Diffusion-weighted Imaging in Cervical Cancer with an Endovaginal Technique: Potential Value for Improving Tumor Detection in Stage Ia and Ib1 Disease

Charles-Edwards, Elizabeth; Messiou, Christina; Morgan, Veronica A.; Silva, Sonali S. De; McWhinney, N.; Katesmark, M; Attygalle, Ayoma; deSouza, Nandita M.

doi:10.1148/radiol.2491072165

Cited by 107 publications

(69 citation statements)

References 32 publications

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“…In our study, the ADC threshold value for differentiating between cancer-affected and non-affected cervical tissues was 0.945 × 10 -3 mm 2 /s. The differences of the ADC threshold values in our research and the cited clinical trials may be dependent on the MRI equipment, test protocols and the insufficient number of patients in other groups (17,22,23). In addition, our study revealed 0.830 × 10 -3 mm 2 /s ADC threshold value differentiating residual tumor tissue and healthy tissue of the uterine cervix after chemoradiation therapy.…”

Section: Discussionmentioning

confidence: 57%

“…To sum up, the ADC numeric value of cervical cancer is significantly lower than of the unaffected cervical tissue (14)(15)(16)(17)(18)(21)(22)(23). The differences between the ADC numerical values obtained in various clinical studies may be related to the MRI equipment, differences of the study protocols (b values of 50, 400, 800 s/mm 2 and b values of 0, 300, 600 s/mm 2 ) and the insufficient number of subjects in some groups.…”

Section: Discussionmentioning

confidence: 99%

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Diffusion-weighted magnetic resonance imaging of cervical cancer

Atstupėnaitė¹,

Basevičius²,

Krimelis³

et al. 2011

AML

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Background. Diffusion-weighted magnetic resonance imaging (DW–MRI) has been employed in the diagnostics of malignant tumors of abdomen and pelvis relatively recently. Nowadays, there exists a particular interest in adaptation DW–MRI for assessing the response of tumors to chemoradiaton therapy. The aim of our study was to compare the mean value of the apparent diffusion coefficient (ADC) in a healthy cervix, cancer-affected cervix and a cervix after chemoradiation therapy, as well as to identify the ADC range typical of cervical cancer. Materials and methods. The study enrolled 108 female patients who underwent pelvic MRI in the Lithuanian University of Health Sciences Kaunas Clinics Hospital in 2008–2010. The study group consisted of 65 patients in whom cervical cancer had been clinically suspected and confirmed by biopsy before MRI examination. All these patients underwent pelvic MRI twice: before the chemoradiation therapy and 6 months after the therapy. The control group consisted of 43 patients in whom cervical cancer had been not suspected and MRI was performed because of other pelvic diseases. Results. The mean ADC value of the study group (0.658 ± 0.118 × 10–3 mm2/s) was lower than of the control group (1.171 ± 0.143 × 10–3 mm2/s) (t = 20.315, p = 0.03). The ADC threshold value of 0.945 × 10–3 mm2/s was defined, differentiating the cancer-affected cervical tissue from the normal. The mean ADC value of the patients who responded to chemoradiation therapy (1.111 ± 0.138 × 10–3 mm2/s) increased and in those who did not respond it remained lower (0.733 ± 0.073 × 10–3 mm2/s) (t = 9.518, p = 0.04). The ADC threshold value of 0.830 × 10–3 mm2/s was defined, differentiating the residual tumor tissue from the healthy cervical tissue after chemoradiation therapy. Conclusions. The ADC value in the case of cervical cancer was significantly lower than in the non-affected cervical tissue. The ADC value increases after effective chemoradiation therapy and becomes closer to the coefficient value of non-affected cervical tissue, but still remains lower. The 0.945 × 10–3 mm2/s ADC threshold was detected while differentiating between cancer-affected and normal cervical tissues, while the ADC threshold was 0.830 × 10–3 mm2/s when differentiating between residual tumor tissue and healthy cervical tissue after chemoradiation therapy at a high sensitivity and specificity. Keywords: diffusion-weighted magnetic resonance imaging, apparent diffusion coefficient, cervical cancer, chemoradiation therapy

