Tumeurs trophoblastiques gestationnelles : éléments clés dans notre pratique radiologique

Gestational trophoblastic tumour corresponds to a spectrum of placental malignant lesions through to the malignant invasive mole, choriocarcinoma and rare placental site trophoblastic tumour and epithelioid trophoblastic tumour. The diagnosis of gestational trophoblastic tumours after a molar pregnancy is based on plasmatic Human chorionic gonadotropin levels, and not on imaging or pathology. However, imaging is crucial for the tumour extent evaluation, follow-up and treatment of complications. Gestational trophoblastic tumours features are non-specific on pelvic imaging, except their hypervascularity. However, ultrasound remains the first-line radiological investigation for initial diagnosis, and it can also predict invasive and recurrent disease. Pelvic magnetic resonance imaging (MRI) is becoming systematic. MRI is more precise to assess extra-uterine tumour extension and to evaluate the risk of local complications. Thoracic and abdominal computed tomography and brain MRI have a pivotal role to evaluate metastatic disease. Arteriography is essential to prevent risk of haemorrhage or to treat vascular complications such as arterio-venous malformations. The objective of this review is to give to radiologists the key points of the oncologic management of such lesions, and the pivotal role and contribution of imaging, to help the optimisation of the patient care.