T2-weighted MRI findings predictive of parametrial involvement in patients with cervical cancer and histologically confirmed full thickness stromal invasion

Charis Bourgioti, Konstantinos Chatoupis, Aristeidis Antoniou, Evangelia Panourgias, Chara Tzavara, Alexandros Rodolakis, Lia Angela Moulopoulos

Abstract


Purpose: To record the T2-weighted imaging (T2WI) appearance of the cervical rim in cervical cancer patients with histologically confirmed full thickness stromal invasion and to identify any signs predictive of parametrial involvement in this particular subset of patients.

Material and Methods: During a 5-year period, 30/115 patients surgically treated for early cervical cancer (FIGO<IIB) had full thickness stromal invasion on surgicopathological examination; 15/30 patients had parametrial invasion on histology. All patients were evaluated with pelvic MRI, preoperatively. Two expert radiologists retrospectively reviewed all MRIs. The presence of the following T2WI characteristics was recorded for each side of the cervical rim: thinning (<3 mm), complete loss of normal hypointense signal, diffuse  signal inhomogeneity, irregularity of inner and outer cervical border and peritumoural fat stranding. The above signs were evaluated alone and in combination in search for any correlation with parametrial involvement.

Results: Diffuse signal inhomogeneity, shaggy inner border and small focal disruptions of the normal low T2 cervical rim were the most frequent findings on T2WI. Diffuse signal inhomogeneity and peritumoural fat stranding were the only MRI features significantly associated with parametrial invasion. Complete loss of the low T2 cervical rim was observed in approximately 25% of patients with parametrial involvement. In 4/15 patients the cervical rim appeared intact.

Conclusions: Diffuse signal inhomogeneity of the cervical rim and peritumoural fat stranding were the only MRI signs significantly associated with parametrial involvement in patients with cervical cancer and full stromal invasion. An intact hypointense cervical rim does not exclude tumour extension to the parametrial fat.


Keywords


cervical cancer; parametria; cervical rim; magnetic resonance imaging

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References


Saatli B, Olgan S, Gorken IB, et al. Tumor-free distance from outermost layer of cervix is of prognostic value in surgically treated cervical cancer patients: A multicenter study. Arch Gynecol Obstet 2014; 289(6): 1331-1335.

Moon SH, Wu HG, Ha SW, et al. Isolated full-thickness cervical stromal invasion warrants post-hysterectomy pelvic radiotherapy in FIGO stages IB-IIA uterine cervical carcinoma. Gynecol Oncol 2007; 104(1): 152-157.

Sedlis A, Bundy BN, Rotman MZ, et al. A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with stage IB carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy: A Gynecologic Oncology Group Study. Gynecol Oncol 1999; 73(2): 177-183.

Takamura A, Mizoe J, Arimoto T, et al. Is postoperative radiotherapy beneficial in the management of stage I-II squamous-cell carcinoma of the uterine cervix with negative metastatic nodes and positive parametrial involvement?: A retrospective review of 70 patients. Asia Oceania J Obstet Gynaecol 1993; 19(2): 145-151.

Shimada M, Kigawa J, Takahashi M, et al. Stromal invasion of the cervix can be excluded from the criteria for using adjuvant radiotherapy following radical surgery for patients with cervical cancer. Gynecol Oncol 2004; 93(3): 628-631.

Pecorelli S. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet 2009; 105(2): 103-104.

Sala E, Wakely S, Senior E, et al. MRI of malignant neoplasms of the uterine corpus and cervix. AJR Am J Roentgenol 2007; 188(6): 1577-1587.

Freeman SJ, Aly AM, Kataoka MY, et al. The revised FIGO staging system for uterine malignancies: Implications for MR imaging. Radiographics 2012; 32(6): 1805-1827.

Bourgioti C, Chatoupis K, Rodolakis A, et al. Incremental prognostic value of MRI in the staging of early cervical cancer: a prospective study and review of the literature. Clin Imaging 2016; 40 (1): 72-78.

Kim SH, Choi BI, Han JK, et al. Preoperative staging of uterine cervical carcinoma: Comparison of CT and MRI in 99 patients. J Comput Assist Tomogr 1993; 17(4): 633-640.

Zand KR, Reinhold C, Haider MA, et al. Artifacts and pitfalls in MR imaging of the pelvis. J Magn Reson Imaging 2007; 26(3): 480-497.

Woo S, Suh CH, Kim SY, et al. Magnetic resonance imaging for detection of parametrial invasion in cervical cancer: An updated systematic review and meta-analysis of the literature between 2012 and 2016. Eur Radiol 2018; 28(2): 530-541.

Sala E, Rockall AG, Freeman SJ, et al. The added role of MR imaging in treatment stratification of patients with gynecologic malignancies: What the radiologist needs to know. Radiology 2013; 266(3): 717-740.

Subak LL, Hricak H, Powell CB, et al. Cervical carcinoma: computed tomography and magnetic resonance imaging for preoperative staging. Obstet Gynecol 1995; 86(1): 43-50.

Seki H, Azumi R, Kimura M, et al. Stromal invasion by carcinoma of the cervix: assessment with dynamic MR imaging. AJR Am J Roentgenol 1997; 168(6): 1579-1585.

Sironi S, De Cobelli F, Scarfone G, et al. Carcinoma of the cervix: Value of plain and gadolinium-enhanced MR imaging in assessing degree of invasiveness. Radiology 1993; 188(3): 797-801.

Park JJ, Kim CK, Park SY, et al. Value of diffusion-weighted imaging in predicting parametrial invasion in stage IA2-IIA cervical cancer. Eur Radiol 2014; 24(5): 1081-1088.

Patel S, Liyanage SH, Sahdev A, et al. Imaging of endometrial and cervical cancer. Insights Imaging 2010; 1(5-6): 309-328.

Kinkel K. Pitfalls in staging uterine neoplasm with imaging: a review. Abdom Imaging 2006; 31(2): 164-173.

Lakhman Y, Akin O, Park KJ, et al. Stage IB1 cervical cancer: Role of preoperative MR imaging in selection of patients for fertility-sparing radical trachelectomy. Radiology 2013; 269(1): 149-158.

Charles-Edwards EM, Messiou C, Morgan VA, et al. Diffusion-weighted imaging in cervical cancer with an endovaginal technique: Potential value for improving tumor detection in stage Ia and Ib disease. Radiology 2008; 249(2): 541-550.




DOI: http://dx.doi.org/10.36162/hjr.v3i1.197

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