Resonance Imaging In Preoperative Staging Research Articles

Role of multi-parametric magnetic resonance imaging in preoperative staging of cervical carcinoma in females

BackgroundIn cervical cancer, accurate diagnosis of parametrial invasion (PMI) helps in determining the next step in management, either surgical resection or neoadjuvant therapy. Cervical cancer staging is still determined according to the clinical findings. But it is widely recognized that there are differences between clinical evaluation and the actual disease extent, particularly for PMI. In this prospective study, we investigate the relationship between clinical staging and magnetic resonance imaging (MRI) staging with post-management findings among patients with cervical cancer who underwent pre-treatment MRI, using fused T2-weighted image/diffusion-weighted imaging (T2/DWI).ResultsBased on examination under anesthesia (EUA), 80% of patients showed PMI, while fused T2/DWI was positive for PMI in 77.5% of patients. In all analyzed cases (40 females), MRI had sensitivity, specificity, and accuracy of 91%, 75%, and 87.5% compared to EUA. In the operated patients (24 females), MRI likewise had sensitivity, specificity, and accuracy of 81.3%, 87.5%, and 83%, respectively. In comparison with the postoperative results, the EUA showed higher sensitivity and accuracy than MRI (92.9% vs. 81.3%) and (83.3% vs. 79.2%), respectively, in the detection of PMI in operated cases. However, MRI was more specific in the PMI detection in cases with cervical cancer than EUA (75% vs. 70%).ConclusionMRI (with the aid of fused T2/DWI) improves the diagnostic performance for the PMI assessment in cases with cervical carcinoma. Therefore, MRI is helpful in choosing surgical candidates.

Three-dimensional transvaginal ultrasound vs magnetic resonance imaging for preoperative staging of deep myometrial and cervical invasion in patients with endometrial cancer: systematic review and meta-analysis.

To evaluate and compare the diagnostic test accuracy (DTA) of three-dimensional transvaginal ultrasound (3D-TVS) and magnetic resonance imaging (MRI) for deep myometrial infiltration (DMI) and cervical invasion for preoperative staging and surgery planning in patients with endometrial cancer (EC). This systematic review and meta-analysis investigated the DTA of MRI and 3D-TVS for DMI and cervical invasion in patients with EC. A literature search was performed using MEDLINE, Scopus, EMBASE, ScienceDirect, The Cochrane library, ClinicalTrials.gov, Cochrane Central Register of Controlled Trials, EU Clinical Trials Register and World Health Organization International Clinical Trials Registry Platform to identify relevant studies published between January 2000 and December 2021. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Five studies, including a total of 450 patients, were included in the systematic review. All five studies compared the DTA of 3D-TVS vs MRI for DMI, and three studies compared the DTA of 3D-TVS vs MRI for cervical invasion. Pooled sensitivity, positive likelihood ratio and negative likelihood ratio for detecting DMI using 3D-TVS were 77% (95% CI, 66-85%), 4.57 and 0.31, respectively. The respective values for detecting DMI on MRI were 80% (95% CI, 73-86%), 4.22 and 0.24. Bivariate metaregression indicated a similar DTA of 3D-TVS and MRI (P = 0.80) for the correct identification of DMI. Pooled ln diagnostic odds ratio for detecting cervical invasion was 3.11 (95% CI, 2.09-4.14) for 3D-TVS and 2.36 (95% CI, 0.90-3.83) for MRI. The risk of bias was low for most of the four domains assessed in QUADAS-2. 3D-TVS demonstrated good diagnostic accuracy in terms of sensitivity and specificity for the evaluation of DMI and cervical invasion, with results comparable with those of MRI. Thus, we confirmed the potential role of 3D-TVS in the preoperative staging and surgery planning in patients with EC. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

A prospective comparison of the diagnostic accuracies of ultrasound and magnetic resonance imaging in preoperative staging of endometrial cancer.

