical candidate, MRI can be used to predict parametrial invasion with a negative predictive value of 95%=-=[2]-=-. Endocervical tumors may be difficult to evaluate clinically, but are well demonstrated by MR imaging. Stromal invasion by the primary tumor is also well delineated by MRI. The overall accuracy of MR...

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... nodal disease FDG PET may also be useful for determining treatment response and prognostication of patients. FDG PET has been used to predict survival in patients with cervical cancer. Grigsby et al.=-=[11]-=- found that 2-year progression free survival was 64% in CT-negative, PET-negative patients; 18% in CT-negative, PET-positive patients; and dropped to 14% in CT-positive, PETpositive patients. A C B D ...

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...n in the ovary can also occur related to follicular and corpus luteum cysts resulting in false positive imaging results. This was shown to occur in 20% of pre-menopausal women in a study by Kim et al.=-=[31]-=-. Due to the false positive results in benign ovarian conditions and the false negative results in borderline tumors and early stage ovarian cancer, the role of FDG PET imaging for the initial diagnos...

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...ive/equivocal CT imaging. PET imaging is also limited in the ability to detect small metastatic deposits and can be limited due to physiologic bowel and bladder activity. In a study by Nakomoto et al.=-=[36]-=-, the overall sensitivity improved from 72.7 to 92.3% and specificity improved from 75 to 100% with the addition of PET to CT imaging. Picchio et al.[37] showed increase in sensitivity from 70 to 83% ...

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...bladder activity. In a study by Nakomoto et al.[36], the overall sensitivity improved from 72.7 to 92.3% and specificity improved from 75 to 100% with the addition of PET to CT imaging. Picchio et al.=-=[37]-=- showed increase in sensitivity from 70 to 83% and increase in specificity from 83 to 92% with the addition of PET to CT compared with CT imaging alone. Bristow et al.[38] evaluated combined PET/CT in...

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...d 80%, but there is a substantial prognostic difference depending on stage, myometrial invasion, and histological type[39]. The overall prognosis is poor in advanced or recurrent endometrial carcinoma=-=[40]-=-. A B 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 PE...

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...accurate assessment by pre-treatment imaging can potentially optimize surgical and non-surgical treatment particularly with regard to the use of pre-operative, neo-adjuvant therapy in advanced disease=-=[42]-=-. MR imaging is used to evaluate the depth of myometrial invasion and cervical invasion, which affects overall prognosis. The likelihood of lymphovascular invasion is greater with greater myometrial p...

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...ied[45]. Early data suggest that combined PET/CT may be useful in the management of endometrial cancer, particularly in the pre-operative detection of pelvic and para-aortic metastatic lymphadenopathy=-=[40,47,51]-=-. FDG PET has been used for detecting and evaluating recurrent endometrial cancer, with the advantage of imaging the entire body in a single study[51,52]. Initial investigations have suggested that wh...

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...n cancer. With the advent of thin section, multidetector CT, smaller metastatic deposits are diagnosed on CT. However, the accuracy of CT drops to 2550% for peritoneal implants less than 1 cm in size=-=[35]-=-. Studies have reported that PET imaging may be of help in patients to detect recurrence due to the high tumor to background FDG uptake. The sensitivity of PET ranges from 80 to 100% and the specifici...

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...ical invasion, which affects overall prognosis. The likelihood of lymphovascular invasion is greater with greater myometrial penetration of tumor. CT or MR may also be used to assess nodal involvement=-=[43,44]-=-. CT and MRI criteria for metastatic lymphadenopathy are based mostly on size criteria. PET imaging has been shown to be more accurate in identifying metastatic lymph nodes, particularly in nodes cons...

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...dometrial cancer staging is unwarranted. The clinical applications of PET/CT in patients with endometrial carcinoma are emerging and further studies will be required to delineate its effect on outcome=-=[45,46]-=-. In the routine interpretation of PET/CT studies, knowledge of physiologic endometrial activity and correlation with the patients menstrual phase are useful to avoid false positive interpretation of...

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...,46]. Like most neoplasms, endometrial carcinoma does demonstrate an increased rate of glycolysis and takes up FDG[47]. There have been case reports of endometrial cancer diagnosed incidentally by PET=-=[48,49]-=-. Malignant uptake in the endometrium has been shown to have a mean SUV of 18.8 9[45]. Non-malignant, physiologic causes of increased 18F-FDG uptake in the endometrium must be taken into account in t...

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...ical invasion, which affects overall prognosis. The likelihood of lymphovascular invasion is greater with greater myometrial penetration of tumor. CT or MR may also be used to assess nodal involvement=-=[43,44]-=-. CT and MRI criteria for metastatic lymphadenopathy are based mostly on size criteria. PET imaging has been shown to be more accurate in identifying metastatic lymph nodes, particularly in nodes cons...

