The Usefulness of Dynamic MR Imaging for the Evaluation of Cervical Cancer

PURPOSE: We wished to evaluate the diagnostic usefulness of dynamic MRI in assessing tumor visualization and the parametrial invasion of cervical cancer, and we also wished to determine the most adequate enhancing time by comparing the T2-weighted image (T2WI) and enhanced T1-weighted image (Gd-T1WI). MATERIALS AND METHODS: Fifty-three women with histopathologically proven cervical cancer underwent a preoperative MRI. Using a 1.5 T magnet, the fast spin echo axial T2WI without fat saturation was taken; after contrast administration, 20, 40, 60, 90, 120 sec-dynamic MRIs were taken using fast SPGR and spin echo axial Gd-T1WI. Tumor conspicuity and parametrial invasion in each pulse sequence and the most adequate enhancing time for the evaluation of the tumor on dynamic MRI were evaluated prospectively by three radiologists working at three separate sessions. The results were then correlated with the histopathologic findings. RESULTS: The conspicuity of tumor on dynamic MRI (99.4%) and T2WI (95.6%) were better than on Gd-T1WI (89.3%). In the assessment of parametrial invasion of the tumor, the diagnostic accuracy of dynamic MRI, Gd-T1WI and T2WI was 79.9%, 78% and 76.1%, respectively; the highest values were for the dynamic MRI, but there was no statistically significant difference among three pulse sequences. The most adequate enhancing time on dynamic MRI was between 90 seconds and 120 seconds. CONCLUSION: Dynamic MRI is useful for the assessment of tumor visualization of cervical cancer, and the most appropriate scan time on dynamic MRI is between 90 seconds and 120 seconds. For the determination of parametrial invasion, the dynamic MRI revealed a higher diagnostic accuracy than that of T2WI or Gd-T1WI, but the differences were statistically insignificant.

Recurrent Uterine Cervical Carcinoma:Spectrum of Imaging Findings

Uterine cervical carcinoma is one of the most common malignant tumors occur-ring in females. After primary treatment, patients are usually followed up with CT or MRI and the findings of these modalities may be the first sign of recurrent disease. Because earlier additional treatment by chemotherapy or radiation therapy may improve the prognosis, the early detection of recurrent cervical carcinoma is clinically important. In this article, we review the CT and MR imaging findings of recurrent uterine cervical carcinoma, and assign them to one of four groups: a)recurrence at the primary site, involving the intrapelvic organs, b) extension to the pelvic side-wall, c) metastases to pelvic and extrapelvic lymph nodes, or d)metastases to distant organs. A further contribution of CT and MR imaging is the detection of hydronephrosis due to ureteral obstruction. The cases in each group are illustrated and discussed, and since an awareness of the spectrum of imaging findings of recurrent cervical carcinoma is likely to lead to its early detection, radi-ologists should be familiar with the information presented.

T2-weighted fast spin-echo MR findings of adenocarcinoma of the uterine cervix: comparison with squamous cell carcinoma

The purpose of this study was to investigate the differences in MR findings of adenocarcinoma (AC) and squamous cell carcinoma (SCC) of the uterine cervix and to compare MR findings with pathologic findings. MR images of 17 patients with pathologically proven AC, using a fast spin-echo (FSE) T2-weighted image (T2WI) with pelvic phased-array coil on a 1.5-T unit, were retrospectively evaluated. After measurement of the signal intensity (SI) ratios of the region of interest between tumors and gluteus maximus muscle, we compared the ratios of AC with those of 16 patients with SCC. AC showed relatively high SI on FSE T2WI with multiseptated lesions in four cases and hydrometrocolpos in three cases. The mean SI ratio was 3.82 +/- 1.68 in AC and 2.35 +/- 0.42 in SCC (p < 0.0001, t-test). Multiple tumorous glands with cytoplasmic and intraglandular mucin or serous fluid were pathologically found in AC, but SCC revealed the compact cellularity of stratified squamous tumor cells. The cervical AC showed higher SI than SCC on FSE T2WI with occasional multiseptated lesions and hydrometrocolpos. If the SI ratio of the tumor was more than 3.0, AC could be diagnosed with a sensitivity of 68.8% and a specificity of 100%.

Dynamic Enhanced MR Imaging is Necessary in the Diagnosis and Staging of Uterine Cervical Cancer?

PURPOSE: To compare the sensitivity and staging accuracy of dynamically enhanced MR imaging(hereafter, DEI)and turbo spin-echo(TSE) T2-weighted imaging(hereafter, T2WI) in cases of cervical carcinoma. MATERIALS AND METHODS: MR images(T2WI and DEI) of 25 cervical carcinoma patients, diagnosed during surgery, were reviewed by tworadiologists. T2WI employed the TSE technique; dynamic MR imaging, the FLASH technique in the axial plane. DEimages were obtained immediately and at 30, 60, 120, and 180 seconds after rapid injection of Gd-DTPA. The degreeof visualization of the tumor, and its invasiveness, were graded as good, fair, or poor. By correlating thehistopathologic results, the accuracy of the two MR imaging techniques was compared. RESULTS: For tumorvisualization, T2WI was good in 13/25 cases (52%), fair in 3/25(12%), and poor in 9/25(36%); DEI was good in5/25(20%), fair in 7/25(28%), and poor in 13/25 cases (52%). CONCLUSION: For the detection and staging of cervicalcarcinoma, T2WI is superior to DEI. For the diagnosis and staging of cervical carcinoma, DEI is thereforeunnecessary.