ObjectiveTo compare the diagnostic accuracies of ultrasound and magnetic resonance imaging (MRI) for deep (≥50%) myometrial invasion (DMI) and cervical stromal invasion (CSI) in women with endometrial cancer.MethodsThis was a prospective study at a gynecology clinic for women with postmenopausal bleeding. Between October 2015–October 2018, consecutive women with suspected endometrial cancer based on ultrasound subjective pattern recognition were simultaneously assessed for DMI and CSI on ultrasound. Subsequently, they also underwent preoperative MRI. We compared the diagnostic accuracies of ultrasound and MRI in predicting DMI and CSI with the final histology as the gold standard.ResultsWe included 51 women. The prevalence of DMI and CSI were 22/51 (43%) and 7/51 (14%), respectively. The majority of malignancies were of endometrioid histological subtype (38/51, 75%) and FIGO stage 1 or 2 (40/51, 78%). Ultrasound diagnosed more cases of DMI compared to MRI (19/22 vs. 17/22), however, the difference was not statistically significant. The sensitivities and specificities of ultrasound and MRI for DMI were 86% vs. 77% and 66% vs. 76%, respectively. For CSI, ultrasound and MRI correctly diagnosed the same number of cases (5/7, 71%); their respective false-positive rates were low, 0/44 (0%) and 1/44 (2%). Ultrasound and MRI had a moderate agreement for DMI (ƙ=0.49; 95% confidence interval [CI]=0.26–0.73), whereas the agreement for CSI was substantial (ƙ=0.69; 95% CI=0.36–1.00).ConclusionEndometrial cancer can be simultaneously diagnosed and staged at women’s initial ultrasound assessment. The accuracies of ultrasound for DMI and CSI are comparable to MRI.Trial RegistrationISRCTN Identifier: ISRCTN24363390

Accuracy of Ultrasonography and Magnetic Resonance Imaging for Preoperative Staging of Cervical Cancer-Analysis of Patients from the Prospective Study on Total Mesometrial Resection.

We aimed to evaluate the accuracy of ultrasonography with gynecologic examination performed by a gynecological oncologist and magnetic resonance imaging (MRI) interpreted by a radiologist for the local and regional staging of patients with early-stage cervical cancer. The study was a single-site sub-analysis of the multi-institutional prospective, observational Total Mesometrial Resection (TMMR) Register Study, which included all consecutive study patients from Gdynia Oncology Center. Imaging results were compared with pathology findings. A total of 58 consecutive patients were enrolled, and 50 underwent both ultrasonography and MRI. The accuracy of tumor detection and measurement errors was comparable across ultrasonography and MRI. There were no significant differences between ultrasonography and MRI in the accuracy of detecting parametrial involvement (92%, confidence interval (CI) 84–100% vs. 76%, CI 64–88%, p = 0.3), uterine corpus infiltration (94%, CI 87–100% vs. 86%, CI 76–96%, p = 0.3), and vaginal fornix involvement (96%, CI 91–100% vs. 76%, CI 64–88%, p = 0.3). The importance of uterine corpus involvement for the first-line lymph node metastases was presented in few cases. The accuracy of ultrasonography was higher than MRI for correctly predicting tumor stage: International Federation of Gynecology and Obstetrics (FIGO)–2018: 69%, CI 57–81% vs. 42%, CI 28–56%, p = 0.002, T (from TNM system): 79%, CI 69–90% vs. 52%, CI 38–66%, p = 0.0005, and ontogenetic tumor staging: 88%, CI 80–96% vs. 70%, CI 57–83%, p = 0.005. For patients with cervical cancer who are eligible for TMMR and therapeutic lymphadenectomy, the accuracy of ultrasonography performed by gynecological oncologists is not inferior to that of MRI interpreted by a radiologist for assessing specific local parameters, and is more accurate for local staging of the disease and is thus more clinically useful for planning adequate surgical treatment.

Magnetic resonance imaging for preoperative staging of pancreatic cancer based on the 8th edition of AJCC guidelines.

