***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE To prospect ively evaluate the efficacy of 3.0-T magnetic resonance ( MR ) imaging in the preoperative staging of cervical carcinoma compared with that at 1.5-T imaging , with surgery and pathologic analysis as the reference st and ards . MATERIAL S AND METHODS Institutional review board approval and informed consent were obtained . Thirty-one consecutive patients ( age range , 27 - 71 years ; mean age , 51.1 years ) underwent 3.0- and 1.5-T MR imaging .  Quantitative and qualitative analyses were performed . Two radiologists independently evaluated images in terms of local-regional staging . MR findings were compared with surgicopathologic findings . RESULTS Mean tumor signal-to-noise ratios , mean cervical stroma signal-to-noise ratios , and mean tumor-to-cervical stroma contrast-to-noise ratios at 3.0-T imaging were significantly higher than those at 1.5-T imaging ( P = 9.1 x 10(-6 ) , P = 1.8 x 10(-6 ) , and P = .008 , respectively ) . Image homogeneity at 3.0-T imaging was significantly inferior to that at 1.5-T imaging ( P = .005 ) . There were no significant differences in terms of the degree of susceptibility artifacts . Interobserver agreement between the two radiologists for local-regional staging was good or excellent ( kappa = 0.65 - 0.89 ) . Sensitivity , specificity , and area under the receiver operating characteristic curve for radiologist 1 in the evaluation of parametrial invasion were ( a ) 75 % for both 3.0- and 1.5-T imaging , ( b ) 70 % for both 3.0- and 1.5-T imaging , and ( c ) 0.82 for 3.0-T imaging and 0.85 for 1.5-T imaging , respectively . Corresponding values for vaginal invasion were ( a ) 67 % for both 3.0- and 1.5-T imaging , ( b ) 68 % for 3.0-T imaging and 72 % for 1.5-T imaging , and ( c ) 0.62 for 3.0-T imaging and 0.67 for 1.5-T imaging , respectively . Corresponding values for lymph node metastases were ( a ) 57 % for both 3.0- and 1.5-T imaging , ( b ) 83 % for 3.0-T imaging and 88 % for 1.5-T imaging , and ( c ) 0.72 for 3.0-T imaging and 0.78 for 1.5-T imaging , respectively . Neither radiologist noted significant differences between values obtained with 3.0-T imaging and those obtained with 1.5-T imaging ( P > .5 for all comparison pairs ) . CONCLUSION In this study , 3.0-T MR imaging was characterized by high diagnostic accuracy in the presurgical evaluation of patients with cervical carcinoma , although 3.0-T imaging was not significantly superior to 1.5-T imaging Demonstration and staging of carcinoma of the cervix with magnetic resonance ( MR ) imaging was evaluated prospect ively in 67 patients with histologically proven lesions . Findings were correlated with surgical/pathologic results obtained within 2 weeks . MR imaging had an accuracy of 95 % in demonstrating invasive disease ( stage IB or higher ) . It was capable of depicting the location and extent of tumor invasion of cervical stroma and helped detect tumor beneath relatively normal epithelium or within the endocervical canal that had not been detected by means of colposcopic biopsy . The overall accuracy of MR imaging in staging carcinoma of the cervix was 76 % , and in demonstrating parametrial status , the overall accuracy was 89 % . In 39 patients with proven invasive disease , the accuracy in demonstrating parametrial status was 82 % . In 13 of these 39 patients the low-signal-intensity stromal ring of the cervix on MR images was completely preserved and there were no false-positive results .  MR imaging is a highly promising method for directly demonstrating and staging carcinoma of the cervix and seems to be capable of providing answers to crucial questions regarding mode of therapy Magnetic resonance imaging ( MRI ) was performed in 11 patients with untreated squamous carcinoma of the cervix . The MRI stage and clinical stage were both compared with the surgical stage . MRI stage was only accurate in three of the 11 patients ( 27.3 % ) while the clinical stage was correct in eight of the 11 cases ( 72.7 % ) .  