E1081. Role of MRI for Cervical Cancer: Staging and Treatment Planning
  1. Juan Guerrero-Calderon; University of Alabama at Birmingham
  2. Kristin Porter; University of Alabama at Birmingham
Cervical cancer is the third most common gynecologic malignancy in the US and the most common gynecologic malignancy in the world. Risk stratification determines management for best clinical outcome. However, historically there has been a staging discrepancy between clinical and surgical staging, given the clinical limitation in evaluating important prognostic factors such as parametrial and pelvic sidewall invasion, tumor size, and lymph node metastases. Thus, since 2009, the use of CT and MR imaging to stage cervical tumors has been recommended to evaluate for involvement of the bladder or rectum, associated hydronephrosis, and metastatic disease. Our objective is to discuss the specific benefits provided by MRI for cervical cancer staging and management.

Educational Goals / Teaching Points
We intend to discuss the staging of cervical cancer and show associated MR images, highlighting the accurate depiction of locoregional involvement. We will emphasize the management implications of cervical MRI staging reports and clarify the relevant imaging findings for surgical and radiation planning.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
MRI of the pelvis delineates a T2 intermediate- to high-signal-intensity mass that replaces the low-signal-intensity cervical stroma. Diffusion restriction aids in depiction of poorly circumscribed lesions on DWI and ADC. These MRI features allow highly accurate and sensitive depiction of parametrial invasion (FIGO Stage IIB), which is difficult to assess at clinical examination and has important management implications. Parametrial invasion is a poor prognostic indicator with a high risk for recurrence, which impedes fertility conserving surgery (trachelectomy). Furthermore, T2 images may be used to exclude local invasion into the bladder and rectum (NPV 100%), reducing the need for invasive procedures such as cystoscopy and sigmoidoscopy in patients with equivocal clinical findings. In addition to staging, pelvic MRI is helpful for radiation planning. The degree of ante- or retroversion of the uterus and the degree of vaginal extension of the tumor are important determinants for brachytherapy success. In addition, MRI can be used for post-treatment follow-up to assess treatment response and complications.

MRI findings in conjunction with tumor grade and histologic subtype enable preoperative risk stratification, which guides surgery and chemoradiotherapy decisions. MRI has higher accuracy than clinical examination and surgical staging in delineating local extent of cervical carcinoma. Post-treatment MRI allows evaluation of recurrent disease and post-radiation complications.