[New opportunities, MRI biomarkers in the evaluation of gynaecological cancer].

The determination and classification of gynaecological tumour stage which is based on clinical and pathological examinations became more precise due to the development of imaging techniques. Recently new MRI methods are being introduced which serve functional, tissue-specific, molecular information; beyond the excellent anatomical and contrast resolution with the aid of high resolution morphological measurements as well as quantification can also be performed. Diffusion-weighted MRI (DW-MRI) is based on the mobility of water molecules and provides information about the cell density of a given tissue and the integrity of cell membranes. Quantification can also be performed using an apparent diffusion coefficient (ADC). DW-MRI is a useful tool in determining myometrium invasion in endometrium carcinomas especially if a tumour has the same signal intensity as the makromomyometrium on the T2-weighted images and the use of contrast agents are contraindicated. The extra-uterine tumour invasion, the peritoneal metastatic foci can be determined by DW-MRI as well. Lymph node status is the most important predictive factor regarding survival. Both CT and MRI have low sensitivity (70-80%) in revealing metastatic lymph nodes. DW-MRI is a promising method with a sensitivity of 87% and specificity of 80% in distinguishing benign and malignant lymph nodes. Dynamic contrastenhanced MRI (DCE-MRI), as a marker of angiogenesis, provides information about vascularisation at the tissue level. In endometrial carcinoma with application of T2-weighted sequence together with DCE-MRI in determining the stage MRI has the accuracy about 90%. DCE-MRI has proven to be useful for distinguishing benign from malignant ovarian tumours, for detecting tumour extension; it can help predict peritoneal carcinomatosis. It is proven by high-level evidence that multiparametric MRI (MP-MRI) is the most precise diagnostic tool in determining the status of cervical carcinoma, its accuracy being above 90%. In the case of parametrial tumour invasion the accuracy of the clinical examination is 78%, while that of CT and MRI are 70% and 92%, respectively. DCE-MRI and DWMRI are promising imaging biomarkers in the early assessment of the effectiveness of the therapy and also in detecting residual as well as recurrent tumours.