title: A prospective study of the value of pre- and post-treatment magnetic resonance imaging examinations for advanced cervical cancer.
abstract: OBJECTIVE
  Cervical cancer has high incidence and mortality in developing countries. It is the only gynecological malignancy that is clinically staged. Staging at the time of diagnosis is crucial for treatment planning. After radiation therapy, clinical examination is limited because of radiation changes. An imaging method relatively unaffected by radiation changes would be useful for the assessment of therapy results and for management. We sought to demonstrate the value of magnetic resonance imaging (MRI) in the pre- and post-treatment assessment of cervical cancer.
  
  
  METHODS
  This was a prospective study, carried out between November 2012 and October 2014 on 18 subjects with advanced-stage cervical cancer diagnosed by colposcopy. The disease stage was determined clinically according to the International Federation of Gynecology and Obstetrics (FIGO) criteria. Only patients with disease stage ≥ IIB or IIA with one of the tumor dimensions > 4 cm were enrolled in the study. All patients underwent abdominal-pelvic contrast-enhanced MRI as part of the workup. Tumor size, local invasion, involved pelvic lymph nodes, and staging according to MRI criteria were evaluated. Clinical and MRI examinations were also performed after chemoradiotherapy. After chemoradiotherapy, 94% of the patients (17 of 18) were treated surgically.
  
  
  RESULTS
  Eighteen patients aged 32-67 met the inclusion criteria and were enrolled: 10 stage IIB, 6 stage IIIA, 1 stage IIA and 1 stage IIIB, according to clinical staging. Using histopathological findings as a reference, MRI staging accuracy was 83.3%. The concordance of the clinical stage with MRI stage at the first examination was 56%. Parametrial involvement was assessed on pretreatment and post-treatment MRI, with post-treatment MRI compared with histology. There was no statistically significant difference between the pre- and post-therapy gynecological examinations (GYN) and the corresponding MRI assessments as to tumor size measurements (p>0.05). The post-therapy restoration of the cervical stroma ruled out tumor recurrence.
  
  
  CONCLUSIONS
  For a detailed characterization of loco-regional extension, the calculation of tumor volume, and the evaluation of distant metastatic changes, clinical examination is insufficient. Magnetic resonance imaging is helpful aftertherapy.
authors.affiliation: Department of Radiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors.forename: Csaba
authors.initials: C
authors.lastname: Csutak
authors.affiliation: Institute of Oncology Prof. Dr. Ion Chiricuta, Cluj-Napoca, Romania.
authors.forename: Claudia
authors.initials: C
authors.lastname: Ordeanu
authors.affiliation: Institute of Oncology Prof. Dr. Ion Chiricuta, Cluj-Napoca, Romania.
authors.forename: Viorica Magdalena
authors.initials: VM
authors.lastname: Nagy
authors.affiliation: Institute of Oncology Prof. Dr. Ion Chiricuta, Cluj-Napoca, Romania.
authors.forename: Diana Cristina
authors.initials: DC
authors.lastname: Pop
authors.affiliation: Department of Medical Informatics and Biostatistics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors.forename: Sorana Daniela
authors.initials: SD
authors.lastname: Bolboaca
authors.affiliation: Department of Medical Imaging, Iuliu Haţieganu University of Medicine and Pharmacy, Institute of Octavian Fodor Gastroenterology and Hepatology, Cluj-Napoca, Romania.
authors.forename: Radu
authors.initials: R
authors.lastname: Badea
authors.affiliation: Department of Medical Imaging, Iuliu Haţieganu University of Medicine and Pharmacy, Institute of Octavian Fodor Gastroenterology and Hepatology, Cluj-Napoca, Romania.
authors.forename: Liliana
authors.initials: L
authors.lastname: Chiorean
authors.affiliation: Department of Radiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors.forename: Sorin Marian
authors.initials: SM
authors.lastname: Dudea
keywords: cervical cancer; clinical protocols; radiochemotherapy; tumor staging