Endometrium
Premenopausal:
- While typically demonstrating little or no metabolic activity, even intense endometrial uptake is considered normal in the premenopausal woman (most intense near or during menstruation). Such activity in a premenopausal woman is considered “physiologic” and is usually not included in the report.
- Unless the uptake is eccentric or accompanied by marked endometrial thickening and/or distention of the endometrial cavity, we presume such uptake is physiologic.
Postmenopausal:
- Any endometrial activity (focal or diffuse) above blood pool background in a postmenopausal woman requires further assessment to exclude malignancy – even in the absence of an associated abnormality on the co-registered CT images.
- Ultrasound is typically the next recommended exam.
- We generally report:
- “Moderate metabolic activity is noted centrally within the uterine cavity (SUV 2.2), presumed to represent endometrial uptake. This requires further clinical assessment in a post-menopausal woman. Correlation with a pelvic and transvaginal ultrasound is recommended.”
Case 1
Case 1 (Image 2)
Fused sagittal image demonstrates no significant metabolic activity in the expected location of the endometrial cavity. This is the typical normal PET/CT appearance of the endometrium.
Case 1 (Image 3)
Fused coronal image demonstrates no significant metabolic activity in the expected location of the endometrial cavity. This is the typical normal PET/CT appearance of the endometrium.
Case 2
Case 2 (Image 2)
Fused axial image demonstrates intense metabolic activity involving the endometrium. The CT image demonstrates no significant associated distension of the endometrial cavity. In a premenopausal woman, such uptake is presumed physiologic.
Case 2 (Image 3)
Fused sagittal image demonstrates intense metabolic activity within the endometrial cavity, presumed physiologic in a premenopausal woman. If this woman was postmenopausal, this uptake would be concerning for malignancy.
Case 3
Case 3 (Image 2)
Fused axial image demonstrates intense metabolic activity involving the endometrium. The CT image demonstrates mild associated distension of the endometrial cavity. As this patient is postmenopausal, this is suspicious for malignancy (biopsy-proven endometrial carcinoma).
Case 3 (Image 3)
Sagittal images demonstrate intense metabolic activity involving the endometrial cavity.
Case 3 (Image 4)
Fused coronal image demonstrates intense metabolic activity involving the endometrium. The CT image suggests mild associated distension of the endometrial cavity. If this patient were premenopausal, this uptake would be presumed physiologic (some might recommend a 6-week follow up ultrasound due to the mild distension of the endometrial cavity).