Figure 16. Introduction. We also offer suggestions for developing a comprehensive, clinically relevant MR imaging examination for the assessment of uterine cervical carcinoma. Therefore, magnetic resonance (MR) imaging is now widely accepted as optimal for evaluation of the main prognostic factors and selection of therapeutic strategy. However, vaginal extension is well evaluated clinically. 3, Seminars in Ultrasound, CT and MRI, Vol. However, this “bullous edema sign” of the posterior wall mucosa should be analyzed carefully for any associated nodulation suggestive of tumor (,Fig 17) (,8). Cervical carcinoma. Viewer. Purpose of review: For uterine cervical cancer, the recently revised International Federation of Gynecology and Obstetrics (FIGO) staging system (2018) incorporates imaging and pathology assessments in its staging. Such a tumor is difficult to evaluate at clinical examination alone.Download as PowerPointOpen in Image Kaur H, Silverman PM, Iyer RB et-al. Figure 9. The International Federation of Gynecology and Obstetrics (FIGO) staging system is widely used for treatment planning but more often for standardization of epidemiologic and treatment results (,Table 1) (,2,,3). 6, 1 July 2013 | Therapeutic Advances in Medical Oncology, Vol. With disruption of the stromal ring but no definite parametrial mass, there may be microscopic invasion (false-negative findings). Lymph node evaluation. 7, 29 August 2011 | Ultrasound in Obstetrics & Gynecology, Vol. 6, 7 October 2008 | European Radiology, Vol. 3, Clinical Hemorheology and Microcirculation, Vol. Axial (a) and sagittal (b) T2-weighted MR images and corresponding axial contrast-enhanced T1-weighted MR image (c) show a cervical carcinoma with direct extension into the rectal wall. Although not included in the FIGO staging system, nodal disease has a great impact on survival, and the presence of metastatic lymph nodes indicates a poorer prognosis within each stage. Viewer. A comparison of MRI and PET scanning in surgically staged loco-regionally advanced cervical cancer: potential impact on treatment. Figure 1. For an imaging pathway on the best modalities in accurate staging of cervical cancer: see reference 9. The cervical tumor is moderately hyperintense on T2-weighted images and in contrast to the homogeneously hypointense normal cervical stroma. Ring flow artifact. Cervical carcinoma. Figure 8b. The most recommended form of treatment for stage 3 cervical cancer is a combination of radiation therapy and chemo. Viewer. Viewer. (a) Axial T2-weighted MR image shows a small, slightly hyperintense carcinoma posterior to and to the left of the cervix (arrow). 2, Reviews in Gynaecological Practice, Vol. Cervical carcinoma with rectal invasion. Sagittal T2-weighted MR image reveals a small, posterior cervical carcinoma (arrow) disrupting the low-signal-intensity fibrous stroma.Download as PowerPointOpen in Image This mass is in contiguity with the anterior wall of the rectum (arrow), infiltrates below the posterior wall of the vagina up to the inferior third and back, in the mesorectal fat There are not evident adenopathies characterized by pathological metabolism. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Sagittal (a) and axial (b) T2-weighted MR images show a posterior cervical carcinoma invading the posterior vaginal fornix (arrow). 6, Asian Pacific Journal of Cancer Prevention, Vol. Cervical cancer staging is the assessment of cervical cancer to decide how far the disease has progressed. (b) On an axial fat-saturated T1-weighted MR image obtained after dynamic intravenous injection of gadopentetate dimeglumine, the carcinoma demonstrates intense enhancement (arrow). Linear stranding around the cervical mass is suggestive of parametrial invasion but may be due to peritumoral inflammatory tissue (false-positive findings) (,1,,2). Magnetic resonance imaging (MRI) is the most sensitive and specific imaging modality for initial staging and follow-up of cervical cancer. Sagittal T2-weighted image shows the position of the axial 5-mm sections obtained in two sequences from the lower poles of the kidneys down to the pubis. Viewer. Cervical carcinoma with bladder invasion. Viewer. The International Federation of Gynecology and Obstetrics (FIGO) staging system is widely used for treatment planning but more often for standardization of epidemiologic and treatment results (,Table 1) (,2,,3). Viewer. Figure 8a. W.B. Figure 17. MR imaging staging, when available, is invaluable for identifying important prognostic factors and optimizing treatment strategies. 39, No. If the address matches an existing account you will receive an email with instructions to reset your password. 3, 9 September 2019 | RadioGraphics, Vol. 26, No. Cervical cancer is the most common gynecologic cancer worldwide and the most frequent cause of cancer-related death in women younger than age 35. 2, 19 March 2011 | La radiologia medica, Vol. Sagittal T2-weighted MR images obtained in two different patients demonstrate bladder wall invasion (arrow) with disruption of the normal hypointense bladder wall and a mass protruding into the lumen.Download as PowerPointOpen in Image 2, 14 June 2005 | European Radiology, Vol. Cervical carcinoma. 34, No. Cervical carcinoma with pelvic wall invasion. Neuroendocrine cervical cancer (NECC) is a rare and aggressive subtype of cervical cancer, accounting for less than 2% of cervical tumors. 