The added value of PET and specifically PET/MR in gynecologic malignancies

Objectives: 1. Review the staging of gynecologic malignancies that are essential for interpretation of PET studies. 2. Describe PET/MR imaging protocols for evaluation of gynecologic malignancies. 3. Illustrate the potentially incremental diagnostic value of PET/MR in gynecologic malignancies.

Methods: Gynecologic malignancies such as cervical, vulvar, ovarian, and endometrial are challenging both diagnostically and clinically. Traditional staging with the FIGO (International Federation of Gynecologic and Obstetrics) is based solely on clinical and surgical evaluation. However, without correlation with functional imaging, this practice places the patients at risk of under-staging and under- treatment.

Results: PET/CT is a validated tool for evaluation of gynecologic malignancies. It has been shown to alter clinical management in up to two thirds of patients and is the best predictor of overall survival. PET/MR has the potential to further improve upon the diagnostic performance of PET/CT in the evaluation of gynecologic malignancies. Specifically, PET/MR may improve the assessment of loco-regional extension (specifically the MR component), lymph node staging, radiotherapy planning, detection of early bone marrow metastasis, and discerning normal physiologic activity from metastasis. Thus, it may become the one-stop-shop study for a comprehensive pre-treatment evaluation of these malignancies.

Conclusion: PET/CT and PET/MR are essential components of the evaluation and staging algorithms of gynecologic malignancies. Research Support: none