الفهرس 
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Abstract
The aim of this work is to study the role of MRI in local staging of endometrial and cervical carcinoma correlating the imaging results with surgical and histopathological findings
Endometrial carcinoma:
Endometrial carcinoma is the most common gynecologic malignancy and the seventh neoplasia worldwide. Endometrial cancer is staged surgically, i.e. hysterectomy, bilateral adnexectomy and lymphadenectomy. Careful preoperative evaluation is essential, as women with endometrial cancer surely would benefit from being addressed in gynecologic oncology centers of excellence for treatment; this would optimize the costs of health care and the likelihood of making a complete surgical staging and an optimal surgical treatment. In particular, an accurate preoperative staging of the disease would assist in planning the optimal course of treatment.
Several techniques have been studied as preoperative tools for endometrial cancer staging. Magnetic resonance imaging (MRI), computed tomography (CT) and transvaginal sonography (TVS) have all been proven to be accurate in the assessment of the depth of myometrial infiltration.
This study was done on 58 patients with endometrial cancer. 13 were excluded due to lack of operative data. The age range in the study group ranged from 50-70 years. All our patients presented with abnormal uterine bleeding with or without pelvic discomfort. Positive family history was noted in 20 patients.
MRI was done in all patients. In all patients morphological sequences as well as DWI were done. The tumor showed T2 iso- to hyperintense signal as compared to the adjoining myometrium in all cases as well as restricted diffusion.
Agreement between MRI and pathology in detecting < 50% myometrial invasion was found in 12/21 cases (57.1%), and in detecting > 50% myometrial invasion was 23/24 cases (95.8%). The overall agreement of myometrial invasion between MRI and pathology was 35/45 patients (77.8%).
Overall sensitivity of MRI in detection of cervical invasion was 44.4%, specificity was 91.7%, PPV 57.1%, NPV was 86.8% and accuracy was 82.2%.
The sensitivity of MRI in detecting positive lymph nodes was 85.7%, specificity was 92.7%, PPV was 66.7%, NPV was 97.2%. Lastly diagnostic accuracy of MRI in detecting pathological lymph nodes was found to be 91.1%.
In general, MRI was able to correctly stage endometrial cancer in 41/45 patients (91.1%) and incorrectly stage patients in only 4 patients (8.9%).
We concluded that MRI is a sensitive tool for preoperative staging of endometrial carcinoma, especially in detection of the depth of myometrial invasion, the presence of cervical stromal infiltration and the presence of lymph node metastasis and is of utmost importance in decision making and determining the treatment plan.
Cervical cancer:
The study was conducted 50 cases with initial clinical diagnosis of cervical carcinoma. 10 were excluded after pathological analysis owing to the presence of malignancies other than carcinoma. Their age ranged from 37 to 81 years.
MRI was done in 40 patients. Standard morphological sequences were used. The examined cervical cancers showed different signal intensities in the T1 and T2 weighted images. Most of the carcinomas showed T1 isointense signal and T2 hyperintense signals. All showed restricted diffusion.
Only five patients underwent operative management allowing us to correlate MRI findings with pathological findings.
We found that MRI has an accuracy of 100% in predicting the exact stage of the disease. However owing to the small sample size, statistical analysis is not accurate enough.
We concluded that MRI is effective in preoperative evaluating cervical cancer. MRI has the ability to accurately determine the exact stage of cervical cancer. However, further evaluation with a larger sample size is recommended.