6, Journal of Computer Assisted Tomography, Vol. Robbins SL, Kumar V, Abbas AK et-al. CT evaluation of cervical cancer: spectrum of disease. Download as PowerPointOpen in Image 26, No. Axial (a) and sagittal (b) T2-weighted MR images and corresponding axial contrast-enhanced T1-weighted MR image (c) show a cervical carcinoma with direct extension into the rectal wall. 38, No. However, in the underdeveloped world where screening remains underutilized, cervical cancer is the second most common cancer in women, with 275,000 deaths worldwide in 2002. Figure 13. There is irregular thickening of the anterior rectal wall (arrow), which enhances after injection of gadopentetate dimeglumine. PET/CT evaluation of cervical cancer: spectrum of disease. Cervical carcinoma. (a) Axial T2-weighted MR image shows a cervical carcinoma with disruption of the stromal ring and extension into the parametrium (arrow). Treatment and prognosis Prognosis is affected by many factors which include: tumor stage; the … MR imaging can also be used to identify important prognostic factors such as lesion volume and metastatic lymph node involvement that will help determine whether treatment will be palliative or curative (,5,,6). 2010;30 (5): 1251-68. Figure 16. Assessment of current clinical guidelines, innovations and controversies, The Added Role of MR Imaging in Treatment Stratification of Patients with Gynecologic Malignancies: What the Radiologist Needs to Know, Management of cervical cancer detected during pregnancy: role of magnetic resonance imaging, The Revised FIGO Staging System for Uterine Malignancies: Implications for MR Imaging, Advanced Imaging Applications for Locally Advanced Cervical Cancer, Evaluation of carcinoma cervix using magnetic resonance imaging: Correlation with clinical FIGO staging and impact on management, Magnetic Resonance Imaging of the Female Pelvis, Size assessment of breast lesions by means of a computer-aided detection (CAD) system for magnetic resonance mammography, Ultrasound scanning of the pelvis and abdomen for staging of gynecological tumors: a review, Pelvic Applications of Diffusion Magnetic Resonance Images, The role of dynamic contrast-enhanced and diffusion weighted magnetic resonance imaging in the female pelvis, Identification of a patient group at low risk for parametrial invasion in early-stage cervical cancer, MRI of the Pelvis in Women: 3D Versus 2D T2-Weighted Technique, The utility of diffusion-weighted MR imaging in cervical cancer, Diagnostic performance of fluorodeoxyglucose positron emission tomography/magnetic resonance imaging fusion images of gynecological malignant tumors: comparison with positron emission tomography/computed tomography, Prognostic nomogram for overall survival in stage IIB-IVA cervical cancer patients treated with concurrent chemoradiotherapy, Traitement des cancers du col de stade précoce, Tratamiento del cáncer de cuello uterino en estadio precoz, Uterine Cervical Carcinoma: Preoperative Magnetic Resonance Imaging Staging, Imaging of gynecologic malignancies with FDG PET–CT: case examples, physiolocic activity, and pitfalls, Localized cervical cancer (stage 4 cm), Complete disruption of stromal ring with tumor extending into the parametrium, Extension to lower one-third of vagina or pelvic wall invasion with hydronephrosis, IIIA  Extension to lower one-third of vagina, IIIB  Pelvic wall invasion with hydronephrosis, Extension to pelvic muscles or dilated ureter, Loss of low signal intensity in bladder or rectal wall. Lymph node evaluation. Staging of cervical cancer can either be based on the TNM or FIGO system.. Revised FIGO staging of cervical carcinoma 2018 8. Figure 4. Sagittal (a) and axial (b) T2-weighted MR images show a posterior cervical carcinoma invading the posterior vaginal fornix (arrow). 34, No. 18, No. Brachytherapy and external beam therapy are optimized with MR imaging evaluation of the shape and direction of lesion growth (,5,,6). 31, No. Revised FIGO staging for carcinoma of the cervix uteri. MRI reporting guidelines for cervical cancer help maintain uniformity of reports and assessment of important imaging staging criteria.. Tumor size. Noninvasive cervical carcinoma. Figure 9. 43, No. 27.1 Mass characterized by abnormal glucose consumption at the cervix, SUV max 12. 5, Seminars in Ultrasound, CT and MRI, Vol. Viewer. 114, No. 2, 18 August 2015 | Archives of Gynecology and Obstetrics, Vol. MR imaging of the uterine cervix: imaging-pathologic correlation. 5, Asian Pacific Journal of Cancer Prevention, Vol. 3, Seminars in Ultrasound, CT and MRI, Vol. FIGO stages for cervical cancer. (a) Axial T2-weighted MR image demonstrates a hyperintense central cervical carcinoma (arrow), in contrast to the hypointense cervical stroma. 55, No. TABLE 1. Dynamic gadolinium-enhanced T1-weighted imaging may help identify smaller tumors, detect or confirm invasion of adjacent organs, and identify fistulous tracts. Figure 5. Dynamic gadolinium-enhanced imaging is useful for evaluating small, enhancing cervical lesions, detecting or confirming invasion of adjacent organs, and identifying fistulous tracts (,10,,11). Figure 14b. (a) Axial T2-weighted MR image shows a cervical carcinoma with disruption of the stromal ring and extension into the parametrium (arrow). 