Added-Value of Diffusion-Weighted Imaging (DWI) and Dynamic Contrast-Enhanced (DCE-MRI) Magnetic Resonance Imaging in the Preoperative Assessment of Cervical Cancer

Purpose: To evaluate the added-value of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in the preoperative assessment of carcinoma cervix.

Methods: This prospective study was carried out on histopathologically proven 45 patients of carcinoma cervix presented to a tertiary care hospital with bleeding per vagina between August 2017 and July 2018. Relevant local per vaginal examination and MRI examination of the pelvis were performed.

Results: A total of 45 patients with carcinoma of the cervix, having 11 patients (24.4%) in Stage-I, 22 patients (48.9%) in Stage-II, 3 patients (6.7%) in Stage-III and 9 patients (20%) in stage-IV, were included in this study sample. The mean ADC value of the carcinoma of cervix was 0.802 ± 0.123 [SD] × 10^-3 mm²/s. The stage-I carcinoma cervix had a mean ADC value of 0.915 ± 0.109 [SD] × 10^-3 mm²/s, Stage-II 0.778 ± 0.099 [SD] × 10^-3 mm²/s, Stage-III 0.762 ± 0.123 [SD] × 10^-3 mm²/s and Stage-IV 0.737 ± 0.116 [SD] × 10^-3 mm²/s. ROC curve analysis showed the percentage of signal intensity changes within cervical tumor on arterial phase of DCE-MRI had a threshold value of 42.25 in differentiating Stage-I carcinoma of cervix from other stages with a sensitivity of 81.8% and specificity of 44.1%.

Conclusion: The DWI and DCE-MRI added valuable inputs over conventional MR sequences in the early diagnosis and preoperative staging of carcinoma cervix. DCE-MRI had a high accuracy for assessing the cervical stromal and parametrial invasions, which helps in selecting the optimal therapeutic protocol and prognostication in gynecological malignancies.