Fusion imaging of ultrasound and MRI in the assessment of locally advanced cervical cancer: a prospective study

Abstract

BackgroundFusion imaging is a new diagnostic method that integrates MRI and ultrasound. It may improve the detection and staging of locally advanced cervical cancer.ObjectiveTo evaluate the feasibility and accuracy of fusion imaging in patients with locally advanced cervical cancer.MethodsPatients with suspicion of locally advanced cervical cancer at clinical examination and/or imaging, who were candidates for neoadjuvant treatment (chemotherapy or chemoradiation) followed by surgery, were prospectively enrolled between March and November 2018. MRI, ultrasound, and fusion images were obtained before and after neoadjuvant treatment. Feasibility, success of the fusion examination, and time needed to perform fusion studies were evaluated. The rates of concordance between MRI and ultrasound before and after performing fusion, using Cohen, Spearman, and McNemar tests were calculated. The agreement between MRI and ultrasound examination, and the agreement between radiologist and gynecologist during the fusion technique in assessing local extension of disease and the presence of residual disease after neoadjuvant therapy, were also analyzed. The rates of concordance between MRI and ultrasound examination before and after performing fusion imaging, using Cohen’s kappa and Spearman’s rank correlation coefficient were calculated. A McNemar test was used to assess if there were statistical significant differences in the parameters’ agreement before and after performing fusion imaging.Results40 patients were selected and of these, 33 were analyzed. A total of 52 fusion examinations were performed: 33 (63.5%) of 52 at the time of diagnosis and 19 (36.5%) of 52 after neoadjuvant treatment. Fusion imaging was feasible in 50 (96%) of 52 studies. The median overall time of fusion execution was 13 min (range 6–30) and the time spent in performing a fusion examination decreased from the first to the last examination (20 vs 6 min). The agreement between MRI and ultrasound parameters increased after performing fusion, particularly for parametrial infiltration (74% vs 86%, p=0.014 for the right posterior parametrium; 66% vs 80%, p=0.008 for the left posterior parametrium, 70% vs 82%, p=0.014 for the right lateral parametrium).ConclusionsFusion of MRI and ultrasound is feasible in patients with locally advanced cervical cancer and may increase the diagnostic accuracy of the single imaging methods. Fusion provides multiple diagnostic opportunities in gynecological oncology.

Fusion imaging in preoperative assessment of extent of disease in patients with advanced ovarian cancer: feasibility and agreement with laparoscopic findings

“…The sample size was calculated on the basis of our primary objective (to evaluate the feasibility of the procedure). Assuming a success rate for fusion imaging of 97%, according to our previous experience 15 , a confidence level of 95% and a margin of error of 5%, a required sample size of 45 was defined. The study population was described in terms of clinical and demographic features using descriptive statistic techniques, quantitative variables being presented as median and range and qualitative variables as absolute numbers and percentages.…”

“…Fusion imaging is an emerging technique that combines real-time ultrasound examination with other imaging modalities, such as CT, magnetic resonance imaging (MRI) and positron emission tomography. Application of this imaging modality in gynecology has been tested in patients with endometriosis [12][13][14] and those with cervical or vulvar cancer [15][16][17] . To our knowledge, however, no study has evaluated the diagnostic feasibility or the performance of fusion imaging in detecting the extent of disease in patients with advanced ovarian cancer.…”

Accuracy of Ultrasonography and Magnetic Resonance Imaging for Preoperative Staging of Cervical Cancer—Analysis of Patients from the Prospective Study on Total Mesometrial Resection

“…The future of imaging for the pretreatment staging of cervical cancer may develop in two directions: fusion of different modalities, as was shown in a recent study [53], or further improvement of the technology of each method and examiners' expertise. A more precise study on parametrial involvement is needed and could be performed as a sub-analysis within clinical trials on TMMR and EMMR.…”

Magnetic resonance imaging and ultrasound fusion technique in gynecology

“…Recent studies underlined the potential value of fusion imaging for some gynaecological cancers 7,9,10,17 . These studies suggested that fusion of MRI or CT and ultrasound is feasible in patients with locally advanced cervical and ovarian cancers and may increase the diagnostic accuracy of the single imaging methods 10,17 . Another study showed that the visualization of lymph node architecture by linear array or transvaginal ultrasound probe can be dynamically fused and assessed with images from previous cross-sectional studies and may help to identify the target lymph node, guiding the examiner to perform a core needle biopsy or to inject radiotracer for selective surgical nodal excision, according to radio-guided occult lesion localization technique 7 .…”