CT Pelvis Without IV Contrast CT without IV contrast provides very poor soft tissue characterization in the pelvis [13] and therefore is not useful for the evaluation of local extent of invasive cervical cancer. FDG-PET/CT Skull Base to Mid-Thigh Fluorine-18-2-fluoro-2-deoxy-D-glucose (FDG)-PET/CT is most commonly used in addition to pelvic MRI for nodal and metastatic disease assessment (as described in Variant 2), although it can also contribute to the evaluation of local disease extent. Physiologic excreted radiotracer in the bladder may obscure FDG uptake in the region of the cervix in some patients [9]. However, a meta-analysis showed similar overall diagnostic performance for PET/CT and MRI for local extent of disease assessment, with an overall sensitivity of 73% (95% CI, 56%-85%) and specificity of 91% (95% CI, 83%-96%) for PET/CT compared to a sensitivity of 71% (95% CI, 62%-79%) and specificity of 91% (88%-93%) for MRI [12]. FDG-PET/MRI Skull Base to Mid-Thigh Although still not in widespread clinical use, research has shown PET/MRI to be a promising new modality for comprehensive examination of cervical cancer disease extent. The MRI examination offers ideal imaging of the primary tumor for local extent evaluation, whereas the PET component offers superior sensitivity for the detection of nodal and hematogenous metastases. This is supported by a prospective study of 53 patients with cervical cancer that showed whole body PET/MRI performed comparably to MRI alone for local disease assessment with 85% accuracy versus 87% but better for the detection of lymph node metastases demonstrating 83% sensitivity, 90% specificity, and 87% accuracy compared to 71%, 83%, and 77%, respectively for MRI alone [14].
Pretreatment Evaluation and Follow up of Invasive Cancer of the Cervix. CT Pelvis Without IV Contrast CT without IV contrast provides very poor soft tissue characterization in the pelvis [13] and therefore is not useful for the evaluation of local extent of invasive cervical cancer. FDG-PET/CT Skull Base to Mid-Thigh Fluorine-18-2-fluoro-2-deoxy-D-glucose (FDG)-PET/CT is most commonly used in addition to pelvic MRI for nodal and metastatic disease assessment (as described in Variant 2), although it can also contribute to the evaluation of local disease extent. Physiologic excreted radiotracer in the bladder may obscure FDG uptake in the region of the cervix in some patients [9]. However, a meta-analysis showed similar overall diagnostic performance for PET/CT and MRI for local extent of disease assessment, with an overall sensitivity of 73% (95% CI, 56%-85%) and specificity of 91% (95% CI, 83%-96%) for PET/CT compared to a sensitivity of 71% (95% CI, 62%-79%) and specificity of 91% (88%-93%) for MRI [12]. FDG-PET/MRI Skull Base to Mid-Thigh Although still not in widespread clinical use, research has shown PET/MRI to be a promising new modality for comprehensive examination of cervical cancer disease extent. The MRI examination offers ideal imaging of the primary tumor for local extent evaluation, whereas the PET component offers superior sensitivity for the detection of nodal and hematogenous metastases. This is supported by a prospective study of 53 patients with cervical cancer that showed whole body PET/MRI performed comparably to MRI alone for local disease assessment with 85% accuracy versus 87% but better for the detection of lymph node metastases demonstrating 83% sensitivity, 90% specificity, and 87% accuracy compared to 71%, 83%, and 77%, respectively for MRI alone [14].