BACKGROUND The evaluation of residual disease (RD) after chemoradiation therapy (CRT) in stage IB2/II cervical carcinoma conventionally is based on a clinical examination and magnetic resonance imaging (MRI) performed 3 to 8 weeks after the end of treatment. Very few studies have correlated MRI and histologic findings specifically in cervix cancer. This was the objective of the current study. METHODS A retrospective review was undertaken of patients who fulfilled the following inclusion criteria: 1) stage IB2/II cervical cancer, 2) external radiotherapy (45 grays [Gy]) was given with concomitant chemotherapy followed by uterovaginal brachytherapy (15 Gy), 3) MRI studies were obtained between 3 weeks and 8 weeks after brachytherapy, and 4) completion surgery included at least a hysterectomy. Postsurgical histologic findings and MRI results were compared. RESULTS Forty‐four patients who were treated between 2003 and 2006 fulfilled all inclusion criteria. Twelve patients (27%) had achieved a radiologic complete response, 16 patients (36.5%) had unclassified lesions (RD or ‘fibrosis’), and 16 patients (36.5%) had radiologic residual tumor. According to the histologic results, 19 patients (43%) had no RD, 10 patients (23%) had inframillimeter RD, 2 patients (5%) had RD that measured <1 cm, and 13 patients (29%) had RD that measured >1 cm. The sensitivity and specificity of MRI in evaluating RD were 80% and 55%, respectively. CONCLUSIONS The current results indicated that the evaluation of RD 3 to 8 weeks after CRT with MRI is difficult, and the risk of false‐positive results is high. Another radiologic procedure or a more technologically advanced MRI technique, such as diffusion‐weighted MRI, should be evaluated. Cancer 2008. © 2008 American Cancer Society.

Although dynamic MRI shows excellent inter- and intra-observer reliability, its agreement with clinical examination is poor whatever the line used.

Magnetic resonance imaging (MRI) remains the standard modality for the local staging of gynecological malignancies but it has several limitations, particularly for lymph node staging or evaluating peritoneal carcinomatosis. Consequently, there has been a growing interest in functional imaging modalities. Based on molecular diffusion, diffusion‐weighted imaging (DWI) is a unique, noninvasive modality that provides excellent tissue contrast and was shown to improve the radiological diagnosis of malignant tumors. Using quantitative apparent diffusion coefficient (ADC) measurement of DWI provides a new tool for better distinguishing malignant tissues from benign tumors. The aim of the present review is to report on the results of DWI for the assessment of patients with gynecological malignancies. An analysis of the literature suggests that DWI studies would improve the diagnosis of cervical and endometrial tumors. It may also improve the assessment of tumor extension in patients with peritoneal carcinomatosis from gynecological malignancies. However, since the signal intensity of some cancers can range from high intensity to low intensity, a degree of uncertainty was demonstrated due to the proximity of the normal uterine myometrium and ovaries. Interestingly, there is also evidence that ADC might improve the follow‐up and monitoring of patients who receive anticancer therapies, including chemotherapy or radiation therapy. J. Magn. Reson. Imaging 2011;33:1020–1027. © 2011 Wiley‐Liss, Inc.

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