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Imaging of cervical cancer

¹ Department of Radiology, Birmingham Women's Hospital, Birmingham, ² Department of Obstetrics and Gynaecology, West Midlands Specialist Registrar Training Scheme, Birmingham, UK

• Cervical cancer remains one of the most common gynaecological malignancies, although its incidence and mortality are falling.
  
• MRI has established a role in staging cervical cancer, the main advantages being assessment of tumour size, relationship of tumour to adjacent structures and presence or absence of lymph nodes.
  
• In addition to standard pelvic sequences (axial T₁ weighted, axial T₂ weighted and sagittal T₂ weighted), the most important sequence to be performed to stage cervical cancer is a high-resolution (thin slice – 4 mm) T₂ weighted sequence angled perpendicular to the cervical canal.
  
• With respect to treatment, stages IIa and below are treated surgically, stages IIb and above are treated with a combination of radiotherapy and chemotherapy.
  
• Extension of the tumour into the parametrium determines stage IIa (absence of parametrial extension) and stage IIb (presence of parametrial extension).
  
• MRI performs better than clinical FIGO staging to determine the likelihood of parametrial extension, with a high negative predictive value for parametrial extension if the low signal cervical stroma is preserved.