[Invasive cervix carcinoma (pT2b-pT4a). Value of conventional and pharmacokinetic magnetic resonance tomography (MRI) in comparison with extensive cross sections and histopathologic findings].
OBJECTIVE
To compare staging of advanced primary cervical carcinoma (pT2b-pT4a) by conventional and pharmacokinetic magnetic resonance imaging (MRI) with the giant cross section specimen and histopathological findings.


METHODS
Seventeen patients with biopsy-proven cancer of the cervix and clinically suspected invasive cancer (FIGO IIB-IVA) were prospectively examined by conventional (T2 and contrast-enhanced T1-weighted spin echo images) and pharmacokinetic MRI. All MRI findings were compared with the giant cross section specimen and histopathology as the standard of reference. For pharmacokinetic MRI, a saturation recovery TurboFLASH sequence was used with a high temporal resolution of 13 s per ten sections. Signal time changes were analyzed using a pharmacokinetic model and the computed parameter values were visualized by color-coded overlay.


RESULTS
Analysis of parametrial invasion on T2-weighted images resulted in an accuracy of 85% and 73% on contrast-enhanced T1-weighted images and on pharmacokinetic MR images respectively. Accuracy of analysis of bladder and/or rectal wall invasion was significantly (P < 0.05) higher on pharmacokinetic MR images (88%) than on T2-weighted images (67%). Contrast-enhanced T1-weighted spin-echo images improved staging accuracy compared with T2-weighted images (76% vs 67%).


CONCLUSIONS
At present, conventional T2-weighted SE images are superior to contrast-enhanced T1-weighted SE and pharmacokinetic MR images in depicting infiltration of the parametrium. However, suspected infiltration of the bladder and/or rectum (pT4a) is diagnosed more accurately on pharmacokinetic images than on conventional MR images.
Hawighorst
H
H
Forschungsschwerpunkt Radiologische Diagnostik und Therapie, Deutsches Krebsforschungszentrum Heidelberg.
Knapstein
P G
PG
Weikel
W
W
Knopp
M V
MV
Schaeffer
U
U
Essig
M
M
Brix
G
G
Zuna
I
I
Schönberg
S
S
van Kaick
G
G
D000293:Adolescent; D000328:Adult; D001706:Biopsy; D002584:Cervix Uteri / Q000473:pathology; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011446:Prospective Studies; D012007:Rectum / Q000473:pathology; D012680:Sensitivity and Specificity; D001743:Urinary Bladder / Q000473:pathology; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology