The New Indian Journal of OBGYN. 12(1):18-25

Comparative MRI evaluation of carcinoma cervix with and without dynamic contrast enhanced study and its implication in the therapeutic decision making

Jaimala Shaw, Pankaj Sharma, Birma Ram, Sourav Bera, R Ravikumar, Tony Jose

ABSTRACT

Background: Cervical Cancer is the one of the major causes of cancer mortality which accounts for 17% of all cancer deaths among women aged between 30 and 69 years. The International Federation of Gynecology & Obstetrics (FIGO) staging system is widely used for clinical staging. The most important issue in staging of cervical cancer is to detect and identify early disease and magnetic resonance imaging (MRI) is the best single imaging investigation that can accurately determine tumour location, tumour size, depth of stromal invasion and extension into the lower uterine segment and status of locoregional lymph nodes. Objectives: Objectives of this study were to precise and better evaluation of patients with cervical cancer in pretreatment workup, as well as to determine sensitivity & specificity of noncontrast and dynamic contrast enhanced MRI for each predefined parameter those are helpful for FIGO staging. Methods: After obtaining clearance from the institutional ethical committee this randomized prospective comparative study was conducted including total of 50 eligible patients with predefined age group & clinically or biopsy proven cervical cancer with the aim to determine if noncontrast or dynamic contrast enhanced magnetic resonance imaging is better for pretreatment evaluation and appropriate FIGO staging of patients with carcinoma cervix. Results: Data were collected under multiple parameters like tumour size, depth of stromal invasion, vaginal spread, parametrial invasion and extent, involvement of ureter, involvement of pelvic and para aortic lymph nodes with size and distal metastasis. In our study, parametrial invasion was accurately assessed in 56% cases. Dynamic post contrast MRI detected stromal invasion in 24% cases when the depth of invasion varied between 5 – 20 mm and in 32% cases when the depth of invasion was more than 40 mm. The tumours measuring >5mm - <2cm sized tumours are better appreciated by DCEMRI which can be missed by NCMRI. Conclusion: This study has shown that there was a significant difference in radiologic staging of the disease using MRI with and without dynamic contrast enhanced (DCE) MRI. Use of MRI in staging improved the evaluation of parametrium and lymph nodal status thereby helping in the therapeutic decision making. Hence, there is a requirement of routine use of DCE MRI in pretreatment evaluation of carcinoma cervix.