MR Imaging of Uterine Cervical Carcinoma: Is Contrast-enhanced Imaging Useful in Staging?

ABSTRACT

PURPOSE: To evaluate the usefulness of contrast-enhanced T1-weighted MR imaging in the diagnosis and stagingof uterine cervical carcinoma. MATERIALS AND METHODS: MR images (T1WI, T2WI and CE-T1WI) of 40 patients withhistologically proven uterine cervical carcinoma were reviewed by three radiologists. Tumor visualization, signalintensity, degree of enhancement, delineation of tumor margin, assessment of parametrial involvement, andevaluation of pelvic lymph node metastasis were analynized on each sequence, retrospectively. We compared theaccuracy of CE-T1WI with that of T2WI in the diagnosis and staging of uterine cervical carcinoma. RESULTS: Tumorswere detected in 35/40 cases (87.5%) on T2WI, and in 34/40 (85.0%) on CE-T1WI. On T2WI, signal intensities of allvisualized tumors were more hyperintense than those of normal cervical stroma. The signal intensities of enhancedtumors were lower(79.4%), similar to (5.9%), or higher than (14.7%) those of well-enhanced normal myometrium. Inthe assessment of parametrial involvement and the evaluation of pelvic lymph node metastasis, accuracy during eachsequence was 85.7% (12/14) and 100% (28/28), respectively. With regard to delineation of tumor margin, nostatistical difference was found between CE-T1WI and T2WI, though in cases of lesions greater than 3 cm in maximalsize, the margin was clearer in 14 cases, and less clear in 4 cases, on CE-T1WI than on T2WI, with a significantstatistical difference. The accuracy of tumor staging was 78.6% (11/14) on T2WI, and 71.4% (10/14) on CE-T1WI. CONCLUSION: There was no significant statistical difference in tumor visualization, accuracy of staging, andevaluation of pelvic lymph node metastasis between T2W1 and CE-T1WI. CE-T1WI was superior to T2WI in delineatingthe margin of tumors more than 3 cm in maximal size. Contrast-enhanced T1WI appears to be useful for evaluatingthe extent of large cervical carcinomas.