Preoperative staging of pancreatic cancer determines the choice of treatment. Magnetic resonance imaging (MRI) plays an important role in preoperative staging of pancreatic cancer. The American Joint Committee on Cancer (AJCC) TNM staging system was revised to its 8th version in 2016, there has been no report correlating the 8th edition of the AJCC TNM staging with preoperative MRI examinations and pathological findings. The purpose of our study is to determine the staging accuracy and evaluate the resectability by using MRI about pancreatic cancer compared with intraoperative or pathological findings according to the 8th edition of the AJCC TNM staging system. One hundred thirty-two patients with a pathological diagnosis of pancreatic cancer who underwent preoperative MRI were identified. The clinical data, MRI findings and pathological findings were analyzed. Preoperative MRI staging and resectability evaluation were compared with pathological findings. The accuracy of MRI for preoperative T and N staging was evaluated, and the sensitivity, specificity and accuracy of MRI in evaluating the resectability were assessed. All the staging and resectability assessments were according to the 8th edition of the AJCC TNM staging system. Analysis showed that the accuracy of MRI for evaluation of the T and N stages was 82.6% (109/132) and 74.2% (98/132), respectively. The sensitivity and specificity of MRI in assessing the resectability were 94.2% and 71.4%, respectively. Integrating the 8th edition of the AJCC TNM stage, no significant differences were identified between the preoperative MRI and pathological results for the staging of pancreatic cancer (P=0.805). MRI is highly accurate for T staging and moderately accurate for N staging. MRI provides important preoperative evaluation of the stage and resectability of pancreatic cancer based on the 8th edition of the AJCC TNM staging system.

Magnetic resonance imaging in preoperative staging of gastric cancer: initial experience

Magnetic resonance imaging in preoperative staging of gastric cancer: initial experience

Value of high resolution magnetic resonance imaging in preoperative staging of rectal cancer

Value of high resolution magnetic resonance imaging in preoperative staging of rectal cancer

Magnetic resonance imaging in pre-operative staging of endometrial cancer.

Endometrial cancer (EC) is one of the most common gynecological cancers and the fourth most common cancer in the female. Although clinical evaluation with diagnostic imaging has not yet proved to be accurate enough in the evaluation of tumor extent to replace surgical staging, it may enable optimization of the surgical procedure and a better tailored therapeutic strategy. This study will review the characteristic magnetic resonance imaging (MRI) findings in endometrial carcinomas in the pre-operative staging of endometrial carcinomas and compare it with the newly revised Federation of Gynecology and Obstetrics (FIGO) staging scheme of 2009 based on post-operative surgical histopathology. It is a retrospective analysis of 36 patients diagnosed and treated for endometrial carcinoma in our institute from January 2009 to December 2012. Majority of the patients (61%) were between the age group of 41-60 years. Most of the patients (72%) were postmenopausal at the time of presentation. Most common histopathology of endometrial carcinoma was endometroid adenocarcinoma (27 patients, 75%). FIGO staging of 12 patients (85.7%) showed concordance with MRI Staging for Stage Ia, with up-gradation of two patients to Stage Ib. The information provided by MRI can define prognosis, help planning the surgical approach and identify those patients requiring neoadjuvant chemotherapy or radiation therapy.

Accuracy of magnetic resonance imaging for preoperative staging of rectal cancer.

New Zealand has one of the highest rates of rectal adenocarcinoma in the world. Magnetic resonance imaging (MRI) is widely used for preoperative staging of rectal cancer. The accuracy of MRI varies, which may affect treatment decisions. The accuracy of MRI for pretreatment staging of rectal adenocarcinoma in a provincial centre in New Zealand has not been investigated. We aimed to assess the accuracy of MRI for pretreatment staging of early rectal adenocarcinoma in patients managed via the MidCentral Regional Cancer Service Multidisciplinary Team. A retrospective review of the MidCentral Regional Cancer Service Multidisciplinary Team database identified 54 patients with rectal adenocarcinoma who proceeded to surgery without preoperative long course chemo-radiotherapy. The pretreatment MRI stage was compared with the histological stage for each of these patients. MRI correctly staged the tumour invasion (T stage) in 24 patients (44% of cases), and lymph node stage in 38 patients (70% of cases). There was moderate agreement between MRI and histological staging for tumour invasion (κ=0.46) and for lymph node involvement (κ=0.41). Twenty-one cases were under-staged and five cases were over-staged with regards to invasion of the muscularis propria. Fourteen cases were under-staged, and two cases over-staged in regards to lymph node involvement. Although MRI provides important pretreatment staging information for rectal adenocarcinoma, in our experience MRI is not as accurate as in other reports. Multidisciplinary teams managing patients with rectal adenocarcinoma should be aware of the limitations of MRI for pretreatment staging.

