Magnetic resonance imaging in the evaluation of parametrial invasion of carcinoma of the cervix uteri: optimization of the study protocol

PURPOSE: To determine the efficacy of three different MR sequences in the evaluation of parametrial invasion by early-stage cervical cancer. MATERIAL AND METHODS: Eighteen consecutive patients with cervical cancer clinically assessed as stage IB1 underwent MR imaging examination with the use of the following sequences: FSE T2-weighted, FSE fat-suppressed T2w, and SE fat-suppressed Gadolinium-enhanced T1w. In all cases, the presence or absence of parametrial invasion on both sides per each sequence used was evaluated. Subsequently all the sequences have been considered together for the evaluation of tumor invasion. Gold standard of the study was the histopathologic analysis of the surgical specimens. RESULTS: At histological examination, parametrial invasion by tumor was found in 6 out of 36 parametria evaluated. The accuracy achieved with each of the sequences used was as follows: 94% with FSE T2w; 86% with FSE fat-suppressed T2w; and 67% with SE fat-suppressed Gadolinium-enhanced T1w. The simultaneous evaluation of all 3 sequences obtained an accuracy level similar to that achieved with FSE T2w. The difference between the accuracy of T2w sequences and that of fat-suppressed contrast-enhanced T1w sequences was statistically significant (p<0.01). DISCUSSION AND CONCLUSIONS: Our data suggest that the MR imaging protocol for the evaluation of parametrial tumor invasion could be restricted to FSE T2w sequences. These proved to have the highest negative predictive value (97%) which allows a reliable selection of patients who can be surgically treated.     

Invasive carcinoma of the cervix uteri (stage IB-IIB): evaluation using magnetic resonance

In patients with cervical carcinoma the selection of the optimal therapy depends on the precise preoperative assessment of the extent of disease. Currently, decisions regarding the management of these patients are made on the basis of clinical (FIGO) staging that has 50% mean error rate. To investigate the value of MR imaging in staging patients with invasive cervical cancer, we performed 25 MR examinations on 23 patients with histologic diagnosis of cervical cancer. All patients were clinically considered as having stage IB or IIB disease and underwent radical hysterectomy, providing specimens for pathologic correlation. The overall accuracy of MR imaging in staging cervical carcinoma (stage IB-IIB) was 78.1%. MR imaging seems to be the most reliable preoperative modality for staging invasive cervical cancer.     

Magnetic resonance imaging in recurrent carcinoma of the cervix

Twenty patients with suspected recurrent cervical carcinoma were evaluated with computed tomography (CT) and high-field magnetic resonance imaging (MRI). Histological verification of the imaging findings were available in all cases. Computed tomography and MRI were equally effective in making the diagnosis of disease recurrence. The extent of vaginal recurrence and involvement of pelvic floor muscles was better shown on MRI than on CT.     

Carcinoma of the cervix: value of MR imaging in detecting parametrial involvement

In patients with cervical carcinoma, precise knowledge of parametrial tumor extension affects the therapeutic decision between surgery and radiation therapy. The purpose of this prospective study was to determine the efficacy of MR imaging in detecting the presence or absence of parametrial invasion in patients with cervical cancer thought clinically to be confined to the cervix. Twenty-five consecutive patients were included in the study. All patients underwent radical hysterectomy or total abdominal hysterectomy and had detailed histologic evaluation of the parametrium. Ten had pathologic evidence of parametrial invasion; in the remaining 15, no parametrial invasion was identified pathologically. MR findings were compared with pathologic findings in all cases. For determining parametrial involvement, MR imaging had an accuracy of 88%, a sensitivity of 100%, and a specificity of 80%. Our results suggest that MR imaging is a reliable means of assessing parametrial invasion by cervical cancer.     

宫颈胃型黏液腺癌的MRI表现

目的 分析宫颈胃型黏液腺癌（GAS）的MRI表现,提高诊断准确率。 方法 回顾性收集12例GAS病人的MRI影像资料,观察肿瘤信号特点、生长部位、生长方式及浸润肌层深度,并绘制动态增强扫描的时间-信号强度曲线（TIC）。 结果 宫颈GAS在MRI上表现为宫颈内生型肿块,其中实性4例,囊实性8例。肿块囊性部分在T₂WI及脂肪抑制（FS）T₂WI上表现为弥漫或簇状分布,大小不一,多位于深肌层。肿块实性成分及囊壁在扩散加权成像上呈高信号,动态增强扫描呈明显持续性强化,11例强化程度高于正常子宫肌层。TIC表现为Ⅱ型11例,Ⅰ型1例。 结论 GAS的MRI影像表现具有特征性,可提供诊断线索。     

Value of magnetic resonance tomography after primary irradiation of carcinoma of the cervix uteri: evaluation of therapeutic success and follow-up