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... using oral contraceptives have endometrial uptake values similar to the non-ovulating, non-menstruating phases of the cycle, likely due to the suppressive effects of contraceptives on the endometrium=-=[45,50]-=-. To avoid a false positive interpretation of endometrial malignancy, the menstrual history should be correlated in pre-menopausal patients[45]. If there is a question of physiologic activity, repeat ...

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...r studies. In subsequent studies, the sensitivities and specificities of FDG PET in the diagnosis of ovarian cancer has been between 58 and 86% and 54 and 86% respectively in women with adnexal masses=-=[26,27]-=-. In a study by Kawahara et al.[28], a total of 38 patients were evaluated. PET imaging showed a sensitivity of 78% and a specificity of 87% compared with 91% and 87% respectively for MRI. False posit...

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...sensitivities and specificities of FDG PET in the diagnosis of ovarian cancer has been between 58 and 86% and 54 and 86% respectively in women with adnexal masses[26,27]. In a study by Kawahara et al.=-=[28]-=-, a total of 38 patients were evaluated. PET imaging showed a sensitivity of 78% and a specificity of 87% compared with 91% and 87% respectively for MRI. False positive results were seen for cystadeno...

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...ically, but are well demonstrated by MR imaging. Stromal invasion by the primary tumor is also well delineated by MRI. The overall accuracy of MR staging of cervical cancer is reported to be about 90%=-=[2,3]-=-. CT is also used for evaluation of advanced disease, nodal involvement and distant metastasis although CT has had a limited role in evaluating the primary cervical tumor as tumors may be isodense to ...

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...ctional imaging modalities primarily rely on morphologic changes such as nodal size and therefore have difficulty detecting metastatic disease in normal sized lymph nodes (short axis diameter 51 cm)=-=[4,5]-=-. Other criteria such as inherent tissue contrast and contrast enhancement are also unreliable[6]. Table 1 Cervix cancer FIGO staging Stage 0 Carcinoma in situ, CIN Stage I Invasive carcinoma confined...

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...arian cancer present with non-specific symptoms such as abdominal bloating and increased distension. These non-specific symptoms lead to a delay in diagnosis and later stage of disease at presentation=-=[12]-=-. The majority of ovarian cancers, up to 85%, arise from the surface epithelium of the ovary[13]. Of the epithelial tumors, the most common type is serous adenocarcinoma. The remaining 15% of all ovar...

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...ion. These non-specific symptoms lead to a delay in diagnosis and later stage of disease at presentation[12]. The majority of ovarian cancers, up to 85%, arise from the surface epithelium of the ovary=-=[13]-=-. Of the epithelial tumors, the most common type is serous adenocarcinoma. The remaining 15% of all ovarian cancers are germ cell tumors (such as teratomas, dysgerminomas and yolk sac tumors), sex cor...

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... tumors, particularly those of gastric, colonic and pancreatic origin (Table 2). Imaging ovarian masses Ultrasound is the study of choice in the initial evaluation of known or suspected adnexal masses=-=[14]-=-. It is sensitive in detection, inexpensive and widely available. Suspicious features seen on ultrasound include the presence of thick nodular walls or septations (43mm), papillary projections and ech...

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...MR imaging. MRI is useful in the diagnosis of benign lesions, such as mature cystic teratomas (containing fat), endometriomas (containing blood products), and non-degenerative leiomyomas in the adnexa=-=[24,25]-=-. The findings most predictive of malignancy on MRI are papillary projections, necrosis in a solid tumor, and septations, which can be readily detected on contrast-enhanced MRI. Table 2 Ovarian cancer...

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...nd surface of bladder, rectum, and diaphragm), and pelvic and para-aortic lymphadenectomy. Optimal debulking refers to the surgical resection of all tumor sites to a maximal diameter of less than 1 cm=-=[32]-=-. Clinical trials have shown that optimal surgical debulking is associated with a more favorable response to post-operative chemotherapy and, therefore, prolonged survival. The role of pre-operative i...

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...at the addition of PET to CT improved the diagnostic accuracy in the staging of ovarian cancer. This study also showed increased FDG uptake in malignant but normal sized para-aortic nodes. Yuan et al.=-=[34]-=- in a study of five patients with recurrent ovarian cancer also demonstrated that PET imaging can detect metastases even in normal sized lymph nodes. The detection of sub-centimeter peritoneal implant...

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...e typically staged surgically[39]. Lymphatic spread is via obturator nodes or internal iliac nodes, and subsequently to retroperitoneal nodes with rare direct para-aortic spread without pelvic disease=-=[41]-=-. Treatment for endometrial cancer is total abdominal hysterectomy with or without lymph node dissection. Systemic treatment is used for palliative purposes in the setting of metastatic or advanced di...

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...c and para-aortic metastatic lymphadenopathy[40,47,51]. FDG PET has been used for detecting and evaluating recurrent endometrial cancer, with the advantage of imaging the entire body in a single study=-=[51,52]-=-. Initial investigations have suggested that whole-body FDG PET in conjunction with CT and MRI may facilitate optimal management of endometrial cancer in well-selected cases[40]. The routine use of PE...