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Objectives: To investigate prognostic values of maximum standardized lymph node (LN) uptake (SUVmax), minimum apparent LN diffusion coefficient (ADCmin), and LN short-axis length in women with cervical cancer., Study Design: Retrospective review of diffusion-weighted magnetic resonance imaging (DWI) and positron emission tomography/computed tomography (PET/CT) of LN confined to the pelvis in 80 cervical cancer patients before undergoing radiotherapy (RT) with or without concurrent chemotherapy. Optimal cut-off values for disease-free survival (DFS) and overall survival (OS) were determined by receiver operating characteristic (ROC) curve analysis. We used ROC curve analyses to evaluate whether LN SUVmax, LN ADCmin and LN short-axis length predicted risk of recurrence or survival., Results: Median DFS and OS for all patients were 18.97 and 22.28 months, respectively. DFS and OS rates of patients with high LN SUVmax was significantly lower than those of patients exhibiting low LN SUVmax (P=0.003 and P=0.019). Patients with low LN ADCmin had poorer DFS and OS than those with high LN ADCmin (P=0.033 and P=0.005). DFS for patients exhibiting longer LN short-axis length was significantly lower than those of patients exhibiting shorter LN short-axis length (P=0.018). Multivariate analyses indicated that high LN SUVmax was an independent predictor for both DFS and OS (P=0.0231 and P=0.0146)., Conclusions: LN SUVmax could be an important predictor of recurrence and survival in patients with cervical cancer confined to the pelvis., (Copyright © 2013. Published by Elsevier Ireland Ltd.)

The objective of this study was to investigate the correlation of pretreatment and posttreatment measurements as the mean apparent diffusion coefficient (ADCmean) by diffusion-weighted magnetic resonance imaging (DWI) findings with prognostic factors in patients with squamous cell carcinoma (SCC) of primary cervical cancer. The pretreatment and posttreatment ADCmean of the primary tumor were examined for their correlations with the prognosis in 69 patients with SCC of primary cervical cancer by radiotherapy (RT) with or without concurrent chemotherapy (CCRT). The median disease-free survival (DFS) and overall survival (OS) times of patients were 20.97 and 23.47 months (follow-up periods for DFS and OS: 1-72 and 1-72 months). The DFS and OS rates of patients with low pretreatment and posttreatment ADCmean of the primary tumor were also significantly worse than those of patients exhibiting high pretreatment and posttreatment ADCmean of the primary tumor (DFS; P = 0.0130 and P < 0.0001, OS; P = 0.0010 and P < 0.0001). Multivariate analyses showed that low posttreatment ADCmean of the primary tumor was an independent prognostic factor for DFS and OS (P < 0.0001 and P < 0.0001). The low posttreatment ADCmean of the primary tumor is a useful clinical prognostic biomarker for recurrence and survival in patients with cervical cancer.

Objective: The purpose of this study is to investigate the correlation of the max, mean and minimal apparent diffusion coefficient values (ADCmax, ADCmean, and ADCmin) on diffusion weighted imaging findings with prognostic factors in cervical cancer., Methods: A cohort of 80 cervical cancer patients underwent pelvic magnetic resonance imaging (MRI) within the 2 to 4 weeks prior to radical hysterectomy. The optimal cutoff value for segregating disease free survival (DFS) was determined by receiver operating characteristic (ROC) curve analysis. We used ROC curve analyses to evaluate whether preoperative ADCmax, ADCmean, ADCmin on MRI predicted the risk group of recurrence., Results: Analyses of ROC curves identified an optimal The ROC curves identified an optimal ADCmax, ADCmean, and ADCmin cutoff values of 1.122 × 10(-3)mm(2)/s, 0.852 × 10(-3)mm(2)/s, 0.670 × 10(-3)mm(2)/s and for predicting the recurrence of cervical cancer. The patients categorized into the lower ADCmean or ADCmin groups showed the shorter disease free survivals compared with the higher ADCmean or ADCmin, respectively (P<0.0001 or P=0.0210). In particular, the ADCmean of primary cervical cancer was an independent predictive factor for disease recurrence by a multivariate analysis (P=0.0133)., Conclusions: The ADCmean of primary cervical cancer calculated by MRI could be an important factor for identifying patients with a risk of disease recurrence., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Purpose: The objectives of this study were to determine if measurements of the maximum standardized uptake value (SUVmax) by positron emission tomography/computed tomography and minimum apparent diffusion coefficient (ADCmin) by magnetic resonance imaging are correlated with the clinical characteristics and prognosis of primary cervical cancer., Methods: The correlations between biological parameters and prognosis and SUVmax and ADCmin of the primary tumour were determined in 66 patients with cervical cancer before radiotherapy or concurrent chemoradiotherapy., Results: There were significant correlations between SUVmax of the primary tumour and FIGO stage (p = 0.036), tumour maximum size (p = 0.018) and pelvic lymph node metastasis (p = 0.044). The median durations of disease-free survival (DFS) and overall survival (OS) were 16.1 and 19.2 months, respectively. The DFS and OS of patients exhibiting high SUVmax of the primary tumour were significantly lower than those of patients exhibiting low SUVmax of the primary tumour (p = 0.0171 and p = 0.0367). The OS of patients exhibiting low ADCmin of the primary tumour was significantly lower than that of patients exhibiting high ADCmin of the primary tumour (p = 0.0376). The DFS and OS of patients exhibiting high SUVmax together with low ADCmin of the primary tumour were significantly lower (p = 0.003 and p = 0.001). Multivariate analyses showed that high SUVmax together with low ADCmin of the primary tumour was an independent prognostic factor for both DFS (p = 0.0030) and OS (p = 0.0036)., Conclusion: High SUVmax together with low ADCmin of the primary tumour is an important predictive factor for identifying patients with cervical cancer who have a poor prognosis.

