Diagnostic imaging in gynecologic malignancy

Advances in imaging techniques over the past few decades have continued at an astounding pace and now physicians have various modalities to examine the human body. These imaging techniques may be used to assist in diagnosis, staging, and follow-up of oncology patients. The increasing complexity of diagnostic radiology provides a challenge to radiologists and oncologists to use these tools in a clinically efficient and cost-effective manner. The ultimate goal is to offer a safe and effective examination that provides clinically relevant information for the management of an individual patient. Currently ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) are being used to evaluate patients with gynecological malignancies. Goal of this review is to provide an overview of clinically available imaging techniques and discuss relative strengths and weaknesses. This article summarizes the diagnostic performance (sensitivity, specificity, positive and negative likelihood ratios) of US, CT, MRI and PET/CT in the diagnosis of various gynecological diseases and tumors. US is the first-line imaging modality of choice and is used to discriminate between benign and malignant adnexal masses and for characterizing adnexal tumors such as dermoid cyst, endometrioma, hemorrhagic corpus luteum, etc., for diagnosing intrauterine pathology in women with dysfunctional uterine bleeding, and for confirming or refuting pelvic pathology in women with pelvic pain. MRI can play a role in detecting the extent of disease and helps in local staging of gynecologic tumors. CT can be used to detect extrapelvic disease and PET/CT can assist in detecting distant metastatic disease in order to select appropriate surgical candidates.