Clinical stage I carcinoma of the uterine cervix value of preoperative magnetic resonance imaging in assessing parametrial invasion.
OBJECTIVE
The purpose of this prospective study was to assess the efficacy of different MR imaging techniques in the evaluation of parametrial tumor invasion in patients with early stage cervical cancer.


METHODS
A total of 73 consecutive patients, clinically considered to have invasive tumor (<3 cm in diameter) confined to the cervix, underwent MR imaging studies at 1 T, according to the following protocol: fast spin-echo (FSE) T2-weighted, gadolinium-enhanced SE T1-weighted, and fat-suppressed gadolinium-enhanced SE T1-weighted sequences. Images obtained with each sequence were evaluated for parametrial invasion with the use of histopathologic findings as the standard of reference.


RESULTS
In the assessment of tumor infiltration of the parametrium, with FSE T2-weighted images accuracy was 83%, with SE T1-weighted gadolinium-enhanced images was 65%, and with SE T1-weighted gadolinium-enhanced fat-suppressed images was 72%. The difference between the accuracy rate achieved with FSE T2-weighted images and those obtained with the other two MR sequences was statistically significant (P <0.05). The high negative predictive value (95%) for the exclusion of parametrial tumor invasion was the principal contributor to the staging accuracy obtained with FSE T2-weighted imaging.


CONCLUSIONS
Unenhanced FSE T2-weighted imaging is a reliable method for determining the degree of tumor invasion in patients with early stage cervical cancer. Our data suggest that contrast-enhanced sequences, even with the use of the fat suppression technique, have limited value in assessing tumor extension.
Sironi
Sandro
S
Division of Radiology, European Institute of Oncology, Milan, Italy.
Bellomi
Massimo
M
Villa
Gaetano
G
Rossi
Silvia
S
Del Maschio
Alessandro
A
D005260:Female; D006801:Humans; D007089:Image Enhancement; D008279:Magnetic Resonance Imaging / Q000379:methods*; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011446:Prospective Studies; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000473:pathology*