The purpose of this study was to investigate the efficacy of dynamic MR imaging in the assessment of parametrial involvement by cervical carcinoma with full-thickness stromal invasion on thin-section oblique axial T2-weighted images. Dynamic MR images of 24 patients with cervical carcinoma with full-thickness stromal invasion on thin-section oblique axial T2-weighted images were evaluated with pathologic correlation. Dynamic MR imaging was performed using a turboFLASH, 3D-FISP, or 2D-FLASH technique. The imaging planes of dynamic MR imaging were oblique axial planes of the uterine cervix. Dynamic MR imaging was performed twice, once for the early phase (40 to 60 sec after the administration of contrast media) and once for the late phase (5 min). Contrast enhancement of the tumor was divided into six types. Type I, cervical stroma with low signal intensity surrounding a tumor with high signal intensity, was seen in the early phase of dynamic MR imaging; type II-RR, the hyperintense rim was seen from the early phase to the late phase; type II-RO, the hyperintense rim was seen in the early phase only; type II-OR, the hyperintense rim was seen in the late phase only; type II-O, the hyperintense rim was not seen at all; and type III, tumor invasion with high signal intensities was seen beyond the cervical stroma in the early phase of dynamic MR imaging. The numbers for each type of cervical carcinoma on dynamic MR images were as follows: type I, four parametrial sites; type II-RR, 0; type II-RO, 0; type II-OR, 13; type II-O, 14; and type III, one. Three-dimensional diameters (transverse, craniocaudal, and anteroposterior) of the primary tumor were measured using dividers. All parametrial sites of type I and type II-OR showed no parametrial involvement. One parametrial site of type III and three parametrial sites of type II-O showed parametrial involvement, and 11 of type II-O showed no parametrial involvement. None of the patients showed type I-RR or type II-RO. When type I and type II-OR were categorized as criteria of no parametrial involvement and type III and transverse diameters of 3.5 cm or over classified as type II-O were categorized as criteria of parametrial involvement, the rate of diagnostic accuracy was 95.8%. Dynamic MR imaging is considered to be substantially useful in the assessment of parametrial involvement with cervical carcinoma with full-thickness stromal invasion by thin-section oblique axial T2-weighted images.

Purpose: The purpose of this work was to investigate the relationship between tumor size on T2-weighted images and parametrial involvement by cervical carcinoma with full-thickness stromal invasion and to evaluate whether the size of the tumor on T2-weighted images is a useful index of parametrial involvement., Method: T2-weighted images of 33 patients with cervical carcinoma showed full-thickness stromal invasion. Three-dimensional diameters (transverse, anteroposterior, and craniocaudal) of the primary tumor were measured on T2-weighted images. The area and volume of the tumor were also calculated., Results: There were statistically significant differences between the patients with parametrial involvement and those without parametrial involvement for each tumor size. The criteria that showed the best accuracy for each tumor size were determined., Conclusion: The tumor size on T2-weighted images is considered to be a useful index for evaluating parametrial involvement by cervical carcinoma with full-thickness stromal invasion.

