Diffusion-weighted imaging in predicting and monitoring the response of uterine cervical cancer to combined chemoradiation

Objectives: Uterine cervical cancer with bladder mucosal invasion is classified as FIGO stage IVA with poor prognosis. MRI can rule out the bladder invasion and skipping cystoscopy may be possible; however, high false-positive rate may be problematic. The purpose of this study is to evaluate the diagnostic performance of reduced field-of-view (FOV) diffusion-weighted imaging (DWI) in evaluating bladder mucosal invasion of cervical cancer. Methods: 3T MRI including T2WI and reduced FOV DWI in 15 women with histologically proven cervical cancer (two stage IIIB, six stage IVA, seven stage IVB) were retrospectively evaluated compared with cystoscopic findings. Results: Cystoscopy revealed mucosal invasion in 13 of 15 cases. The border between the tumor and the bladder wall was unclear on T2WI and clear on reduced FOV DWI in all 15 cases. The diagnosis of mucosal invasion on reduced FOV DWI had a sensitivity of 100%, specificity of 50%, accuracy of 93%, PPV of 93%, and NPV of 100%. Conclusions: Addition of reduced FOV DWI may improve the staging accuracy of MRI for cervical cancer in assessing the bladder mucosal invasion. Advances in knowledge: Reduced FOV DWI may improve the staging accuracy of cervical cancer in assessing bladder mucosal invasion with high NPV and PPV, which may be helpful for avoiding unnecessary cystoscopy.

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Reduced field-of-view diffusion-weighted MR imaging for assessing the local extent of uterine cervical cancer

Acta Radiologica ◽

10.1177/0284185119852733 ◽

2019 ◽

Vol 61 (2) ◽

pp. 267-275

Author(s):

Mayumi Takeuchi ◽

Kenji Matsuzaki ◽

Yoshimi Bando ◽

Masafumi Harada

Keyword(s):

Cervical Cancer ◽

Magnetic Resonance ◽

Diffusion Weighted Imaging ◽

Uterine Cervical Cancer ◽

Field Of View ◽

Resonance Imaging ◽

Tumor Margins ◽

Diffusion Weighted ◽

Contrast Enhanced ◽

Tumor Extent

Background Recently, the evaluation of the tumor size and local extension of early-stage uterine cervical cancer on magnetic resonance imaging is important for the accurate clinical staging and to determine the indication of less extensive surgery such as fertility sparing radical trachelectomy. Purpose To compare the diagnostic ability of reduced field-of-view diffusion-weighted imaging with those of three-dimensional (3D) contrast-enhanced T1-weighted imaging and T2-weighted imaging for assessing the tumor margin delineation and local extent of uterine cervical cancer. Material and Methods 3T magnetic resonance images, including T2-weighted imaging, reduced field-of-view diffusion-weighted imaging, and 3D contrast-enhanced T1-weighted imaging, in 27 women with surgically proven cervical cancer (19 FIGO stage IB1, 3 IB2, and 5 IIA1) were retrospectively evaluated. Tumor margins and local tumor extent, including the presence of invasion to parametrium and vagina were evaluated on both sagittal and oblique axial (short axis) images; the results were compared with histologically confirmed tumor extension. Results Reduced field-of-view diffusion-weighted imaging diagnosed the tumor margins, which was more accurate than T2-weighted imaging ( P<0.001) and slightly better than 3D contrast-enhanced T1-weighted imaging. Reduced field-of-view diffusion-weighted imaging could define the tumor margins well even in small lesions (≤ 20 mm). Histological examination revealed parametrial invasion in two cases (clinically under-staged) and vaginal invasion in four cases. Reduced field-of-view diffusion-weighted imaging could demonstrate local extension of all lesions, which was more accurate than clinical examination and T2-weighted imaging. Conclusion Addition of reduced field-of-view diffusion-weighted imaging may improve the staging accuracy of magnetic resonance imaging for cervical cancer in assessing the local tumor extent.

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Node-by-node correlation between MR and PET/CT in patients with uterine cervical cancer: diffusion-weighted imaging versus size-based criteria on T2WI

European Radiology ◽

10.1007/s00330-009-1350-5 ◽

2009 ◽

Vol 19 (8) ◽

pp. 2024-2032 ◽

Cited By ~ 41

Author(s):

Eugene K. Choi ◽

Jeong Kon Kim ◽

Hyuck Jae Choi ◽

Seong Ho Park ◽

Bum-Woo Park ◽

...

