PET/CT and MRI in the imaging assessment of cervical cancer

Abstract

Imaging plays a central role in the evaluation of patients with cervical cancer and helps guide treatment decisions. The purpose of this pictorial review is to describe magnetic resonance (MR) imaging and positron emission tomography (PET)/computed tomography (CT) assessment of cervical cancer, including indications for imaging, important findings that may result in management change, as well as limitations of both modalities. The International Federation of Gynecology and Obstetrics cervical cancer staging system does not officially include imaging; however, the organization endorses the use of MR imaging and PET/CT in the management of patients with cervical cancer where these modalities are available. MR imaging provides the best visualization of the primary tumor and extent of soft tissue disease. PET/CT is recommended for assessment of nodal involvement, as well as distant metastases. Both MR imaging and PET/CT are used to follow patients post-treatment to assess for recurrence. This review focuses on the current MR imaging and PET/CT protocols, the utility of these modalities in assessing primary tumors and recurrences, with emphasis on imaging findings which change management and on imaging pitfalls to avoid. It is important to be familiar with the MR imaging and PET/CT appearance of the primary tumor and metastasis, as well as the imaging pitfalls, so that an accurate assessment of disease burden is made prior to treatment.

Three‐Dimensional Transvaginal Sonography and Magnetic Resonance Imaging for Local Staging of Cervical Cancer

“…In fact, a recent study performed by expert examiners confirmed these limitations 20 . However, as stated above, MRI also has limitations for this task 6 …”

“…Magnetic resonance imaging is currently considered the first‐line imaging technique for assessing the local extent in cervical cancer 6 , 7 . However, this technique has some limitations for assessing lymph node involvement.…”

“…However, this technique has some limitations for assessing lymph node involvement. For this reason, positron emission tomography/CT is preferred for evaluating the nodal status and extrapelvic disease 6 , 7 …”

“…Specifically, parametrial infiltration may be underestimated in 13% to 25% of stages IB through IIA 4 , 5 . For this reason, the use of imaging techniques as complementary tools for locoregional staging is currently advised 6 …”

Patterns of care survey: Radiotherapy for women with locally advanced cervical cancer

“…Target delineation, choice of treatment technique and dose prescription for cervical cancer patients may all be influenced by PET-CT and might also obscure the comparability of treatment results between centres [20][21][22][23].…”