Diffusion tensor imaging determines three-dimensional architecture of human cervix: a cross-sectional study

Objective To determine the microarchitecture of the cervix using high resolution diffusion-tensor (DT) magnetic resonance imaging (MRI). Design Cross-sectional study. Setting Leeds, United Kingdom. Population or Sample Women undergoing hysterectomy for benign pathology. Methods Ex-vivo DT-MRI measurements were obtained using a 9.4T Bruker NMR on seven fixed human cervices obtained at hysterectomy. A deterministic fibre tracking algorithm was used to indirectly visualise underlying fibre organisation. Interregional differences in tissue structure were sought using quantitative measurements of diffusion. Main outcome measures Identification of an occlusive structure in the region corresponding to the internal cervical os. Results Fibre tracking demonstrated two regions: an outer circular and inner longitudinal layer. The total circumferential tract volume (TV) was greatest in the proximal region of the cervix (TV: proximal= 271 ± 198 mm3, middle= 186 ± 119 mm3, distal= 38 ± 36 mm3). Fractional anisotropy (FA) and apparent diffusion coefficient(ADC) measurements were significantly different between regions in all samples (P < 0.0005), indicating greater tract density and organisation towards the internal os. Conclusions Fibre tracking infers a system of dense, well-defined, encircling fibres in the proximal region of the cervix, corresponding to the location of the internal os. These findings may provide evidence of specific anatomic microarchitecture within the cervix able to resist intrauterine forces associated with pregnancy. This article is protected by copyright. All rights reserved.