Imaging in Gynecological Cancers
Özet
Gynecological cancers of the cervix, endometrium, ovary, vulva, and vagina remain a major global health burden, with rising incidence and mortality underscoring the need for accurate diagnosis, staging, and treatment planning. Imaging is central to every step of the patient pathway. Ultrasound, particularly transvaginal ultrasound, is the first-line modality for evaluating uterine and adnexal pathology, enabling early detection, assessment of tumor extent, and guidance of biopsy, with risk stratification enhanced by standardized systems such as O-RADS and structured reporting. Computed tomography (CT) provides rapid whole-abdomen and thoracic assessment for nodal and distant metastases, while magnetic resonance imaging (MRI) offers superior soft-tissue contrast and functional techniques such as diffusion-weighted and dynamic contrast-enhanced imaging, which are now embedded in modern FIGO staging of cervical and endometrial cancers. For ovarian and adnexal masses, MRI and O-RADS MRI refine characterization of indeterminate lesions and optimize surgical planning. Molecular imaging, particularly 18F-FDG PET-CT, contributes to accurate staging, detection of recurrence, assessment of treatment response, and radiotherapy planning, with emerging roles for PET-MRI and novel tracers, including hypoxia- and receptor-targeted agents. Hybrid PET-MRI integrates high-resolution anatomic, functional, and metabolic data with reduced radiation dose, showing promise in complex pelvic disease and recurrent malignancy. Increasingly, artificial intelligence, deep learning, radiomics, and radiogenomics enable extraction of quantitative imaging biomarkers that capture tumor heterogeneity, support prognostication, and may predict treatment response. The integration of multiparametric imaging with AI-driven analysis is poised to advance precision, standardization, and personalization in the management of gynecological cancers.
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