Objective: We attempted to prospectively determine the role of magnetic resonance imaging (MRI) in very early cervical cancer., Study Design: T2-weighted and T1-dynamic enhanced images from patients with invasive or noninvasive lesions of the cervix were reviewed by two radiologists who had no clinical information on these patients. At least 12 longitudinal sections prepared from the surgically removed cervix were reviewed by a pathologist. The correlation between MRI and histological findings was analyzed in terms of depth of invasion., Results: Seventy-nine cases were entered into the study and 75 were evaluable. Accuracy of T2 MR images for invasive and noninvasive disease by Radiologist 1 and Radiologist 2 was 0.8533 and 0.7733, respectively. Accuracy was greater (0.9867 and 0.9467, respectively) for the detection of noninvasive plus microinvasive lesions 5 mm. Dynamic technique provided only limited additional value in the detection of microinvasive cervical carcinoma., Conclusion: Simple T2 MRI is useful in differentiating noninvasive or microinvasive cervical lesions from invasive cervical carcinoma of the cervix >5 mm., (Copyright 2000 Academic Press.)

The aim of this study was to prospectively determine if invasive carcinoma of the cervix can be ruled out by negative magnetic resonance image (MRI) findings. Eligible patients were those who were scheduled to undergo either hysterectomy or conization because of invasive or non-invasive lesions of the cervix. T2-weighted and T1-dynamic enhancement images were reviewed by two radiologists who had no information on these patients except for the preoperative diagnosis. Clinical information regarding location of the disease was not given. At least 12 longitudinal sections prepared from the surgically removed cervix were reviewed by a pathologist who was not provided with MRI information. The correlation between MRI and histological findings was analyzed in terms of depth of invasion. Seventy cases were entered and 66 were evaluable. Sensitivities of T2 and dynamic MRI for invasive and non-invasive disease by radiologist 1 were 0.8824 and 0.8235, respectively, and those by radiologist 2 were 0.6296 and 0.7647, respectively. Specificities were 0.8776 and 0.8571, respectively, for radiologist 1 and 0.8974 and 0.8367, respectively, for radiologist 2. When sensitivities and specificities were calculated for prediction of non-invasive plus microinvasive lesions < or = 5 mm vs. invasive lesions > 5 mm, specificities of T2 and dynamic MRI became 1.0000 for both radiologists. Negative findings on T2 and/or dynamic MRI indicated non-invasive or early invasive cervical diseases < or = 5 mm. The dynamic technique provided only limited additional value in the detection of early invasive cervical carcinoma.

Background: To investigate the efficacy of thin-section oblique axial T2-weighted images in the assessment of parametrial invasion by cervical carcinoma., Methods: One hundred parametria of 50 patients with cervical carcinoma were evaluated with pathologic correlation. We compared the sensitivity, specificity, and diagnostic accuracy in the assessment of parametrial invasion by cervical carcinoma between axial T2-weighted images and thin-section oblique axial T2-weighted images., Results: Thin-section oblique axial T2-weighted images provided accurate cross sections of the cervix with excellent detail and detected parametrial invasion more accurately than did axial T2-weighted images showing cross sections of the trunk. Although the sensitivity, specificity, and accuracy for parametrial invasion were 46.4%, 91.7%, and 79.0%, respectively, on axial T2-weighted images, the corresponding values were 67.9%, 97. 2%, and 89.0%, respectively, on thin-section oblique axial T2-weighted images. There were statistically significant differences in the sensitivity (p = 0.014), specificity (p = 0.046), and accuracy (p = 0.002) in detecting parametrial invasion between these two types of images., Conclusions: Thin-section oblique axial T2-weighted images are useful for the assessment of parametrial invasion by cervical carcinoma.

The purpose of this study was to evaluate the characteristic findings of cervical carcinoma in dynamic MR imaging with a turbo-FLASH technique and to investigate the cause of the hyperintense rim surrounding the tumor on dynamic MR images by comparing them with the pathological findings in the resected specimens. Sixty consecutive patients with cervical carcinoma were included in this study. Dynamic MR imaging was performed with the rapid administration of Gd-DTPA using the turbo-FLASH technique. After dynamic MR imaging, T1-weighted spin echo (SE) images were obtained. Dynamic patterns of the lesions were investigated from images acquired in the early and late phases of dynamic MR imaging. The causes of the hyperintense rim were investigated by comparing dynamic MR images with the pathological findings. Most of the cervical carcinomas showed higher signal intensity than normal cervical stroma in the early phase of dynamic MR imaging. The pathological findings of the hyperintense rim on dynamic MR images differed according to the time of appearance of the hyperintense rim. Dynamic MR imaging with the turbo-FLASH technique, which shows high contrast between the lesion and normal cervical stroma, should be performed before obtaining contrast-enhanced T1-weighted SE images in patients with cervical carcinoma.