Another meta-analysis of 72 studies showed MRI had a comparable performance to CT and an inferior performance to PET, with a sensitivity of 58% and a specificity of 93% compared to 75% and 98% for PET and 58% and 92% for CT [36]. MRI Pelvis Without IV Contrast Evaluation for pelvic and lower para-aortic lymph node metastases can be performed at the time of local disease assessment. Nodes are considered abnormal on MRI if their axial short axis is >1 cm or if they display abnormal morphologic characteristics such as rounded shape, loss of the normal fatty hilum, heterogenous signal, or more pronounced diffusion restriction than uninvolved lymph nodes. Although IV contrast administration is preferred because it may increase the conspicuity of small lesions, it still demonstrates inherent superior soft tissue contrast compared to nonenhanced CT, and MRI may help detect even subcentimeter-sized disease foci [39]. In a study of 53 patients, MRI was able to detect tumors as small as 0.6 cm but missed a 0.3 cm sized lesion [40]. Follow-up of Invasive Cancer of the Cervix Radiography Chest Chest radiographs are recommended by the Society of Gynecologic Oncology for the detection of pulmonary metastases (in the form of pulmonary nodules or pleural effusions). However, chest radiographs have a low rate of detection of thoracic metastases (ranging from 0%-20%) compared to 80% to 95% reported by chest CT [41,42]. Therefore, chest CT is preferred. US Abdomen Abdominal US can be used to detect hydronephrosis, which may indicate parametrial invasion and ureteral obstruction corresponding to stage IIIb disease. Although abdominal US may also show metastatic disease in other organs such as the liver or upper abdominal lymph nodes, its narrow field of view makes it a poor modality for a complete nodal and metastatic disease assessment. Cross-sectional imaging with CT or MRI is preferred for this evaluation.
Pretreatment Evaluation and Follow up of Invasive Cancer of the Cervix. Another meta-analysis of 72 studies showed MRI had a comparable performance to CT and an inferior performance to PET, with a sensitivity of 58% and a specificity of 93% compared to 75% and 98% for PET and 58% and 92% for CT [36]. MRI Pelvis Without IV Contrast Evaluation for pelvic and lower para-aortic lymph node metastases can be performed at the time of local disease assessment. Nodes are considered abnormal on MRI if their axial short axis is >1 cm or if they display abnormal morphologic characteristics such as rounded shape, loss of the normal fatty hilum, heterogenous signal, or more pronounced diffusion restriction than uninvolved lymph nodes. Although IV contrast administration is preferred because it may increase the conspicuity of small lesions, it still demonstrates inherent superior soft tissue contrast compared to nonenhanced CT, and MRI may help detect even subcentimeter-sized disease foci [39]. In a study of 53 patients, MRI was able to detect tumors as small as 0.6 cm but missed a 0.3 cm sized lesion [40]. Follow-up of Invasive Cancer of the Cervix Radiography Chest Chest radiographs are recommended by the Society of Gynecologic Oncology for the detection of pulmonary metastases (in the form of pulmonary nodules or pleural effusions). However, chest radiographs have a low rate of detection of thoracic metastases (ranging from 0%-20%) compared to 80% to 95% reported by chest CT [41,42]. Therefore, chest CT is preferred. US Abdomen Abdominal US can be used to detect hydronephrosis, which may indicate parametrial invasion and ureteral obstruction corresponding to stage IIIb disease. Although abdominal US may also show metastatic disease in other organs such as the liver or upper abdominal lymph nodes, its narrow field of view makes it a poor modality for a complete nodal and metastatic disease assessment. Cross-sectional imaging with CT or MRI is preferred for this evaluation.