38, No. Prolapsed submucous fibroids are distinctly more hypointense at T2-weighted imaging than cervical carcinomas. Figure 10a.Cervical carcinoma with vaginal invasion. 46, No. In young women, cervical carcinoma usually originates from the squamocolumnar junction and tends to be more exophytic, whereas in older women it originates more often in the endocervical canal. However, in 2018, the FIGO Gynecologic Oncology Committee made revisions to allow stage assignment based on imaging and patho-logical findings, when available [26]. Cervical carcinoma with bladder invasion. Hyperintense thickening of the bladder mucosa at T2-weighted imaging indicates edema and is not a direct sign of invasion. 1, European Journal of Radiology, Vol. The revision calls for a more precise measurement of primary tumor size, best assessed with imaging. 23 (2): 425-45. 16, No. Viewer. Figure 7b. Pap test. Imaging modalities used to evaluate the extent of cervical cancer include excretory urography, barium enema, lymphangiography, sonography, CT, MR imaging, and positron emission tomography (PET). Sagittal T2-weighted MR image shows a barrel-shaped cervical carcinoma expanding the inner cervix, with preservation of the external os (arrow). 195, No. 19, No. Sagittal T2-weighted MR image shows a large cervical mass infiltrating the lower myometrium and endometrium.Download as PowerPointOpen in Image 77, No. 28, No. (b) On a T2-weighted MR image, the enlarged lymph node (arrow) is more clearly differentiated from these structures.Download as PowerPointOpen in Image Axial T2-weighted MR image demonstrates a slightly hyperintense ring flow artifact (arrows), a finding that is often seen in the iliac veins and should not be confused with adenopathy. Viewer. Contrast material–enhanced T1-weighted imaging has not proved to be more accurate than T2-weighted imaging in this setting (,13,,14). Fat-saturated T1-weighted MR image obtained after intravenous injection of gadopentetate dimeglumine shows a cervical carcinoma extending posteriorly through the uterosacral ligament (arrow).Download as PowerPointOpen in Image (a) Axial T2-weighted MR image shows a small, slightly hyperintense carcinoma posterior to and to the left of the cervix (arrow). Axial contrast-enhanced T1-weighted MR image shows a cervical carcinoma with direct extension into the bladder wall (arrow). 36, No. 2, Journal of Computer Assisted Tomography, Vol. Cervical carcinoma has intermediate signal intensity at T2-weighted imaging and is seen disrupting the low-signal-intensity fibrous stroma (,Fig 3). Since publication of the last FIGO cervical cancer staging in 2009, considerable progress has been made in the use of imaging modalities to evaluate women with cervical cancer. Figure 17. The disease is staged using the International Federation of Gynecology and Obstetrics (FIGO) system, which was updated in 2018. 6. Complete disruption of the ring with nodular or irregular tumor signal intensity extending into the parametrium are reliable signs of invasion (,,,Fig 12). (b, c) On consecutive axial fat-saturated T1-weighted MR images obtained shortly after intravenous injection of gadopentetate dimeglumine, the carcinoma demonstrates rapid enhancement (arrow). In general, cervical carcinoma is better defined at T2-weighted imaging, but small tumors may be more readily identified by their early enhancement after dynamic injection of gadopentetate dimeglumine (,,,,Figs 7, ,,,8) (,10,,11). (b) Axial T2-weighted MR image obtained in a different patient shows a cervical carcinoma with more extensive bilateral parametrial invasion (arrow). This permits differentiation from an endometrial mass (polyp or adenocarcinoma), which is centered in the endometrial cavity but protrudes into the endocervical canal. 14, 14 July 2014 | RadioGraphics, Vol. 4, 5 December 2005 | Abdominal Imaging, Vol. 41, No. 3, Journal of Computer Assisted Tomography, Vol. Viewer. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Sala E, Wakely S, Senior E et-al. Sagittal T2-weighted MR image demonstrates hyperintense bullous thickening of the bladder wall (arrow). 4, American Journal of Roentgenology, Vol. 40, No. 34, No. 23, No. Imaging plays a central role in the 2018 International Federation of Gynecology and Obstetrics staging system for uterine cervical cancer. 3, Reviews in Gynaecological Practice, Vol. 4, Indian Journal of Gynecologic Oncology, Vol. With the FIGO 2018 staging system for uterine cervical cancer, imaging is formally incorporated as a source of staging information and as a supplement to clinical examination (ie, pelvic examination, cystoscopy, and colposcopy) to obtain an accurate description of tumor spread . 3, No. However, the size of the lesion may rarely be overestimated at T2-weighted imaging due to inflammation or edema (,12). Figure 14a. Sagittal T2-weighted MR image demonstrates a large, exophytic cervical mass protruding into the posterior vaginal fornix (arrow). (b) Axial T2-weighted MR image obtained in a different patient shows a cervical carcinoma with more extensive bilateral parametrial invasion (arrow). Viewer. 6, Journal of Computer Assisted Tomography, Vol. Therefore, detection of nodal disease is crucial for treatment planning.
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