Zervixkarzinom

The treatment of uterine cervical carcinoma is largely dependent on the tumor stage. Despite significant inaccuracies in the clinical examination, uterine cervical cancer remains the only gynecological form of cancer still largely staged according to clinical findings. Although imaging is still not included in the staging the recently published revised FIGO (Fédération International de Gynécologie et d'Obstétrique) system encourages the use of modern cross-sectional imaging (magnetic resonance imaging MRI and computed tomography CT). Due to its high soft tissue contrast MRI allows excellent non-invasive assessment of the cervix with direct tumor delineation as well as assessment of the prognosis based on morphological factors. Studies in the literature report an accuracy of 93% for MRI in the preoperative assessment of tumor size and in the differentiation of operable from advanced cervical cancer. Therefore MRI is considered to be the optimal modality for diagnostic evaluation starting from FIGO stage IB1, for radiation therapy planning, and for exclusion of recurrence in follow-up. In this paper we give an overview of the role of magnetic resonance imaging in preoperative staging of uterine cervical cancer.

Optimising magnetic resonance imaging for preoperative staging and surgical planning in colon cancer at 1.5 tesla and 3.0 tesla.

395 Background: The aim of this study was to determine best technique for future preoperative staging and operative planning in colon cancer using MRI at 1.5T, and feasibility at 3.0T. Methods: 39 scans were performed in 4 healthy volunteers comparing bowel distension using different oral contrast techniques; no oral preparation, 1L of water, 1L of poly ethylene glycol (Klean-Prep), and 1L of 2.1% barium sulphate and 3.2% sorbitol solution (E-Z-Cat) at 1.5T. Bowel distension was scored blindly by 2 experienced radiologists. A further 35 scans compared image quality of T2-weighted pulse sequences; 2D-TrueFISP, 3D-TrueFISP, HASTE, 2D-TSE and 3D-TSE. Scans were scored for movement artefact, colon wall and colon mesentery visualisation. Signal to noise ratio (SNR) was calculated. Inter-observer agreement was assessed using Cohen's Kappa. Equivalent optimised protocols were derived at 3.0T and tested for feasibility. Results: Inter-observer agreement for scoring was good (kappa = 0.61-0.67). Sorbitol-barium sulphate gave significantly better small bowel distension than no oral preparation, water and Klean-Prep (mean score 3.8 vs 1.6, 2.2 and 1.9, p≤0.007). 2D TrueFISP sequences gave the highest mean score for scan quality, significantly better than 3D-TSE, 2D-TSE, 3D-TrueFISP and HASTE (mean 10.6 vs 3.2, 7.8, 7.7 and 7.4, p≤0.012). 2D-TSE sequences obtained best SNR, significantly greater than obtained using 3D-TSE (p=0.045). 3.0T sequences were comparable or superior. Conclusions: Colon imaging using MRI requires fast sequences and adequate bowel distension. Our observations indicate that 2D-TrueFISP and 2D-TSE sequences with 1L Sorbitol-Barium sulphate orally give the best T2-weighted images of the colon wall and adjacent structures for cancer staging at 1.5T; equivalent 3.0T protocols are possible. No significant financial relationships to disclose.

Accuracy of High-Resolution Magnetic Resonance Imaging in Preoperative Staging of Rectal Cancer

To achieve better prognosis and quality of life for patients with rectal cancer, extent of surgery and neoadjuvant chemoradiotherapy should accurately reflect disease extent. The aim of this study was to evaluate accuracy of high-resolution magnetic resonance imaging (HRMRI) for preoperative staging of rectal cancer. Between 2001 and 2003, 104 patients with primary rectal cancer were examined with HRMRI and underwent radical surgery. Transmural invasion depth and lymph node metastasis were assessed prospectively and classified according to the American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) system by both HRMRI and histopathology, and results were compared. Criteria for mesorectal and lateral pelvic lymph node involvement were short-axis diameters of > or =5 mm and > or =4 mm, respectively. There were 15 pT1, 25 pT2, 50 pT3, and 14 pT4 tumors. Overall accuracy rate for transmural invasion depth was 84%. The mesorectal fascia could be visualized in 98% of patients. Twenty-three patients had mesorectal fascia involvement and the overall accuracy rate was 96% (sensitivity, 96%; specificity, 96%). Fifty-three patients had mesorectal lymph node metastasis and the overall accuracy rate was 74% (sensitivity, 83%; specificity, 64%). Lateral pelvic lymph node metastasis was observed in 15 patients and the overall accuracy rate was 87% (sensitivity, 87%; specificity, 87%). HRMRI was moderately accurate for prediction of mesorectal lymph node metastasis and highly accurate regarding transmural invasion depth, and mesorectal fascia and lateral pelvic node involvement. Therefore, HRMRI appears useful for preoperative decision-making in rectal cancer treatment.