Keyword(s):

Cervical Cancer ◽

Diffusion Weighted Imaging ◽

Uterine Cervical Cancer ◽

Diffusion Weighted ◽

Pet Ct

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Added value of diffusion weighted mri to conventional mri in the assessment of uterine cervix cancer post therapy

QJM ◽

10.1093/qjmed/hcaa068.018 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

A M Nasr ◽

O A Kamal ◽

O F Kamel ◽

S A N Hashim

Keyword(s):

Cervical Cancer ◽

Diffusion Weighted Imaging ◽

Tumor Resection ◽

Post Treatment ◽

Added Value ◽

Diffusion Weighted Mri ◽

Conventional Mri ◽

Diffusion Weighted ◽

Adc Mapping ◽

Post Therapy

Abstract Purpose of this study is: Assessing the role of Diffusion weighted imaging with ADC mapping in the evaluation of uterine cervical cancer post therapy regarding tumor residual, recurrence or post treatment benign changes/ complications after tumor resection and/or chemotherapy/radiotherapy. Methods The study included 48 female underwent cervical cancer treatment, referred to Radio diagnosis Department of National Cancer Institute for post therapy assessment. Each patient included in the study was subjected to full history taking, reviewing medical sheet and MR examination including: Conventional MR examination and Diffusion Weighted imaging. Results The study showed that the use of quantitative DW imaging with ADC mapping provide added value in the detection of post-treatment malignant masses and differentiating it from post-treatment benign changes. Conclusion The current application of diffusion Weighted MRI as a routine with conventional MRI sequences increased the accuracy of detection of post therapy benign and malignant masses , Our results suggested also that the use of ADC can be helpful in differentiating post-treatment malignant masses from benign post-treatment changes.

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Value of diffusion-weighted imaging in preoperative evaluation and prediction of postoperative supplementary therapy for patients with cervical cancer

Annals of Translational Medicine ◽

10.21037/atm-21-5319 ◽

2021 ◽

Vol 0 (0) ◽

pp. 0-0

Author(s):

Liying Liu ◽

Shuo Wang ◽

Tao Yu ◽

Haoyan Bai ◽

Jingyu Liu ◽

...

Keyword(s):

Cervical Cancer ◽

Diffusion Weighted Imaging ◽

Preoperative Evaluation ◽

Diffusion Weighted

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Combining tumor size and diffusion-weighted imaging to diagnose normal-sized metastatic pelvic lymph nodes in cervical cancers

Acta Radiologica ◽

10.1177/0284185118780903 ◽

2018 ◽

Vol 60 (3) ◽

pp. 388-395 ◽

Cited By ~ 4

Author(s):

Jiacheng Song ◽

Qiming Hu ◽

Junwen Huang ◽

Zhanlong Ma ◽

Ting Chen

Keyword(s):

Cervical Cancer ◽

Lymph Nodes ◽

Cancer Patients ◽

Tumor Size ◽

Diffusion Weighted Imaging ◽

Area Under The Curve ◽

Adc Value ◽

Cervical Cancers ◽

Pelvic Lymph Nodes ◽

Diffusion Weighted

Background Detecting normal-sized metastatic pelvic lymph nodes (LNs) in cervical cancers, although difficult, is of vital importance. Purpose To investigate the value of diffusion-weighted-imaging (DWI), tumor size, and LN shape in predicting metastases in normal-sized pelvic LNs in cervical cancers. Material and Methods Pathology confirmed cervical cancer patients with complete magnetic resonance imaging (MRI) were documented from 2011 to 2016. A total of 121 cervical cancer patients showed small pelvic LNs (<5 mm) and 92 showed normal-sized (5–10 mm) pelvic LNs (39 patients with 55 nodes that were histologically metastatic, 53 patients with 71 nodes that were histologically benign). Preoperative clinical and MRI variables were analyzed and compared between the metastatic and benign groups. Results LN apparent diffusion coefficient (ADC) values and short-to-long axis ratios were not significantly different between metastatic and benign normal-sized LNs (0.98 ± 0.15 × 10−3 vs. 1.00 ± 0.18 × 10−3 mm2/s, P = 0.45; 0.65 ± 0.16 vs. 0.64 ± 0.16, P = 0.60, respectively). Tumor ADC value of the metastatic LNs was significantly lower than the benign LNs (0.98 ± 0.12 × 10−3 vs. 1.07 ± 0.21 × 10−3 mm2/s, P = 0.01). Tumor size (height) was significantly higher in the metastatic LN group (27.59 ± 9.18 mm vs. 21.36 ± 10.40 mm, P < 0.00). Spiculated border rate was higher in the metastatic LN group (9 [16.4%] vs. 3 [4.2%], P = 0.03). Tumor (height) combined with tumor ADC value showed the highest area under the curve of 0.702 ( P < 0.00) in detecting metastatic pelvic nodes, with a sensitivity of 59.1% and specificity of 78.8%. Conclusions Tumor DWI combined with tumor height were superior to LN DWI and shape in predicting the metastatic state of normal-sized pelvic LNs in cervical cancer patients.

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