The Added Role of Diffusion-Weighted Magnetic Resonance Imaging in Staging Uterine Cervical Cancer

Cervical cancer is considered one of the most common gynecological malignancies with an increased incidence in developing countries. Magnetic resonance imaging (MRI) plays a valuable role in staging cervical cancer and providing valuable information necessary for selecting the appropriate treatment plan, while closely correlating with the prognosis of the patient.

The aim of this study is to assess the diagnostic value of diffusion-weighted imaging (DWI) in the preoperative loco-regional staging of cervical carcinoma. Our purpose is to establish apparent diffusion coefficient (ADC) values of cervical carcinoma compared with normal cervical tissue and their variability based on different pathological characteristics of the lesions.

It is a retrospective analysis of 57 patients diagnosed with cervical cancer, who underwent MRI examinations. The study evaluated the aspect of the lesions on T2-weighted imaging, DWI, ADC maps, and pre- and post-contrast T1-weighted imaging with fat saturation.

The ADC mean values ranged between 0.63 × 10^-3 mm²/second and 0.99 × 10^-3 mm²/second (mean 0.79) for tumoral tissue and 1.33 × 10^-3 mm²/second and 1.74 × 10^-3 mm²/second (mean 1.59) for surrounding non-affected cervical tissue. The ADC mapping showed a decreasing trend with the increased sizes of the tumors (p<0.001). The ADC mean showed lower values with increased International Federation of Gynecology and Obstetrics (FIGO) stage of the tumors. The ADC mean value for cases that had spread to other organs (IVA+IVB) was significantly lower than that of the early stages (IB1 + IB2 + IIA2), stage IIB, and stages IIIA+IIIC1+IIIC2 (p<0.001). The ADC mean value of stage III disease was significantly lower than that of stage IIB, respectively early stages (p<0.001). The ADC mean value of the stage IIB tumor was significantly lower than that of the early stages (p<0.001). The differences in ADC mean values based on the histopathological type and differentiation grade were not statistically significant. The ADC mean value of the cases with positive pelvic lymph nodes was significantly lower than in those with negative lymph nodes (p<0.001).

ADC mean values of cervical carcinoma are significantly lower than those from unaffected uterine tissue and they also correlate with the severity of the disease. The advancements and additional capabilities DWI can bring are the elements of interest in this article. Using DWI means a more accurate capability in diagnosing cervical cancer, providing a compelling argument for its integration into standard clinical practice. This study discusses the quantitative imaging parameters of DWI such as ADC values, which can provide objective measurements for tumor evaluation. These parameters can be standardized and used across different institutions, enhancing the reproducibility and reliability of imaging findings.