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Parametrial invasion in cervical carcinoma: evaluation of detection at MR imaging with fat suppression
J Scheidler1, A F Heuck, M Steinborn
1Department of Diagnostic Radiology, Klinikum Grosshadern, Ludwig Maximilians University of Munich, Germany.
Purpose:
To evaluate detection of parametrial invasion at magnetic resonance (MR) imaging with fat suppression.
Materials And Methods:
In 35 patients with cancer of the cervix, MR imaging was performed with the following sequences: T2-weighted turbo spin echo (SE), turbo short inversion time inversion recovery (STIR), and unenhanced or gadolinium-enhanced T1-weighted SE with and without excitation-spoiling fat suppression. Images obtained with each sequence were evaluated for parametrial invasion by two blinded radiologists separately, who scored their level of diagnostic confidence from 0 to 10 (no confidence to high confidence). Then, all images were evaluated together and findings were correlated with histopathologic findings.
Results:
No statistically significant differences were found between staging with T2-weighted turbo SE, turbo STIR, and T1-weighted fat-suppressed gadolinium-enhanced SE images. Staging with T1-weighted SE, T1-weighted gadolinium-enhanced SE, and T1-weighted fat-suppressed SE images was significantly worse (P < .05). Diagnostic confidence was lower (P < .001) with T1-weighted gadolinium-enhanced SE and T1-weighted fat-suppressed gadolinium-enhanced SE images (5.5 and 6.2 points, respectively) compared to staging with T2-weighted turbo SE and turbo STIR images (8.2 and 7.6 points, respectively). No statistically significant improvement in staging accuracy was found when all images were evaluated together.
Conclusion:
In MR diagnosis of parametrial invasion, the addition of fat-suppressed or gadolinium-enhanced MR images did not improve the accuracy with T2-weighted turbo SE images alone.
Insights
Magnetic resonance (MR) imaging for cervical cancer staging showed that T2-weighted sequences alone are sufficient for detecting parametrial invasion. Adding fat suppression or gadolinium enhancement to MR imaging did not improve diagnostic accuracy.
Area of Science:
- Radiology
- Oncology
- Medical Imaging
Background:
- Parametrial invasion is a critical factor in staging cervical cancer.
- Accurate detection of parametrial invasion impacts treatment decisions and patient prognosis.
- Magnetic resonance (MR) imaging is a key modality for evaluating cervical cancer spread.
Purpose of the Study:
- To evaluate the effectiveness of fat suppression in magnetic resonance (MR) imaging for detecting parametrial invasion in cervical cancer.
- To compare the diagnostic performance of different MR imaging sequences for parametrial invasion.
Main Methods:
- MR imaging was performed on 35 cervical cancer patients using T2-weighted turbo spin echo (SE), turbo short inversion time inversion recovery (STIR), and T1-weighted SE sequences (unenhanced and gadolinium-enhanced with/without fat suppression).
- Two blinded radiologists independently assessed images for parametrial invasion, scoring diagnostic confidence.
- Findings were correlated with histopathologic results.
Main Results:
- No significant differences in staging accuracy were found between T2-weighted turbo SE, turbo STIR, and T1-weighted fat-suppressed gadolinium-enhanced SE images.
- Staging accuracy was significantly worse with T1-weighted SE, T1-weighted gadolinium-enhanced SE, and T1-weighted fat-suppressed SE images compared to T2-weighted sequences.
- Diagnostic confidence was lower with T1-weighted enhanced and fat-suppressed enhanced sequences compared to T2-weighted sequences.
Conclusions:
- The addition of fat-suppressed or gadolinium-enhanced MR images does not improve the accuracy of T2-weighted turbo SE images for diagnosing parametrial invasion in cervical cancer.
- T2-weighted turbo SE imaging alone appears sufficient for evaluating parametrial invasion.