Imaging the Female Pelvis: When Should MRI be Considered?

Jennifer Hubert, MD; Diane Bergin, MD


Appl Radiol. 2008;37(1):9-24. 

In This Article

Cervical Carcinoma

Like the uterus, the cervix has a zonal anatomy that is well delineated on T2W images. Cervical cancer is the third most common gynecologic malignancy in women. MRI is not initially used to diagnose cervical cancer but is used to stage disease in women who have had a diagnosis established by a Pap smear or biopsy. T2-weighted images obtained in the sagittal plane and in a plane along the short axis of the cervix are the most useful for local staging. On T2W images, cervical cancer appears as a mass of higher signal intensity than the adjacent fbrous cervical stroma, but the mass is of lower signal intensity than the endometrium.[33] If the low signal intensity of the inner cervical stroma is preserved, stage IIB or higher disease is excluded, which indicates that the patient is likely a surgical candidate. Macroscopic extension of tumor into the parametrial fat establishes a diagnosis of stage IIB disease. MRI has an accuracy range of 75% to 95% in detecting parametrial invasion (Figure 14). MRI can accurately assess for more advanced disease such as pelvic sidewall invasion and obstruction of the distal ureter.[33] Localizing the tumor and determining the presence or absence of ureteral obstruction can provide a road map for radiation therapy.

Cervical carcinoma. (A) An axial T2-weighted fast spin-echo image, (B) an axial T1-weighted (T1W) fat-suppressed 3-dimensional (3D) gradient-recalled echo (GRE) precontrast image, and (C) an axial T1W fat-suppressed 3D GRE postcontrast image show low T2 signal and a hypoenhancing cervical mass (arrowheads) with parametrial invasion.


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