Contrast enhanced MR imaging of female pelvic cancers: established methods and emerging applications

Contrast enhanced magnetic resonance imaging of female pelvic cancers has been established for over 20 years. Conventional contrast enhanced imaging involves acquiring a set of pre-contrast T1 weighted images, followed by intravenous injection of an gadolinium based contrast agent and subsequent acquisition of a second set of contrast enhanced images. Developments in MR hardware and pulse sequences over the last 10 years have made dynamic contrast enhanced (DCE) protocols possible. DCE-MRI entails imaging of the same volume repeatedly prior to, during and following contrast injection. There have also been developments in image analysis methods and tools to reflect the increased data acquired. Qualitative analysis of contrast enhanced imaging (whether a single set or temporal series) by radiologists remains the mainstay for clinical reporting. Semi-quantitative assessment of signal intensity versus time curves and full pharmacokinetic modelling methods have emerged for evaluation of DCE-MRI data. DCE-MRI has found an established role in the detection, localisation and staging of female pelvic malignancies. Emerging applications of DCE-MRI include assessment of tumour grade, histology prior to and following treatment and prediction of individual and final treatment outcome. This article reviews the biophysical basis of contrast enhancement, the technical aspects of performance and analysis of DCE-MRI studies, and the established and emerging clinical utility of DCE-MRI in female pelvic malignancies.