Cervical carcinoma: Computed tomography and magnetic resonance imaging for preoperative staging

Subak, Leslee L.; Hricak, Hedvig; Powell, C. Bethan; Azizi, Louisa; Stern, Jeffrey L.

doi:10.1016/0029-7844(95)00109-5

Cited by 350 publications

(175 citation statements)

References 20 publications

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“…CT can detect lymph nodes that are enlarged by more than 1 cm but cannot determine lymph node architecture. 40 Subak et al 35 reviewed studies comparing the accuracy of CT and MRI in the preoperative evaluation of parametrial invasion, disease stage, and lymph node involvement. Yang et al 36 compared helical CT and dynamic MRI, evaluating their sensitivity (64.7% vs. 70.6%), specificity (96.6% vs. 89.9%), positive predictive value (84.6% vs. 66.7%), negative predictive value (90.5% vs. 91.4%), and accuracy (89.5% vs. 85.5%).…”

Section: Computed Tomographymentioning

confidence: 99%

“…49 The absence of parametrial invasion holds great importance in determining whether a patient is a surgical candidate. The reported negative predictive value of MRI in detecting parametrial invasion is approximately 95% 35 ; when the fibrocervical stroma surrounding the tumor is seen as intact on imaging, the possibility of parametrial spread can be readily excluded. In contrast, the positive predictive value for parametrial invasion is considerably lower, because imaging cannot easily distinguish the occurrence of peritumoral reactive changes from the presence of invasive tumor.…”

Section: Mrimentioning

confidence: 99%

“…30 The overall accuracy of MRI staging of cervical cancer is reported to be approximately 90%. 35,49 Dynamic imaging also has been advocated as an aid in predicting tumor response to radiotherapy. [51][52][53] MRI also has been shown to be a cost-effective staging technique.…”

Section: Mrimentioning

confidence: 99%

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Section: Computed Tomographymentioning

confidence: 99%

Section: Mrimentioning

confidence: 99%

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Imaging in cervical cancer

Follen

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et al. 2003

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“…Russell et al, in 1992, reported for the first time on the value of pelvic MRI in designing the lateral fields of the box technique [5] . MRI offers the possibility of visualising the anatomy of the pelvis on all planes and enables much better evaluation of soft tissue structures and tumour depiction than CT [11][12][13][14][15][16] . Russell [3,6,7] .…”

Section: Figurementioning

confidence: 99%

The use of MRI in planning radiotherapy for gynaecological tumours

Barillot

Reynaud-Bougnoux²

2006

Cancer Imaging

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Parameters that significantly influence results in radiation treatment of gynaecological malignancies are mainly related to the tumour characteristics and the radiotherapy technique used. High-dose radiotherapy requires accurate localisation of the tumour volume and its relationship to surrounding normal tissues. For many years the standard technique used for irradiation of the pelvic area was the four-field box technique which offered the potential benefit of the lateral fields to shield the rectum and small bowel. However, this conventional technique was designed according to bony landmarks and offered limited information regarding the topography of the tumour and the flexion of the uterus which are influenced by the tumour burden and bladder and rectal filling. CT and MRI enable the visualisation of the cervix, uterus, vagina, iliac vessels and organs at risk, but MRI allows tumour depiction in all planes. In the early 1990s, several studies reported on the value of pelvic MRI in designing the lateral fields of the box technique. They demonstrated that conventional lateral portals would have resulted in a marginal tumour miss and incomplete coverage of the uterine fundus in more than 50% of cases, thus leading to the conclusion that if a box technique is used its design should be based on sagittal MRI. CT-based 3D planning systems are now routinely used in the vast majority of radiotherapy departments. Target volumes and organs at risk are delineated by the physician on each CT slice in order to conform the radiotherapy fields to the tumour volume. For several reasons, such as distortion and lack of electron density which is essential for dose calculation, the implementation of MRI into radiation treatment planning has its limitations. However, MRI can still be used if planning systems integrate tools for CT/MR image registration. There is little experience in the literature for gynaecological malignancies demonstrating that image fusion allows an improvement of the definition of the target and the organ at risk compared to CT alone. Only a few papers in the literature report on the use of CT/MR image registration in planning the external irradiation of gynaecological tumours. Most demonstrate feasibility, but they fail to quantify the improvement for volume definition compared to the use of CT alone. Finally, recent possibilities offered by MRI technology are promising in the area of brachytherapy planning as the full potential of individually defining and evaluating GTV and CTV based on tumour extent and anatomical structures is exploited.

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“…Also critical is the assessment of prognostic variables such as the depth and width of stromal invasion, local extension into the vagina or the parametrium, as well as the spread of the tumour into the pelvic wall and beyond into the bladder and/or the rectum [1,2,13,15]. In the assessment of primary cervical cancers, the value of MRI is well documented [4,5,16,17]. More recently, increasing amounts of data also have shown that 18 FDG PET may detect an intense metabolic signal at the level of the primary site with a high sensitivity (81-100%) [10,11,12,13,14,18,19,20].…”

Section: T Stagingmentioning

confidence: 99%

Whole-body 18FDG PET plus pelvic MRI in the pre-treatment assessment of cervical cancers: an alternative to the FIGO clinical staging

Belhocine

2004

Gynecol Surg

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Growing evidence indicates that whole-body 18 F-fluorodeoxyglucose positron emission tomography (wb-18 FDG PET) plus pelvic magnetic resonance imaging (pMRI) may significantly improve the pre-treatment staging of primary cervical cancers. Such a combined protocol provides complementary insights into primary tumour delineation, loco-regional involvement and distant spread. As such, pMRI appears particularly reliable for the accurate measurement of tumour size, the detection of parametrial invasion and, even more so, for its exclusion. So far, wb-18 FDG PET yields unique information about extra-pelvic nodal and visceral tumour status. Of note, however, is the limitation of both imaging techniques for the detection of microscopic pelvic lymph node metastases, especially in early stage disease. Promising data also highlight the prognostic value of 18 FDG uptake as a marker of disease aggressiveness and of tumour resistance to treatment. The recent development of combined PET-CT scans as well as the validation of the sentinel node concept in gynaecological malignancies may grant new perspectives for optimal management of cervical cancers in the pre-treatment setting.

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Cervical carcinoma: Computed tomography and magnetic resonance imaging for preoperative staging

Abstract: Compared with CT, MRI offered significantly improved evaluation of tumor size, stromal invasion, and local and regional extent of disease in pre-treatment imaging for cervical cancer.

Cited by 350 publications

References 20 publications

Imaging in cervical cancer

Imaging in cervical cancer

The use of MRI in planning radiotherapy for gynaecological tumours

Whole-body 18FDG PET plus pelvic MRI in the pre-treatment assessment of cervical cancers: an alternative to the FIGO clinical staging

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