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Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Diffusion-weighted magnetic resonance imaging of cervical cancer

Atstupėnaitė¹,

Basevičius²,

Krimelis³

et al. 2011

AML

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“…In large tumors, peritumoral edema due to tumor inflammation or post-biopsy changes may be mistaken for tumor. In such cases, DWI may be of value, since edema lacks molecular restriction [34] .…”

Section: Patients With Large Tumors (≥ 4 CM Figo ⅰB2-ⅱa)mentioning

confidence: 99%

“…Cervical invasive carcinoma exhibits significantly lower ADC values than normal cervix, facilitating tumor detection and definition of extent. It may also be used to discriminate between post-biopsy changes and residual cancer; however, haemorrhage may also exhibit restricted diffusion and may, therefore, be responsible for false positive results [34,51] . DWI is excellent in identifying small, even a few mm, lymph nodes; however, so far it has not been able to discriminate between normal and malignant nodes.…”

Section: Mri Protocolsmentioning

confidence: 99%

Current imaging strategies for the evaluation of uterine cervical cancer

Bourgioti

Chatoupis

Moulopoulos

2016

WJR

105

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Uterine cervical cancer still remains an important socioeconomic issue because it largely affects women of reproductive age. Prognosis is highly depended on extent of the disease at diagnosis and, therefore, accurate staging is crucial for optimal management. Cervical cancer is clinically staged, according to International Federation of Gynecology and Obstetrics guidelines, but, currently, there is increased use of cross sectional imaging modalities [computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography-CT (PET-CT)] for the study of important prognostic factors like tumor size, parametrial invasion, endocervical extension, pelvic side wall or adjacent/distal organs involvement and lymph node status. Imaging indications also include cervical cancer follow-up, evaluation of tumor response to treatment and selection of suitable candidates for less radical surgeries like radical trachelectomy for fertility preservation. The preferred imaging method for local cervical cancer evaluation is MRI; CT is equally effective for evaluation of extrauterine spread of the disease. PET-CT shows high diagnostic performance for the detection of tumor relapse and metastatic lymph nodes. The aim of this review is to familiarize radiologists with the MRI appearance of cervical carcinoma and to discuss the indications of cross sectional imaging during the course of the disease in patients with cervical carcinoma.

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“…Although there is little published data, DWI seems to be a very promising emerging technique in the evaluation of uterine cervical cancer [8,[22][23][24][25]. Seven ESUR centres routinely use DWI.…”

Section: Diffusion Weighted Imaging (Dwi)mentioning

confidence: 99%

Staging of uterine cervical cancer with MRI: guidelines of the European Society of Urogenital Radiology

Balleyguier

Sala

Cunha³

et al. 2010

Eur Radiol

270

199

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Objective: To design clear guidelines for the staging and follow-up of patients with uterine cervical cancer, and to provide the radiologist with a framework for use in multidisciplinary conferences. Methods: Guidelines for uterine cervical cancer staging and follow-up were defined by the female imaging subcommittee of the ESUR (European Society of Urogenital Radiology) based on the expert consensus of imaging protocols of 11 leading institutions and a critical review of the literature. Results: The results indicated that high field Magnetic Resonance Imaging (MRI) should include at least two T2-weighted sequences in sagittal, axial oblique or coronal oblique

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Diffusion-weighted Imaging in Cervical Cancer with an Endovaginal Technique: Potential Value for Improving Tumor Detection in Stage Ia and Ib1 Disease

Abstract: ADCs from invasive cervical carcinoma are significantly lower than those from nontumor epithelium; good interobserver agreement by using T2-weighted and DW MR imaging makes this technique potentially useful to help detect early-stage disease.

Cited by 107 publications

References 32 publications

Diffusion-weighted magnetic resonance imaging of cervical cancer

Diffusion-weighted magnetic resonance imaging of cervical cancer

Current imaging strategies for the evaluation of uterine cervical cancer

Staging of uterine cervical cancer with MRI: guidelines of the European Society of Urogenital Radiology

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