Aktueller Stellenwert von MRT, CT und PET in der Diagnostik des Zervixkarzinoms

MRI is estabished as a modality available for use in the diagnosis of cervical cancer. The soft tissue contrast it supplies is far better than that of any other method, making it the modality of choice for direct visualization of the carcinoma and thus also for tumor staging. Pelvic MRI performed as part of the pretreatment evaluation has been shown to be cost effective, and it is recommended for use in macroscopic cervical cancer in the guidelines of professional societies for gynecologists and oncologists. It has proved to be a reliable method for the early detection of recurrent tumors. It remains unsurpassed for accurate visualization of local tumor extent and involvement of adjacent pelvic organs in recurrent cervical cancer. It is also the method of choice for use in the planning of brachytherapy. With the increasing use of PET and PET/CT for investigations in oncology patients a second method has emerged. This seems to have advantages particularly in the detection of lymph node metastases by whole-body examination. Encouraging results on detection of recurrent cervical cancer during follow-up treatment by PET/CT have also been published, but a definitive assessment of the value of PET in tumor aftertreatment cannot be reached without more comparative studies against MRI. Moreover, there have so far been no studies evaluating the cost effectiveness of PET. In the near future it will be necessary to reconsider the new diagnostic modalities with reference to their accuracy in staging, since therapy is oriented increasingly to disease stage and increasingly specific treatment methods are applied.