title: Preoperative MR staging of cervical carcinoma: are oblique and contrast-enhanced sequences necessary?
abstract: BACKGROUND
  As the choice of treatment in patients with cervical carcinoma depends on cancer stage at diagnosis, accurate staging is essential.
  
  
  OBJECTIVE
  To compare three different combinations of magnetic resonance (MR) sequences for preoperative staging.
  
  
  METHODS
  Fifty-seven consecutive patients with biopsy proven cervical carcinoma underwent MR imaging (MRI) staging followed by primary surgical treatment. Thirty-two of 57 patients had had a cone biopsy prior to MRI. Three MR pulse sequence combinations were retrospectively reviewed by two experienced radiologists. The first imaging protocol consisted of pre-contrast sagittal and transverse images (protocol A), the second protocol included additionally oblique high-resolution T2-weighted (T2W) MR images of the cervix (protocol A+B), and the third included also contrast-enhanced sequences (protocol A+B+C). The imaging findings in the three steps (A, A+B, A+B+C) were recorded. The TNM stage was used for comparison between preoperative imaging and histopathology. Histopathology, together with surgical findings, served as gold standard.
  
  
  RESULTS
  In 4/57 (7%) patients, the MR assessment of tumor stage (mrT) was altered when oblique sequences were added to the standard two plane imaging protocol (A+B). The mrT stage was altered in 1/57 (2%) patient when contrast-enhanced sequences were added to standard and oblique sequences (protocol A+B+C). The correlation between visible tumor on MRI and presence of tumor in the resected specimen did not change by adding oblique or contrast-enhanced images.
  
  
  CONCLUSIONS
  It is not necessary to perform oblique and contrast-enhanced sequences in small cervical carcinomas, i.e. without parametrial invasion. To avoid erroneous interpretation, information on previous cone biopsy is essential.
authors.affiliation: Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Susanne
authors.initials: S
authors.lastname: Fridsten
authors.affiliation: Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Ann-Cathrin
authors.initials: AC
authors.lastname: Hellström
authors.affiliation: Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Kristina
authors.initials: K
authors.lastname: Hellman
authors.affiliation: Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Sundin
authors.affiliation: Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Boel
authors.initials: B
authors.lastname: Söderén
authors.affiliation: Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Lennart
authors.initials: L
authors.lastname: Blomqvist
keywords: Magnetic resonance imaging (MRI); cervix uteri; conization; neoplasm staging; observer variation