Cervical carcinoma: comparison of standard and pharmacokinetic MR imaging.
OBJECTIVE
To stage advanced cervical carcinoma with conventional or pharmacokinetic magnetic resonance (MR) imaging by correlating imaging findings with whole-mount specimens and histopathologic findings.


METHODS
Twenty-six adult patients with primary cervical cancer (stages IIB-IVA) underwent T2-weighted turbo spin-echo (SE) MR imaging; gadolinium-enhanced, T1-weighted SE MR imaging; and gadolinium-enhanced, saturation-recovery, turbo fast low-angle shot MR imaging. All imaging findings were correlated with the whole-mount specimens and histopathologic findings. Signal intensity changes versus time were analyzed by using a pharmacokinetic model and parameter values displayed as a color-coded overlay.


RESULTS
Histopathologic stages were IIB (n = 9), IIIB (n = 1), and IVA (n = 16). The overall accuracy for tumor staging was 73% for T2-weighted, 81% for T1-weighted, and 92% for pharmacokinetic MR imaging. Pharmacokinetic MR imaging was accurate (90%) in the diagnosis of tumor extension into the bladder and/or rectal wall but inaccurate (69%) in that of parametrial invasion. T2-weighted images were most accurate (86%) in the assessment of parametrial tumor extension but less accurate (69%) in that of bladder or rectal invasion.


CONCLUSIONS
T2-weighted turbo SE images are still superior to contract medium-enhanced T1-weighted SE or pharmacokinetic MR images in the diagnosis of parametrial infiltration by uterine cervical carcinoma. However, pharmacokinetic MR imaging is a promising method for demonstrating and staging IVA disease.
Department of Radiology Diagnostics and Therapy, German Cancer Research Center, Heidelberg, Germany.
H
H
Hawighorst
P G
PG
Knapstein
W
W
Weikel
M V
MV
Knopp
U
U
Schaeffer
G
G
Brix
M
M
Essig
U
U
Hoffmann
I
I
Zuna
S
S
Schönberg
G
G
van Kaick
D000230:Adenocarcinoma / Q000175:diagnosis / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000473:pathology; D003287:Contrast Media / Q000493:pharmacokinetics; D004338:Drug Combinations; D005260:Female; D005682:Gadolinium; D019786:Gadolinium DTPA; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008536:Meglumine / Q000493:pharmacokinetics; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009942:Organometallic Compounds / Q000493:pharmacokinetics; D004369:Pentetic Acid / Q000031:analogs & derivatives* / Q000493:pharmacokinetics; D011446:Prospective Studies; D012007:Rectum / Q000473:pathology; D001743:Urinary Bladder / Q000473:pathology; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology; D014599:Uterus / Q000473:pathology; D014621:Vagina / Q000473:pathology
D003287:Contrast Media; D004338:Drug Combinations; D009942:Organometallic Compounds; D008536:Meglumine; D004369:Pentetic Acid; D005682:Gadolinium; D019786:Gadolinium DTPA