Additional diagnostic value of Diffusion-Weighted Magnetic Resonance Imaging to conventional Magnetic Resonance Imaging in local staging of primary uterine cervical cancer

Abstract

Objective: Magnetic resonance (MR) imaging is a helpful modality for detecting and staging gynecological cancers. Diffusion-weighted imaging (DWI) could improve the accuracy rates of MR imaging. The aim of this study was to assess the additional diagnostic value of DWI over conventional MR imaging in assessing the local extent of primary cervical cancer. Method: Forty patients with primary uterine cervical cancer were enrolled in the study, prospectively. All MR examinations were performed using a 1.5 Tesla Unit MR with a body coil. Sagittal and axial T2-weighted MR images, sagittal and axial DWI (at b values of 0, 500,1000 s/mm 2 ) with ADC maps were obtained. The images were evaluated by two different readers independently. The degree of the interobserver agreement between the radiologists was assessed with kappa statistics. Results: Mean age of the study population was 50.7±11.1 years. Kappa values ranged from 0.76 to 1 for both readers indicating excellent agreement. Accuracy rates were as follows for reader 1 respectively with conventional and conventional plus DWI; stromal invasion 0.92/0.95; parametrial invasion 0.87/0.92; vaginal invasion 0.87/0.92; pelvic sidewall invasion 0.90/0.97. Accuracy rates were as follows for reader 2 respectively with conventional and conventional plus DWI images; stromal invasion 0.90/0.95; parametrial invasion 0.87/0.92; vaginal invasion 0.87/0.97; pelvic sidewall invasion 0.90/0.95. Conclusions: MR provides satisfactory accuracy rates in the evaluation of the local extent of uterine cervical carcinoma, and adding DWI improves the diagnostic performance of conventional MR.