This study investigates the reliability of magnet resonance imaging in the evaluation of response to therapy and in follow-up after primary irradiation (RTX) of uterine cervical carcinomas in 25 patients (follow-up eleven to 39 months). Most of the tumors showed six months after RTX a significant reduction of volume and signal intensity in T2 weighted images. 20/25 (80%) showed a total tumor regression, 5/25 (20%) had a residual tumor (all of them had a primary tumor volume higher than 50 ccm). Four patients got a recurrent tumor in follow-up. Residual and recurrent tumors showed like the primary in heavily T2 weighted images significant higher signal intensity than fibrosis. Therefore posttreatment fibrosis is distinguishable from residual or recurrent neoplasm. Early radiation fibrosis (less than 6 months after RTX) showed higher signal intensity than fibrosis in later stages. This fact may be the cause of false positive results in searching for residual tumor within the first six months after RTX. Our results indicate that magnet resonance imaging is a reliable method to evaluate tumor response after radiation treatment and to detect recurrent neoplasm. The results of a greater patient population over a longer period of follow-up will be presented in future.     

Evaluation of the process of lumbo-aortic metastasis in carcinoma of the cervix uteri

Paraaortic lymph nodes involvement in patients with cervical carcinoma, even in less advanced stages, found in 100 cases examined, besides the data reported in literature, has driven the authors to locate, through the examination of lymphangiograms, the routes by which paraaortic metastases can occur. Authors pointed out different ways of invasion, besides the more common subsequent involvement going from pelvic to paraaortic nodes or from posterior channels that can lead to paraaortic spread without lesions in common iliac nodes. In detail lymphatic pathways have been opacified connecting distant nodal chains and finally external routes from external iliac lymph nodes directly to paraaortic chain.     

Magnetic resonance imaging, computed tomography and endosonography in the local staging of carcinoma of the cervix

Thirty-seven patients with carcinoma of the cervix were prospectively staged by examination under anaesthesia (EUA), transvaginal and transrectal ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI). Pathological correlation was available for 20 patients. In the pathologically staged patients, EUA agreed with the staging in 17, understaging three patients. Endosonography agreed with the staging in 19, CT in 16 and MRI in 18 patients. For the remaining 17 patients, endosonography agreed with the EUA findings in 13, CT in 12 and MRI in 12. This study has shown that endosonography and MRI are more accurate than CT in the local staging of carcinoma of the cervix. Computed tomography was least accurate in staging early tumours and differentiating between Stage Ib and IIb disease. Lymph node involvement was detected with equal frequency by both CT and MRI. Magnetic resonance imaging was useful in identifying vaginal and bladder wall involvement and in one patient showed features due to an unsuspected early pregnancy.     

Accuracy of computed tomography and magnetic resonance imaging in the detection of lymph node involvement in cervix carcinoma

Lymphnodes status in cervical carcinoma is important in therapeutic planning, and the role of Computed Tomography (CT) and Magnetic Resonance (MR) is controversial: this paper aims to evaluate their accuracy in diagnosing nodal metastases in patients with cervical carcinoma. We reviewed, retrospectively and blindly, CT and MR of 62 patients, before surgical lymphnode resection: 45 of these patients had pre-surgical chemotherapy. Lymphnodes were defined metastatic by CT and MRI when larger than 1 cm short axis. Both diagnoses by the original routine reports and by a second blind expert were compared with pathological reports. Results: combining the reading results of both observers CT showed a sensitivity of 64.6% and specificity of 93.3%; MRI a sensitivity of 72.9% and specificity of 93.1%. Positive Predictive Value was 50.8% for CT and 53% for MR, while Negative Predictive Value was 96% both for CT and MR. The expert Radiologist reviewing the films obtained better results. Inter-observer variability in the lower quadrants was high for each imaging technique (kappa for CT: 0.71; kappa for MRI: 0.84). Both imaging techniques showed similar screening accuracy in identifying nodal metastases. The radiologists experience is important in determinig the performance of the imaging technique. Anyway, CT and MRI are only moderately sensitive for detection of nodal metastases and the clinical impact of their results in patients management is limited.     

Magnetic resonance imaging of primary lymphoma of the cervix

Although uterus and cervix infiltration is a frequent finding in the later stages of lymphomatous disease, primary lymphoma of the cervix is very uncommon; however, this entity can occasionally be distinguished from cervical carcinoma by means of MRI. This is an important fact as treatment and prognosis differ between these neoplasms. We present a case of primary cervical lymphoma studied with high-field (1.5 T) MRI and we make an extensive review of the literature. The cervical mass was found in a routine pelvic examination in a patient with no previous history of gynecologic disorders. This is an uncommon way of presentation of this disease. T2-weighted turbo spin-echo (TSE) sequences in the axial, sagittal, and coronal planes, and T1-weighted SE pre- and post-contrast images, were obtained. The lack of involvement of the mucosa, as well as sparing of cervical stroma and uterine junctional zone, are the most important findings to differentiate cervical lymphoma from carcinoma, and are best evaluated with T2 TSE sequences. Post-contrast images help to delineate the extent of the disease.