MRI Abdomen Without IV Contrast At present there is no relevant literature to support the use of MRI abdomen without IV contrast for surveillance of patients with asymptomatic cervical cancer [37]. For stage II through IV patients, NCCN guidelines recommend PET/CT (preferred) or CT of chest, abdomen and pelvis [37]. If MRI is performed, IV contrast should be used unless contraindicated. Imaging of the chest, abdomen, and pelvis is often concurrently performed. MRI Pelvis Without and With IV Contrast MRI pelvis has a role in the surveillance imaging after initial treatment; however, at present there is no consensus on the time interval of follow-up imaging after the initial treatment or the optimal frequency of follow-up imaging [54]. Treatment-related changes in T2 signal can limit early detection of recurrent tumor, which is seen as heterogeneous intermediate to high T2 signal, diffusion-restricting tissue on the background of established low- signal radiation-induced fibrosis [54]. In a meta-analysis including 4 studies and 147 patients, MRI had 83.5% sensitivity, 88.5% specificity, and 84.3% accuracy for detection of residual tumor after brachytherapy [59]. In another retrospective study, MRI had an 81.8% PPV and an 87.5% NPV in detecting histologically confirmed recurrent disease in patients who did not have complete response on posttreatment PET/CT [44]. MRI parameters are also shown to predict recurrence-free interval and therefore may influence the imaging surveillance strategy. In a retrospective study of 103 patients with stage IB to IVA cervical cancer, the smaller increase in ADC values and the smaller decrease in tumor volume during chemoradiation or radiation treatment were predictors of tumor recurrence over a median follow-up period of 2.7 years [77].
Pretreatment Evaluation and Follow up of Invasive Cancer of the Cervix. MRI Abdomen Without IV Contrast At present there is no relevant literature to support the use of MRI abdomen without IV contrast for surveillance of patients with asymptomatic cervical cancer [37]. For stage II through IV patients, NCCN guidelines recommend PET/CT (preferred) or CT of chest, abdomen and pelvis [37]. If MRI is performed, IV contrast should be used unless contraindicated. Imaging of the chest, abdomen, and pelvis is often concurrently performed. MRI Pelvis Without and With IV Contrast MRI pelvis has a role in the surveillance imaging after initial treatment; however, at present there is no consensus on the time interval of follow-up imaging after the initial treatment or the optimal frequency of follow-up imaging [54]. Treatment-related changes in T2 signal can limit early detection of recurrent tumor, which is seen as heterogeneous intermediate to high T2 signal, diffusion-restricting tissue on the background of established low- signal radiation-induced fibrosis [54]. In a meta-analysis including 4 studies and 147 patients, MRI had 83.5% sensitivity, 88.5% specificity, and 84.3% accuracy for detection of residual tumor after brachytherapy [59]. In another retrospective study, MRI had an 81.8% PPV and an 87.5% NPV in detecting histologically confirmed recurrent disease in patients who did not have complete response on posttreatment PET/CT [44]. MRI parameters are also shown to predict recurrence-free interval and therefore may influence the imaging surveillance strategy. In a retrospective study of 103 patients with stage IB to IVA cervical cancer, the smaller increase in ADC values and the smaller decrease in tumor volume during chemoradiation or radiation treatment were predictors of tumor recurrence over a median follow-up period of 2.7 years [77].