MRI assessment of parametrial and lymph-node involvement was difficult to interpret . These preliminary findings suggest that MRI is not , at present , a useful adjunct to staging in the evaluation of patients with carcinoma of the cervix Using MR imaging with a body coil parametrial invasion was determined prospect ively in 169 consecutive patients considered on the basis of clinical examination to have carcinoma confined to the cervix . After radical hysterectomy correlation with histologic examination was performed for the left and right parametrium separately . The criterion for parametrial invasion was a high-signal-intensity lesion with disruption of the full thickness of the cervical stroma combined with areas of abnormal signal intensity within the parametrial region on T2-weighted images . Histologic examination showed that 18 parametria in 13 patients were invaded by tumor . MR had an overall accuracy of 93 % , a sensitivity of 89 % , and a specificity of 93 % in demonstrating parametrial involvement . Positive and negative predictive values were 43 % and 99 % . The main weakness of MR was 21 false-positive tests . This represents a limitation when MR is performed with a body coil Purpose : To assess the validity of low-field MR in staging cervical cancer compared to clinical staging . Material and Methods : A total of 95 women entered the study over a 3-year period .  MR examinations with a 0.1 T resistive magnet using a body coil and clinical staging according to the FIGO recommendations ( 1988 ) were performed within 2 weeks from clinical diagnosis . T1- and T2-weighted sequences were obtained in transversal and sagittal acquisitions , and an additional T1 before and after contrast ( r and omisation to 0.1 or 0.3 mmol/kg b.w . gadodiamide ) . Treatment decisions on surgery or radiation therapy were made solely on the clinical staging . Results : Sixty-one patients were found to be eligible for surgery . In 5 women , the pathological results revealed a more advanced stage of the disease than assessed by clinical staging . MR correctly staged 4 of the 5 but otherwise tended to overstate the disease . Contrast enhancement significantly reduced this trend ( p<0.05 ) regardless of the contrast medium dose used . Divided into two groups , an operable ( less than stage 2b ) and an inoperable group ( more than stage 2a ) , the clinical staging correctly classified 57 patients ( accuracy 92 % ) compared to 52 patients with MR using contrast enhancement ( accuracy 84 % ) . The specificity was no higher than 31 % , whereas the reproducibility of the MR assessment was fairly good with kappa values around 0.65 for both intra- and interobserver variations . Conclusion : In the present set-up , clinical assessment was superior to low-field MR in staging cervical cancer . When using contrast enhancement , the staging accuracies of low-field MR were comparable to the ones reported for techniques with higher tesla values , whereas the specificity and reproducibility errors were lower . The method , therefore , needs to be optimised Objective To determine the accuracy of the preoperative staging of uterine cervical cancer by  magnetic resonance ( MR ) imaging  in 115 patients in a prospect i ve study . Methods A prospect i ve study was performed in 115 patients who underwent MR imaging at 1.5 T before surgery or biopsy .  Histopathologic findings were correlated with MR imaging results for all patients . Results The accuracy of preoperative tumor staging by MR imaging in the 115 patients was 77 % . In terms of the evaluation of parametrial status , this study had an accuracy of 94 % and a sensitivity of 38 % . The accuracy and sensitivity of MR imaging for vaginal invasion were 81 % and 87 % , respectively . In terms of lymph node metastasis , this study had an accuracy of 97 % and a sensitivity of 36 % . Conclusion Magnetic resonance imaging has high accuracy in the preoperative staging of uterine cervical cancer A prospect i ve study was undertaken to assess the ability of magnetic resonance imaging ( MRI ) to stage  cervical carcinoma .  Compared to computed tomography ( CT ) , MRI showed a high degree of accuracy in correctly demonstrating involvement of the vagina , parametria and sidewalls , bladder , and lymph nodes but tended to overestimate disease in all of the categories studied . Large-scale studies comparing the two modalities are necessary because the most accurate staging of cervical carcinoma is crucial for selecting the best treatment protocol BACKGROUND Stage Ib and IIa cervical carcinoma can be cured by radical surgery or radiotherapy . These two procedures are equally effective , but differ in associated morbidity and type of complications . In this prospect i ve r and omised trial of radiotherapy versus surgery , our aim was to assess the 5-year survival and the rate and pattern of complications and recurrences associated with each treatment . METHODS Between September , 1986 , and December , 1991 , 469 women with newly diagnosed stage Ib and IIa cervical carcinoma were referred to our institute . 