Value of diffusion-weighted MRI in diagnosis of uterine cervical cancer: a prospective study evaluating the benefits of DWI compared to conventional MR sequences in a 3T environment

Abstract

Background Imaging of cervical carcinoma remains challenging as local infiltration of surrounding tissues cannot always be discriminated safely. New imaging techniques, like diffusion-weighted imaging (DWI) have emerged, which could lead to a more sensitive tumor detection. Purpose To evaluate the benefits of DWI for determination of size, local infiltration, and tumor grading, in patients with primary and recurrent cervical cancer. Material and Methods In this prospective, study we enrolled 50 patients with primary ( n = 35) and recurrent ( n = 15) tumors. All patients underwent 3T magnetic resonance imaging (MRI) including conventional (e.g. T1/T2 ± fs ± contrast) sequences and DWI (b-values of 0, 50, 400, 800 s/mm2). All images were analyzed by three readers with different experience levels (1, 3, 6 years), who compared image quality, tumor delineation, dimensions, local infiltration, lymph node involvement, and quantified ADC values compared to the histopathological grading. Results Additional use of DWI resulted in significantly better ( P < 0.001) tumor delineation for the least experienced reader, but not for experienced readers. Tumor dimensions were assessed almost equally ( P > 0.05) in conventional sequences and DWI. Use of DWI led to an increase in sensitivity of infiltrated adjacent tissue (from 86% to 90%) and detection of lymph node metastases (from 47% to 67%). Quantitative assessment of carcinomas showed lower ADC values ( P < 0.001) with significant inverse correlations between different grading levels. Conclusion Our study demonstrates the overall benefits using DWI in 3T MRI resulting in a higher reader confidence, sensitivity of tissue infiltration, and tumor-grading for cervical cancer.