DIAGNOSIS, STAGING OF CERVICAL

CARSINOMA
Nurul Amilya
12-039

PRESEPTOR
Dessy Wimelda, Sp.Rad
 Cervical cancer is the third most potential risk factors in cervical
cancer that incommon gynecologic malignancy. In the United States, it is
anticipated that 13,000 new cases of cervical cancer will bediagnosed in
2002, and 4100 deaths will be attributed to the disease.
Staging for Cervical Carsinoma is based on the FIGO

Stage I
Stage II
Stage III
Stage IV
MR Imaging

MR imaging with its superior soft-tissue resolution is the single

best modality for preoperative staging of cervical cancer.
1,5 T magnet, T1 weighted images can be obtained Using a
spin-echopulse sequence with a TR of 500– 600 msec, a TE of 12
msec, and ak - space matrix size 512 × 256 in the axial and sagittal
planes.
38 years old woman with squamous cell carsinoma of cervix (FIGO IIB)

Axial T1-weight MR image shows excellent Axial T2-weighted MR image shows tumor as
parametrial - to- tumor tissue contrast, ireeguler hyperintense. Tumor is seen extending into
parametrial -to- tumor (arrow) is noted bilaterally. parametrium.
60 years old woman with poorly differentiated carsinoma of sevix ( FIGO
stage IIA

Axial T2 weight MR image shows full- oblique axial T2-weigth MR image obtained parametrial
thickness stromal involvement and dicular to endocervical canal clearly shows left
questionable parametrial invasion. parametrial invasion abutting periuterine vessles
 Dynamic MR imaging reportedly improves tumor detection and
depiction of the depth of stromal and parametrial invasion. This is because
small cervical tumor senhance early (30–60 sec) compared with normal
cervical stroma and epithelium .
56 years old woman with papillary squamous carsinoma of servix
( FIGO IB)

Sagittal T2-weight hyperintesa endocervical dynamic sagittal MR image obtained at 30 sec shows
tumor invading posterior cervical lip (arrow) early enhancement of tumor, in contrast to nonhancing
cervical stroma.
 40 years old woman with squamous cell carsinoma of cervix

Sagittal T2-weigth MR image shows

bulky hyperintense mass involving sagittal dynamic MR image obtained at 30 and 90 sec show minimal early
anterior and posterior lips cervix. enhancement of tumor.
 MR imaging is superior to clinical evaluation in the assessment of
tumor size; measurements are within 0.5 cm of the surgical size in 70–90%
of cases. The accuracy of MR imaging for parametrial invasion
ranges from 77% to 96% .
The highest accuracy is seen in small tumors, in which preservation
of an intact dark stromal ring has a negative predictive value of 94–100% in
excluding parametrial invasion.
35 years old woman with endocervical mass

Axial T2 weigthed MR image shows

hyperintensa tumor, Surrounded
by intac hypointensa
stromal ring.
 With larger tumors, the entire thickness of the cervical
stroma may be hyperintense on T2-weighted images. This can lead
to overstaging because edema cannot be distinguished from tumor
or underestimation of early parametrial involvement.
27 tahun years old woman with squamous cell carsinoma of cervix (FIGO IB

Coronal illustrasition shows large mass Axial T2-weighted MR image shows hyperintense
confined to cervix. mass with no normal struma identified.
 For tumors located in the supravaginal cervix, the
presence of an irregular margin or abutment or encasement
of periuterine vessels suggests parametrial spread .
48 years old woman with squamous cell carsionoma of servix (FIGO IIB)

Coronal illustration show tumor involving vaginal Axial T2-weighted MR image shows tumor shows
and supravaginal cervix with parametrial invasion hypeterintense mass replacing cervix, with bilateral
On left ,and tumor abutting parametrial vessels.
27 years old woman with poorly differentiated
( FIGO IIIA)

Coronal illustration with tumor extendinginto Sagittal T2-weighted MR image shows

lower third vagina. hyperintense mass invanding ant and post with
extension into lower third of vagina,
 CT

CT differs from MR imaging that CT is inaccurate in the

detection of local disease because 50% of tumors are isodense to cervical stroma on
contrast-enhanced CT. Advanced parametrial invasion is more easely assedsed : the signs
include obliteration of periureteral fat planes, eccentric parametrial mass.
70year-old woman with squamous cell carcinoma of cervix (FIGO stage IIIB

Axial contrast-enhanced CT scan shows necrotic

hypodense tumor extending into right parametrium
Conclusion

MR imaging represents the single most effective modality for

detection primary tumor and local spread. CT and MR imaging are
Equally effective.The addition of dynamic MR imaging improves
specificity and provides prognostic information.
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