343 eligible patients were r and omised : 172 to surgery and 171 to radical radiotherapy . Adjuvant radiotherapy was delivered after surgery for women with surgical stage pT2b or greater , less than 3 mm of safe cervical stroma , cut-through , or positive nodes . The primary outcome measures were 5-year survival and the rate of complications . The analysis of survival and recurrence was by intention to treat and analysis of complications was by treatment delivered . FINDINGS 170 patients in the surgery group and 167 in the radiotherapy group were included in the intention-to-treat analysis ; scheduled treatment was delivered to 169 and 158 women , respectively , 62 of 114 women with cervical diameters of 4 cm or smaller and 46 of 55 with diameters larger than 4 cm received adjuvant therapy . After a median follow-up of 87 ( range 57 - 120 ) months , 5-year overall and disease-free survival were identical in the surgery and radiotherapy groups ( 83 % and 74 % , respectively , for both groups ) , 86 women developed recurrent disease : 42 ( 25 % ) in the surgery group and 44 ( 26 % ) in the radiotherapy group . Significant factors for survival in univariate and multivariate analyses were : cervical diameter , positive lymphangiography , and adeno-carcinomatous histotype . 48 ( 28 % ) surgery-group patients had severe morbidity compared with 19 ( 12 % ) radiotherapy-group patients ( p = 0.0004 ) . INTERPRETATION There is no treatment of choice for early-stage cervical carcinoma in terms of overall or disease-free survival . The combination of surgery and radiotherapy has the worst morbidity , especially urological complications . The optimum therapy for each patient should take account of clinical factors such as menopausal status , age , medical illness , histological type , and cervical diameter to yield the best cure with minimum complications BACKGROUND AND METHODS On behalf of the Gynecologic Oncology Group , we performed a r and omized trial of radiotherapy in combination with three concurrent chemotherapy regimens -- cisplatin alone ; cisplatin , fluorouracil , and hydroxyurea ; and hydroxyurea alone -- in patients with locally advanced cervical cancer . Women with primary untreated invasive squamous-cell carcinoma , adenosquamous carcinoma , or adenocarcinoma of the cervix of stage IIB , III , or IVA , without involvement of the para-aortic lymph nodes , were enrolled . The patients had to have a leukocyte count of at least 3000 per cubic millimeter , a platelet count of at least 100,000 per cubic millimeter , a serum creatinine level no higher than 2 mg per deciliter ( 177 micromol per liter ) , and adequate hepatic function . All patients received external-beam radiotherapy according to a strict protocol . Patients were r and omly assigned to receive one of three chemotherapy regimens : 40 mg of cisplatin per square meter of body-surface area per week for six weeks ( group 1 ) ; 50 mg of cisplatin per square meter on days 1 and 29 , followed by 4 g of fluorouracil per square meter given as a 96-hour infusion on days 1 and 29 , and 2 g of oral hydroxyurea per square meter twice weekly for six weeks ( group 2 ) ; or 3 g of oral hydroxyurea per square meter twice weekly for six weeks ( group 3 ) . RESULTS The analysis included 526 women . The median duration of follow-up was 35 months . Both groups that received cisplatin had a higher rate of progression-free survival than the group that received hydroxyurea alone ( P<0.001 for both comparisons 
    Output:
    
Different technical aspects of MRI influenced the summary results .
Conclusions MRI is significantly better than clinical examination in ruling out parametrial invasion and advanced disease in patients with cervical carcinoma .
Key Points• MRI has a higher sensitivity than clinical examination for staging cervical carcinoma . •
Clinical examination and MRI have comparably high specificity for staging cervical carcinoma . •
The use of newer MRI techniques positively influences the summary results . •
Anaesthesia during clinical examination positively influences the summary results