Updated endometrial cancer FIGO staging: the role of MRI in determining newly included histopathological criteria.

PURPOSE: Endometrial cancer (EC) is among the prevalent malignancies in gynecology, showing an increasing occurrence and mortality rate. The updated 2023 FIGO staging integrates both histopathological and molecular analyses, which significantly impact the prognosis and treatment approaches. This research aims to examine the effectiveness of MRI in identifying essential histopathological tumor features, including histological subtype, grade, and lymphovascular space invasion. METHODS: A total of 106 patients diagnosed with EC from February 2018 to December 2023 underwent preoperative pelvic MRI. Surgical procedures followed ESMO guidelines, with histopathological assessments using FIGO 2009 criteria. Two radiologists independently evaluated MRI images, measuring maximum tumor size, minimum tumor ADC value (using a free-hand ROI technique), and ADC tumor/myometrium ratio. MRI findings were compared with histopathological data. RESULTS: Peritoneal implant presence and tumor size exhibited significant differences between endometrioid adenocarcinoma (EAC) and non-endometrioid endometrial carcinoma (NEEC), with p values of < 0.001 and 0.003, respectively. Significant differences in age, tumor size, ADC tumor, and ADC tumor/myometrium between low-grade and high-grade tumors were observed, with p values of < 0.001, 0.004, 0.006, and 0.011, respectively. Increased tumor size, reduced ADC tumor, ADC tumor/myometrium, and pelvic peritoneal implant presence were significantly associated with LVSI, with p values of < 0.001, 0.001, 0.002, and 0.001, respectively. The AUC values for tumor size, ADC tumor, and ADC tumor/myometrium were 0.842, 0.781 and 0.747, respectively, in distinguishing between low and high-grade endometrial tumors. Similarly, obtained AUC values for predicting LVSI were 0.836, 0.719, and 0.696, respectively. CONCLUSION: Our study emphasizes MRI's role in predicting tumor characteristics such as histological subtype, grade, and LVSI based on updated FIGO criteria. By highlighting the potential of MRI, this research contributes to our comprehension of improving diagnostic and clinical management for EC. Further multicenter studies are warranted to validate these findings and establish MRI's role in EC management.

Importance of Susceptibility-weighted-imaging in Methanol Toxicity.

Methanol poisoning is a rare but potentially lethal condition. Haemorrhagic necrosis of bilateral basal ganglia, particularly of the putamen, is one of the distinctive features of this entity. One of the proposed responsible mechanisms for putaminal haemorrhagic necrosis due to methanol toxicity is inadequate venous drainage of this region. Advanced imaging modalities are used to guide diagnosis and patient management. Here, we report a 61-year man who had a fulminant acute methanol toxicity due to accidental ingestion. Susceptibility-weighted-imaging (SWI) showed marked bilateral basal ganglia and brainstem haemorrhage. Also, congested and dilated venous structures were detected in SWI, which may be an indirect sign of inadequate venous drainage of this region. We intend to present the cerebral SWI features of a patient with fulminant methanol toxicity in order to clarify the underlying physiopathology of the brain damage, which has not yet been presented in the literature to the best of our knowledge. Key Words: Methanol, Toxic encephalopathy, Magnetic resonance imaging, Cerebral haemorrhage.