The Utility of Contrast-Enhanced Magnetic Resonance Imaging in Uterine Cervical Cancer: A Systematic Review

Abstract

Correct staging of cervical cancer is essential to establish the best therapeutic procedure and prognosis for the patient. MRI is the best imaging modality for local staging and follow-up. According to the latest ESUR guidelines, T2WI and DWI-MR sequences are fundamental in these settings, and CE-MRI remains optional. This systematic review, according to the PRISMA 2020 checklist, aims to give an overview of the literature regarding the use of contrast in MRI in cervical cancer and provide more specific indications of when it may be helpful. Systematic searches on PubMed and Web Of Science (WOS) were performed, and 97 papers were included; 1 paper was added considering the references of included articles. From our literature review, it emerged that many papers about the use of contrast in cervical cancer are dated, especially about staging and detection of tumor recurrence. We did not find strong evidence suggesting that CE-MRI is helpful in any clinical setting for cervical cancer staging and detection of tumor recurrence. There is growing evidence that perfusion parameters and perfusion-derived radiomics models might have a role as prognostic and predictive biomarkers, but the lack of standardization and validation limits their use in a research setting.

An Update on the Role of MRI in Treatment Stratification of Patients with Cervical Cancer

“…Studies have shown that tumours demonstrating lower enhancement (poorly perfused hypoxic tumours are linked to increased aggressiveness, increased risk of metastasis, and treatment failure) had a poorer response to therapy and a lower survival rate. However, the studies did not identify a precise, reproducible value for those parameters, limiting their use in current clinical practice [28].…”

“…A systematic review by Avesani et al did not find strong evidence to indicate contrast-enhanced (CE) sequences to be helpful in the initial staging or the detection of tumour recurrence and did not find CE-MRI could provide any additional information than that obtained from DWI sequences [28]. Combined chemoradiotherapy is the treatment of choice for large cervical cancers.…”