MR imaging of uterine cevical carcinoma: Is contrast-enhanced imaging useful in staging?

To evaluate the usefulness of contrast-enhanced T1-weighted MR imaging in the diagnosis and staging of uterine cervical carcinoma. MR images (T1WI, T2WI and CE-T1WI) of 40 patients with histologically proven uterine cervical carcinoma were reviewed by three radiologists. Tumor visualization, signal intensity, degree of enhancement, delineation of tumor margin, assessment of parametrial involvement, and evaluation of pelvic lymph node metastasis were analynized on each sequence, retrospectively. We compared the accuracy of CE-T1WI with that of T2WI in the diagnosis and staging of uterine cervical carcinoma. Tumors were detected in 35/40 cases (87.5%) on T2WI, and in 34/40 (85.0%) on CE-T1 WI. On T2WI, signal intensities of all visualized tumors were more hyperintense than those of normal cervical stroma. The signal intensities of enhanced tumors were lower(79.4%), similar to(5.9%), or higher than (14.7%) those of well-enhanced normal myometrium. In the assessment of parametrial involvement and the evaluation of pelvic lymph node metastasis, accuracy during each sequence was 85.7% (12/14) and 100% (28/28), respectively. With regard to delineation of tumor margin, no statistical difference was found between CE-T1WI and T2WI, though in cases of lesions greater than 3 cm in maximal size, the margin was clearer in 14 cases, and less clear in 4 cases, on CE-T1WI than on T2WI, with a significant statistical difference. The accuracy of tumor staging was 78.6% (11/14) on T2WI, and 71.4% (10/14) on CE-T1WI. There was no significant statistical difference in tumor visualization, accuracy of staging, and evaluation of pelvic lymph node metastasis between T2WI and CE-T1WI. CE-T1WI was superior to T2WI in delineating the margin of tumors more than 3 cm in maximal size. Contrast-enhanced T1WI appears to be useful for evaluating the extent of large cervical carcinomas.=20