Utilization of functional MRI in the diagnosis and management of cervical cancer

Abstract

IntroductionImaging is integral part of cervical cancer management. Currently, MRI is used for staging, follow up and image guided adaptive brachytherapy. The ongoing IQ-EMBRACE sub-study is evaluating the use of MRI for functional imaging to aid in the assessment of hypoxia, metabolism, hemodynamics and tissue structure. This study reviews the current and potential future utilization of functional MRI imaging in diagnosis and management of cervical cancer.MethodsWe searched PubMed for articles characterizing the uses of functional MRI (fMRI) for cervical cancer. The current literature regarding these techniques in diagnosis and outcomes for cervical cancer were then reviewed.ResultsThe most used fMRI techniques identified for use in cervical cancer include diffusion weighted imaging (DWI) and dynamic contrast enhancement (DCE). DCE-MRI indirectly reflects tumor perfusion and hypoxia. This has been utilized to either characterize a functional risk volume of tumor with low perfusion or to characterize at-risk tumor voxels by analyzing signal intensity both pre-treatment and during treatment. DCE imaging in these situations has been associated with local control and disease-free survival and may have predictive/prognostic significance, however this has not yet been clinically validated. DWI allows for creation of ADC maps, that assists with diagnosis of local malignancy or nodal disease with high sensitivity and specificity. DWI findings have also been correlated with local control and overall survival in patients with an incomplete response after definitive chemoradiotherapy and thus may assist with post-treatment follow up. Other imaging techniques used in some instances are MR-spectroscopy and perfusion weighted imaging. T2-weighted imaging remains the standard technique used for diagnosis and radiation treatment planning. In many instances, it is unclear what additional information functional-MRI techniques provide compared to standard MRI imaging.ConclusionsFunctional MRI provides potential for improved diagnosis, prediction of treatment response and prognostication in cervical cancer. Specific sequences such as DCE, DWI and ADC need to be validated in a large prospective setting prior to widespread use. The ongoing IQ-EMBRACE study will provide important clinical information regarding these imaging modalities.

The Role of Imaging in Cervical Cancer Staging: ESGO/ESTRO/ESP Guidelines (Update 2023)

“…Nevertheless, validation through robust prospective data, before extensive adoption of DWI and DCE-MRI in cervical cancer, is essential. Particular attention must be paid to the use of uniform protocols, standardised nomenclature and correlation of imaging findings with histopathology [41,42]. PET-MRI integration has not yet been shown to significantly improve local staging performance compared to MRI alone [43].…”

Clinical value of conventional magnetic resonance imaging combined with diffusion-weighted imaging in predicting pelvic lymph node metastasis of cervical cancer

“…Furthermore, it can be quantified using apparent diffusion coefficient (ADC). ADC maps can assist in the diagnosis of local malignancy or nodal metastasis, because ADC is lower in malignancies than in normal tissues (12). DWI with ADC has been recognized as a helpful marker for lymph node follow-up after chemoradiotherapy when patients are not suitable for surgery, because changes in ADC values correlate with treatment response (13).…”

18F-FDG PET radiomics-based machine learning model for differentiating pathological subtypes in locally advanced cervical cancer

“…MRI is widely utilized for primary tumor evaluation in cervical cancer. Technological advancements have introduced various functional MR sequences, including DWI, dynamic contrast-enhanced (DCE) imaging, and perfusion-weighted imaging(Matani et al 2022). The DWI sequence enables differentiation of cellular structures based on water molecule diffusion differences, quanti ed by the ADC map.…”

“…DCE imaging is extensively studied and indirectly characterizes tumor perfusion by examining tumor microvasculature. Perfusion-weighted imaging, using a contrast agent such as gadolinium, assesses enhancement and other pharmacokinetic characteristics on T1 or T2-weighted sequences(Matani et al 2022). Wang et al also achieved good differentiation between SCC and AC using a multi-parameter MRI radiomics model based on ADC, enhanced T1-weighted imaging, and other anatomical and functional sequences(Wang et al 2022).…”