Malignant gestational trophoblastic disease: CT findings

Eight patients with malignant gestational trophoblastic disease had CT of the pelvis as part of their staging before chemotherapy. CT appearance of the uterus fell into three major types: normal size with irregular areas of hypodensity, uniform enlargement with areas of hypodensity, and focal areas of enlargement with or without areas of hypodensity. Patients with the second and third types were much more likely to have distant metastases and to require hysterectomy for successful treatment. CT findings of tumor nodules in the parametrium or myometrium were confirmed in three of the four surgical specimens of the uterus available for correlation. Myometrial tumor nodules were seen as areas of focal enlargement or as irregular eccentric areas of hypodensity. In one patient, parametrial extension was seen as an enhancing mass adjacent to the uterus. CT may be accurate in defining the extent of myometrial and adnexal disease and may have prognostic and therapeutic value.