Role of Diffusion Weighted MRI in Diagnosis of Cervical Cancer

Abstract

Background: Diffusion weighted magnetic resonance imaging (DW-MRI) is a functional, non-invasive imaging technique which generates tissue contrast from differences in mobility of water molecules that occurs during an MR pulse sequence. Information regarding the integrity of cellular membranes and tissue cellularity can be obtained, so that DW-MRI can now be included in routine patient assessment. Aim of the Work: The aim of this study is to evaluate the role of DW-MRI in the diagnosis of cervical carcinoma, withpathological diagnosis was taken as the reference. Patients and Methods: This is a retrospective study that included 20 patients in whom cervical cancer had been suspected clinically or by transvaginal ultrasound (U/S) and the control group consisted of 20 patients in whom cervical cancer had not been suspected and MRI was performed because of other Pelvic diseases. The study was conducted in El-Demerdash Hospital. The patients were referred from the Gynecology Department to the Radiology Department (Women’s imaging unit) for further MRI assessment with diffusion weighted images (DWIs). Results: Lesions in all cases show restricted diffusion, however on apparent diffusion coefficient (ADC) map, only one case showed high signal proved to be chronic cervicitis on histopathology. Also, the mean ADC values for malignant lesions were (0.82 x10-3 mm2/sec), while the mean ADC value in the control group was (1.58x10–3 mm2/sec). Therefore, ADC value of (1.04 x10-3 mm2/sec) is a cut off between normal cervical tissue and malignant cervical lesion by sensitivity 95% and specificity 95 %. DWIs had elicited the same accuracy to Dynamic contrast-enhanced (DCE) sequences (95%) when added to the non-contrast MRI in the estimation of cancer cervix. Conclusion: Our results proved that (DW–MRI) was significantly beneficial in terms of diagnostic performance that increases the radiologist’s confidence in image interpretation. So, it implies a non-invasive technique which can be used especially if contrast intake is avoided as in pregnancy. Thus, we suggest that DWI should be included in the routine pelvic MRI protocol. The ADC value in case of cervical carcinoma was significantly lower than in the normal cervical tissue. The ADC threshold of (1.04 x10-3 mm2/sec) was a cut off value, which was detected when differentiating between cancer-affected and non-affected cervical tissues