title: Comparison of optimised endovaginal vs external array coil T2-weighted and diffusion-weighted imaging techniques for detecting suspected early stage (IA/IB1) uterine cervical cancer.
abstract: OBJECTIVE
  To compare sensitivity and specificity of endovaginal versus external-array coil T2-W and T2-W + DWI for detecting and staging small cervical tumours.
  
  
  METHODS
  Optimised endovaginal and external array coil MRI at 3.0-T was done prospectively in 48 consecutive patients with stage Ia/Ib1 cervical cancer. Sensitivity/specificity for detecting tumour and parametrial extension against histopathology for a reading radiologist were determined on coronal T2-W and T2W + DW images. An independent radiologist also scored T2-W images without and with addition of DWI for the external-array and endovaginal coils on separate occasions >2 weeks apart. Cohen's kappa assessed inter- and intra-observer agreement.
  
  
  RESULTS
  Median tumour volume in 19/38 cases positive on subsequent histology was 1.75 cm(3). Sensitivity, specificity, PPV, NPV were: reading radiologist 91.3 %, 89.5 %, 91.3 %, 89.5 %, respectively; independent radiologist T2-W 82.6 %, 73.7 %, 79.1 %, 77.8 % for endovaginal, 73.9 %, 89.5 %, 89.5 %, 73.9 % for external-array coil. Adding DWI improved sensitivity and specificity of endovaginal imaging (78.2 %, 89.5 %); adding DWI to external-array imaging improved specificity (94.7 %) but reduced sensitivity (66.7 %). Inter- and intra-observer agreement on T2-W + DWI was good (kappa = 0.67 and 0.62, respectively).
  
  
  CONCLUSIONS
  Endovaginal coil T2-W MRI is more sensitive than external-array coil for detecting tumours <2 cm(3); adding DWI improves specificity of endovaginal imaging but reduces sensitivity of external-array imaging.
  
  
  CONCLUSIONS
  • Endovaginal more accurate than external-array T2-W MRI for detecting small cervical cancers. • Addition of DWI improves sensitivity and specificity of endovaginal T2-W imaging. • Addition of DWI substantially reduces sensitivity of external-array T2-W imaging.
authors.affiliation: CRUK Cancer Imaging Centre, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Downey
authors.affiliation: Department of Histopathology, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK.
authors.forename: Ayoma D
authors.initials: AD
authors.lastname: Attygalle
authors.affiliation: CRUK Cancer Imaging Centre, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT, UK.
authors.forename: Veronica A
authors.initials: VA
authors.lastname: Morgan
authors.affiliation: CRUK Cancer Imaging Centre, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT, UK.
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Giles
authors.affiliation: CRUK Cancer Imaging Centre, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT, UK.
authors.forename: A
authors.initials: A
authors.lastname: MacDonald
authors.affiliation: Department of Gynaecology, Kingston Hospital, Galsworthy Road, Kingston-upon-Thames, Surrey, KT2 7QB, UK.
authors.forename: M
authors.initials: M
authors.lastname: Davis
authors.affiliation: Gynecology Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK.
authors.forename: Thomas E J
authors.initials: TE
authors.lastname: Ind
authors.affiliation: Gynecology Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK.
authors.forename: John H
authors.initials: JH
authors.lastname: Shepherd
authors.affiliation: CRUK Cancer Imaging Centre, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT, UK. nandita.desouza@icr.ac.uk.
authors.forename: Nandita M
authors.initials: NM
authors.lastname: deSouza
mesh_terms: D000328:Adult; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D015588:Observer Variation; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D047368:Tumor Burden; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*
keywords: Cervical cancer; Diffusion-weighted MRI; Endovaginal coil; External array coil; Fertility