. 2023 Dec 15;34(2):309–323. doi: 10.1055/s-0043-1777355

Table 4. Imaging modalities for evaluation of endometrial malignancies.

Imaging Modalities	Indications	Strength	Weaknesses
Transvaginal sonography	First line of imaging investigation for evaluating women with postmenopausal bleeding; intermenstrual or abnormal uterine bleeding in premenopausal women Used for screening patients on hormonal therapy and breast cancer patients on tamoxifen	Easily available Low cost High negative predictive value in postmenopausal women ¹²	Interobserver variation. Low sensitivity and specificity for depth of myometrial invasion, nodal assessment, and parametrial invasion.
CECT scan (thorax + abdomen +pelvis)	Locally advanced endometrial carcinoma High-grade endometroid or serous type of endometrial carcinoma Recurrent/metastatic endometrial carcinoma for response evaluation	Faster and easily available than PET-CT for distant nodal and distant metastatic workup	Poor soft tissue contrast and spatial resolution. Lower sensitivity and accuracy for locoregional staging in comparison to MRI and in detection of nodal metastasis.
MRI (pelvis)	Histological proven endometrial cancer, sonographically suspected endometrial cancer, and vaginal stenosis (when biopsy inaccessible) ESMO and NCCN recommends MRI preoperative workup of endometrial cancer ¹³ ¹⁴	Best method to delineate endometrial tumor >10 mm. Excellent soft tissue contrast resolution. Facilitates accurate anatomical extent of disease. The diagnostic accuracy for predicting depth of myometrial invasion and cervical stromal invasion improves with dynamic post-contrast MRI. ¹² ¹⁵ ¹⁶ ¹⁷ ¹⁸ ¹⁹ ²⁰ ²¹ Differentiates post-treatment fibrosis and local recurrence.	Limits the visualization of anatomical details beyond the uterus and pelvis structures. Limited availability of MRI scanner, expertise for image interpretation, and long scan time. Lower sensitivity in evaluation of metastatic pelvic nodes. Motion/metallic implant artifacts from pelvic bones/Hip joints limits anatomical details of pelvis and makes locoregional extension evaluation more difficult.
PET-CT	Locoregionally advanced endometrial cancers. Equivocal/indeterminate nodal/distant metastatic lesions on CECT scan. Follow-up imaging of locally advanced endometrial cancers. Evaluation of recurrent disease.	Detects nodal metastasis with sensitivity (53–73%) specificity (90–97%). ¹⁵ ¹⁶ ¹⁷ Superior in evaluation of distant metastatic spread and recurrent disease.	Limited spatial resolution can mask small volume peritoneal disease and small lymph nodes. Physiological uptake in endometrium may mimic cancer, over/underestimate the depth of myometrial invasion. Necrotic/mucinous lesions may show less metabolic activity.

Abbreviations: CECT, contrast-enhanced computed tomography; ESMO, European Society of Medical Oncology; MRI, magnetic resonance imaging; NCCN, National comprehensive cancer Network; PET-CT, positron emission tomography-computed tomography.