Endorectal ultrasonography versus phased-array magnetic resonance imaging for preoperative staging of rectal cancer

To compare the diagnostic accuracy of pelvic phased-array magnetic resonance imaging (MRI) and endorectal ultrasonography (ERUS) in the preoperative staging of rectal carcinoma. Thirty-four patients (15 males, 19 females) with ages ranging between 29 and 75 who have biopsy proven rectal tumor underwent both MRI and ERUS examinations before surgery. All patients were evaluated to determine the diagnostic accuracy of depth of transmural tumor invasion and lymph node metastases. Imaging results were correlated with histopathological findings regarded as the gold standard and both modalities were compared in terms of predicting preoperative local staging of rectal carcinoma. The pathological T stage of the tumors was: pT1 in 1 patient, pT2 in 9 patients, pT3 in 21 patients and pT4 in 3 patients. The pathological N stage of the tumors was: pN0 in 19 patients, pN1 in 9 patients and pN2 in 6 patients. The accuracy of T staging for MRI was 89.70% (27 out of 34). The sensitivity was 79.41% and the specificity was 93.14%. The accuracy of T staging for ERUS was 85.29% (24 out of 34). The sensitivity was 70.59% and the specificity was 90.20%. Detection of lymph node metastases using phased-array MRI gave an accuracy of 74.50% (21 out of 34). The sensitivity and specificity was found to be 61.76% and 80.88%, respectively. By using ERUS in the detection of lymph node metastases, an accuracy of 76.47% (18 out of 34) was obtained. The sensitivity and specificity were found to be 52.94% and 84.31%, respectively. ERUS and phased-array MRI are complementary methods in the accurate preoperative staging of rectal cancer. In conclusion, we can state that phased-array MRI was observed to be slightly superior in determining the depth of transmural invasion (T stage) and has same value in detecting lymph node metastases (N stage) as compared to ERUS.

Magnetic resonance imaging for preoperative staging of rectal cancer in clinical practice: high accuracy in predicting circumferential margin with clinical benefit

The aims were to determine agreement between staging of rectal cancer made by magnetic resonance imaging (MRI) and histopathological examination and the influence of MRI on choice of radiotherapy (RT) and surgical procedure. In this retrospective audit, preoperative MRI was performed on 91 patients who underwent bowel resection, with 93% having total mesorectal excision. Tumour stage according to mural penetration, nodal status and circumferential resection margin (mCRM) involvement was assessed and compared with histopathology. Five radiologists interpreted the images. Overall agreement between MRI and histopathology for T stage was 66%. The greatest difficulty was in distinguishing between T1, T2 and minimal T3 tumours. The accuracy for mCRM (MRI) was 86% (78/91),with an interobserver variation between 80% and 100%. In the 13 cases with no agreement between mCRM and pCRM (pathological), seven had long-term RT and nine en bloc resections, indicating that the margins initially were involved with an even higher accuracy for mCRM. Preoperative short-term RT was routine, but based on MRI findings, choice of RT was affected in 29 cases (32%); 17 patients had no RT and 12 long-term RT. The surgical procedure was affected in 17 cases (19%) with planned perirectal en bloc resections in all. CRM was involved (< or = 1 mm) in 14.7% of the 34 cases in which MRI had an effect upon choice of RT and/or surgery compared with 8.8% of the remaining 57 cases where it had no impact. Magnetic resonance imaging predicted CRM with high accuracy in rectal cancer. MRI could be used as a clinical guidance with high reliability as indicated by the low figures of histopathologically involved CRM.

