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Rofo 2004; 176(6): 817-828
DOI: 10.1055/s-2004-813157
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Magnetresonanztomographie benigner und maligner Tumoren des weiblichen Beckens

Magnetic Resonance Imaging in the Diagnosis of Benign and Malignant Pelvic TumorsE. A. M. Hauth1 , J. Stattaus1 , J. F. Debatin1 , S. G. Ruehm1
  • 1Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Essen
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Publication History

Publication Date:
02 June 2004 (online)

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Zusammenfassung

Die Magnetresonanztomographie (MRT) gilt als etabliertes Verfahren in der bildgebenden Diagnostik von Pathologien des weiblichen Beckens. Die vorliegende Übersichtsarbeit beschreibt die Rolle der MRT in der Diagnostik benigner und maligner Tumoren unter Verwendung geeigneter Untersuchungstechniken. Sagittale T2-gewichtete FSE-Sequenzen sind zur Diagnostik von Leiomyomen des Uterus gut geeignet und ermöglichen eine exakte präoperative Größenbestimmung und Lokalisation. Fettgesättigte T1-gewichtete Gradienten-Echo-Sequenzen erlauben in der Diagnostik des Endometriumkarzinoms eine präzise Bestimmung der Infiltrationstiefe in das Myometrium und sollten in die präoperative Therapieplanung einbezogen werden. Beim Staging des Zervixkarzinoms ermöglicht die MRT neben dem Nachweis der lokalen Tumorausdehnung auch die Bestimmung des Tumorvolumens zur Planung und Verlaufsbeurteilung einer Radiotherapie. Grenzen der MRT beim Staging des Zervixkarzinoms liegen in der eingeschränkten Nachweisbarkeit von Tumoren im Frühstadium (FIGO-Stadium I A und kleinen Tumoren im FIGO-Stadium I B). Daher erscheint die MRT als Screeningverfahren für das Zervixkarzinom nicht geeignet. Die MRT vermag mit einer hohen Sensitivität und Spezifität zwischen benignen und malignen ovariellen Tumoren zu unterscheiden. Die Diagnose eines Teratoms gelingt unter Verwendung von normalen und fettgesättigten T1-gewichteten Sequenzen in der Regel mit einer Spezifität von 100 %. Zum Staging von malignen Ovarialtumoren sind axiale fettgesättigte T1-gewichtete SE-Sequenzen nach Kontrastmittelgabe geeignet, um eine bessere Beurteilbarkeit der Binnenarchitektur oder einer peritonealen Metastasierung zu diagnostizieren. Neben dem Staging kann die MRT zur Lokalisationsdiagnostik und Verlaufskontrolle des Ovarialkarzinoms eingesetzt werden.

Abstract

Magnetic resonance imaging (MRI) is an accepted imaging method for diagnosing diseases of the female pelvis. This review article describes the role of MR imaging for the diagnosis of benign and malignant pelvic tumors. Sagittal T2-weighted fast spin echo sequences can be effectively applied to diagnose leiomyomas of the uterus and provide exact pretreatment measurements of size and localization. In the diagnostic work-up of endometrial carcinoma, fat-saturated, T1-weighted gradient echo sequences make it possible to determine precisely how deep myometrial infiltration extends and what tissue should be included in preoperative treatment planning. In cervical cancer staging, MRI permits both assessment of local tumor extent and determination of tumor volume for planning and monitoring radiotherapy. The usefulness of MRI in cervical cancer staging is, however, limited since not all early-stage cancer (FIGO stage IA and small stage IB tumors) can be detected. Hence, it appears that the use of MRI as a screening method for cervical cancer cannot be recommended. MRI can distinguish between benign and malignant ovarian tumors with high sensitivity and specificity. Standard and fat-saturated T1-weighted sequences usually can diagnose teratomas with a specificity of 100 %. Axial fat-saturated, contrast enhanced T1-weighted spin echo sequences are useful in the staging of malignant ovarian tumors since they facilitate evaluation of their internal structure and will disclose peritoneal metastases. Besides staging of ovarian cancer, MRI can be applied for localization and for monitoring treatment response.

Key words

Magnetic resonance imaging (MRI) - female pelvis - benign uterine tumors - cervical carcinoma - endometrial carcinoma - benign adnexal masses - ovarian carcinoma

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Dr. med. Elke A. M. Hauth

Universitätsklinikum Essen, Institut für Diagnostische und Interventionelle Radiologie, Sektion gynäkologische Radiologie

Hufelandstraße 55

45122 Essen

Phone: ++ 49/2 01/7 23-15 01

Fax: ++ 49/2 01/7 23-15 48

Email: elke.hauth@uni-essen.de