CT Chest Without IV Contrast CT chest without IV contrast is not useful for the evaluation of initial treatment response assessment of primary cervical cancer after chemoradiation; however, it may be used for response assessment of distant metastatic disease [37]. Although the use of IV contrast material is preferred, the assessment may be performed without IV contrast. If there is distant metastatic disease, imaging of the chest, abdomen, and pelvis is concurrently performed. FDG-PET/CT Skull Base to Mid-Thigh Multiple studies have shown that FDG-PET/CT is useful in assessing metabolic response of cervical cancer to chemoradiation [43-47]. In a prospective study with 88 patients, changes in FDG-PET/CT metabolic parameters such as SUVmax and total lesion glycolysis (TLG) helped predict histopathological response to chemoradiation [48]. In a retrospective study involving 82 patients, metabolic tumor volume (MTV), TLG, and nodal involvement on PET/CT were the significant predictors of response [45]. Higher tumor SUVmax and TLG are also shown to be significantly associated with poor response to chemoradiation [49], whereas MTV has been shown to adversely affect prognosis [50]. A meta-analysis including 12 studies with 1,104 patients demonstrated that response on FDG- PET/CT was a significant prognostic factor and suggested that PET/CT has a role in follow-up assessment of patients with cervical cancer [51]. PET/CT reportedly has better performance than MRI for the detection of active disease after chemoradiation. In a study that included 55 patients, sensitivity, specificity, and accuracy of PET/CT for detection of residual disease was 60%, 100%, and 89%, whereas that of MRI was 27%, 100%, and 80%, respectively [52]. FDG-PET/MRI Skull Base to Mid-Thigh The literature on the use of FDG-PET/MRI for response assessment of cervical cancer is limited. FDG-PET/MRI likely has a role in assessment of response after chemoradiation.
Pretreatment Evaluation and Follow up of Invasive Cancer of the Cervix. CT Chest Without IV Contrast CT chest without IV contrast is not useful for the evaluation of initial treatment response assessment of primary cervical cancer after chemoradiation; however, it may be used for response assessment of distant metastatic disease [37]. Although the use of IV contrast material is preferred, the assessment may be performed without IV contrast. If there is distant metastatic disease, imaging of the chest, abdomen, and pelvis is concurrently performed. FDG-PET/CT Skull Base to Mid-Thigh Multiple studies have shown that FDG-PET/CT is useful in assessing metabolic response of cervical cancer to chemoradiation [43-47]. In a prospective study with 88 patients, changes in FDG-PET/CT metabolic parameters such as SUVmax and total lesion glycolysis (TLG) helped predict histopathological response to chemoradiation [48]. In a retrospective study involving 82 patients, metabolic tumor volume (MTV), TLG, and nodal involvement on PET/CT were the significant predictors of response [45]. Higher tumor SUVmax and TLG are also shown to be significantly associated with poor response to chemoradiation [49], whereas MTV has been shown to adversely affect prognosis [50]. A meta-analysis including 12 studies with 1,104 patients demonstrated that response on FDG- PET/CT was a significant prognostic factor and suggested that PET/CT has a role in follow-up assessment of patients with cervical cancer [51]. PET/CT reportedly has better performance than MRI for the detection of active disease after chemoradiation. In a study that included 55 patients, sensitivity, specificity, and accuracy of PET/CT for detection of residual disease was 60%, 100%, and 89%, whereas that of MRI was 27%, 100%, and 80%, respectively [52]. FDG-PET/MRI Skull Base to Mid-Thigh The literature on the use of FDG-PET/MRI for response assessment of cervical cancer is limited. FDG-PET/MRI likely has a role in assessment of response after chemoradiation.