676 PUBLICATION Comparison between endorectal ultrasonography and magnetic resonance imaging in preoperative staging of rectal cancer

676 PUBLICATION Comparison between endorectal ultrasonography and magnetic resonance imaging in preoperative staging of rectal cancer

EUS in the Management of the Patient With Dysplasia in Barrett's Esophagus

Barrett's esophagus is the most important risk factor in the development of adenocarcinoma of the esophagus. Barrett's esophagus is generally regarded as the most significant complication of gastroesophageal reflux disease. Adenocarcinoma occurs more frequently in the setting of high-grade dysplasia. The prognosis of adenocarcinoma of the esophagus is strongly correlated with the stage of disease. The prognosis of late stage disease is extremely poor. Cure may be achieved when disease is found at an early stage. Esophagectomy has been the definitive treatment of limited stage adenocarcinoma of the esophagus. The morbidity and mortality rate for esophagectomy is high. Therefore, alternative endoscopic methods for curative treatments have gained popularity. The two main endoscopic therapies, photodynamic therapy and endoscopic mucosal resection, are both effective when applied to early-stage disease. Traditional evaluation of the patient with Barrett's esophagus with high-grade dysplasia includes esophago-gastro-duodenoscopy (EGD) with biopsy and computed tomography of the chest. Endoscopic ultrasound (EUS) has gained popularity in the evaluation of the patient with Barrett's esophagus and high-grade dysplasia because it is the only imaging technique capable of delineating the separate histologic layers of the gastrointestinal tract. The principal role of EUS in evaluating patients with Barrett's-associated dysplasia is to identify patients who may be candidates for endoscopic ablative (endoscopic mucosal resection, photodynamic therapy) therapies. EUS has been shown to be superior to computed tomography (including high resolution spiral CT) or magnetic resonance imaging for preoperative staging in patients with high-grade dysplasia and carcinoma. This review of the literature summarizes the ability of EUS to evaluate patients with Barrett's esophagus and high-grade dysplasia.

Accuracy of Breath-Hold Magnetic Resonance Imaging in Preoperative Staging of Organ-Confined Renal Cell Carcinoma

To determine the accuracy of breath-hold magnetic resonance (MR) imaging for preoperative staging of patients with organ-confined (stage I) renal cell carcinoma. Preoperative MR examinations of 43 patients (50 lesions) who underwent nephrectomy were reviewed. The MR examination consisted entirely of breath-hold sequences, and images were retrospectively evaluated by 2 blinded radiologists. Reviewers independently evaluated each case for findings that could affect the radiologic staging, particularly those that distinguish between organ-confined (stage I) and non-organ-confined (>stage II) disease. Each reviewer assigned a stage, and results were correlated with findings at surgery and pathologic examination. The difference between both reviewers and pathologic findings in evaluating an intact renal capsule (stage I) was statistically significant (P < 0.05) and resulted in a statistically significant difference between radiologic and pathologic staging (Wilcoxon test, P < 0.05). The kappa test demonstrated moderate agreement between radiologic and pathologic staging (82% and 80% for reviewers 1 and 2, kappa = 0.54 and 0.80, respectively) and substantial agreement (90%, kappa = 0.80) between the 2 reviewers in assigning a radiologic stage. Breath-hold MR imaging has an accuracy ranging between 80% and 82% in staging patients with organ-confined renal cell carcinoma, with substantial (90%) agreement between readers.

Cervical carcinoma: Computed tomography and magnetic resonance imaging for preoperative staging

To assess the accuracy of computed tomography (CT) and magnetic resonance imaging (MRI) in the evaluation of invasive cervical cancer. Seventy-nine women with untreated cervical cancer underwent pre-treatment MRI (n = 71) and/or CT (n = 37) within 4 weeks of surgical evaluation. Twenty-nine women had both MRI and CT. Images were evaluated for tumor detection, size, stromal invasion, local extension, and nodal metastases. Tumor size was evaluated accurately by MRI, with a correlation coefficient of 0.93. Magnetic resonance estimates of tumor size were within 0.5 cm of the surgical sample in 64 of 69 women (93%). Magnetic resonance was 88% accurate evaluating the presence of stromal invasion and 78% accurate for depth of stromal invasion. Computed tomography could not evaluate tumor size or stromal invasion because it could not distinguish cancer from the surrounding normal cervical tissue. In evaluating stage of disease, MRI had an accuracy of 90%, compared with 65% for CT (P < .005). Magnetic resonance imaging was more accurate than CT (94 versus 76%, P < .005) in assessing parametrial invasion. Both modalities were comparable in evaluating lymph node metastases (86% each). In determining operative candidates (stage I and minimal IIA), MRI was 94% accurate, compared with 76% for CT (P < .005). Compared with CT, MRI offered significantly improved evaluation of tumor size, stromal invasion, and local and regional extent of disease in pre-treatment imaging for cervical cancer.