This is supported by a prospective study of 53 patients with cervical cancer that showed whole body PET/MRI performed comparably to MRI alone of the local disease extent with 85% accuracy versus 87% but was 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]. Higher SUVmax is associated with poorer prognosis [16,17]. In addition to the staging evaluation, PET/MRI offers prognostic information with a higher SUVmax associated with poorer prognosis [16,17], and in 1 study was found to be an independent predictor of progression-free survival (HR = 4.57). MRI Abdomen Without and With IV Contrast MRI abdomen without and with IV contrast may be used for the assessment of nodal and distant metastatic disease, preferably with IV contrast. It may be obtained along with the pelvic MRI performed for local disease extent assessment. If these examinations are obtained simultaneously, dynamic contrast-enhanced (DCE) imaging should be obtained of the pelvis to prioritize the local extent of disease assessment, with only delayed contrast-enhanced imaging obtained of the abdomen. With regards to nodal disease assessment, nodes are considered abnormal on MRI if their axial short axis is >1 cm in the abdomen 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. Using these criteria, a meta-analysis of 115 studies published from 2000 to 2019 showed MRI performed comparably to PET for nodal metastatic disease assessment, with a pooled sensitivity and specificity of 57% (95% CI, 49%-64%) and 93% (95% CI, 89%-95%), compared to 57% (95% CI, 48%-65%) and 95% (95% CI, 93%-97%) for PET.
Pretreatment Evaluation and Follow up of Invasive Cancer of the Cervix. This is supported by a prospective study of 53 patients with cervical cancer that showed whole body PET/MRI performed comparably to MRI alone of the local disease extent with 85% accuracy versus 87% but was 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]. Higher SUVmax is associated with poorer prognosis [16,17]. In addition to the staging evaluation, PET/MRI offers prognostic information with a higher SUVmax associated with poorer prognosis [16,17], and in 1 study was found to be an independent predictor of progression-free survival (HR = 4.57). MRI Abdomen Without and With IV Contrast MRI abdomen without and with IV contrast may be used for the assessment of nodal and distant metastatic disease, preferably with IV contrast. It may be obtained along with the pelvic MRI performed for local disease extent assessment. If these examinations are obtained simultaneously, dynamic contrast-enhanced (DCE) imaging should be obtained of the pelvis to prioritize the local extent of disease assessment, with only delayed contrast-enhanced imaging obtained of the abdomen. With regards to nodal disease assessment, nodes are considered abnormal on MRI if their axial short axis is >1 cm in the abdomen 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. Using these criteria, a meta-analysis of 115 studies published from 2000 to 2019 showed MRI performed comparably to PET for nodal metastatic disease assessment, with a pooled sensitivity and specificity of 57% (95% CI, 49%-64%) and 93% (95% CI, 89%-95%), compared to 57% (95% CI, 48%-65%) and 95% (95% CI, 93%-97%) for PET.