A retrospective study of 55 patients found that MRI had overall 73% accuracy in detection of pathologically proved residual tumor [56]. In a small retrospective study of 32 patients, T2-weighted images were useful in assessing change in the tumor volume [57]. In a study of 185 patients, MRI was able to demonstrate the change in size of primary tumor after radiation. Initial tumor size and the rate of decrease of tumor size were significantly associated with local recurrence-free survival and overall survival rates [58]. A meta-analysis including 4 studies and 147 patients Follow-up of Invasive Cancer of the Cervix demonstrated that MRI had 83.5% sensitivity, 88.5% specificity, and 84.3% accuracy for detection of residual tumor after brachytherapy [59]. In other studies, the sensitivity, specificity, and accuracy of MRI was 27% to 69%, 71% to 100%, and 71% to 80%, with 1 of these studies concluding that MRI had an overall lower performance than PET/CT [52,60]. In another study, there was a relatively low agreement between posttreatment MRI and pathology for assessment of tumor size [23]. A small retrospective study of 51 patients also demonstrated that MRI had high sensitivity and low specificity in identifying persistent parametrial invasion after neoadjuvant chemotherapy [14]. DWI and DCE MRI likely have a role in assessment of these patients. In a retrospective study of 52 patients using DWI and DCE MRI, an initial increase in tumor signal intensity on DCE MRI, higher than myometrium, as well as low signal on ADC images were significantly associated with incomplete response [61]. In this study, there was excellent agreement between the 3 readers. In a meta-analysis, pretreatment ADC values alone were not reliable in assessing treatment response [62]; however, other studies have indicated that multiparametric MRI with DWI and DCE images together may help predict response to chemoradiation [63,64].
Pretreatment Evaluation and Follow up of Invasive Cancer of the Cervix. A retrospective study of 55 patients found that MRI had overall 73% accuracy in detection of pathologically proved residual tumor [56]. In a small retrospective study of 32 patients, T2-weighted images were useful in assessing change in the tumor volume [57]. In a study of 185 patients, MRI was able to demonstrate the change in size of primary tumor after radiation. Initial tumor size and the rate of decrease of tumor size were significantly associated with local recurrence-free survival and overall survival rates [58]. A meta-analysis including 4 studies and 147 patients Follow-up of Invasive Cancer of the Cervix demonstrated that MRI had 83.5% sensitivity, 88.5% specificity, and 84.3% accuracy for detection of residual tumor after brachytherapy [59]. In other studies, the sensitivity, specificity, and accuracy of MRI was 27% to 69%, 71% to 100%, and 71% to 80%, with 1 of these studies concluding that MRI had an overall lower performance than PET/CT [52,60]. In another study, there was a relatively low agreement between posttreatment MRI and pathology for assessment of tumor size [23]. A small retrospective study of 51 patients also demonstrated that MRI had high sensitivity and low specificity in identifying persistent parametrial invasion after neoadjuvant chemotherapy [14]. DWI and DCE MRI likely have a role in assessment of these patients. In a retrospective study of 52 patients using DWI and DCE MRI, an initial increase in tumor signal intensity on DCE MRI, higher than myometrium, as well as low signal on ADC images were significantly associated with incomplete response [61]. In this study, there was excellent agreement between the 3 readers. In a meta-analysis, pretreatment ADC values alone were not reliable in assessing treatment response [62]; however, other studies have indicated that multiparametric MRI with DWI and DCE images together may help predict response to chemoradiation [63,64].