Role Magnetic Resonance Imaging In Staging Of Uterine Cervical Cancer And Evaluation Of Neoadjuvant Chemotherapy Effect

Objective:The aims of this study were to assess the accuracy of staging of uterine cervical cancer based on FIGO system (Internatio-nal Federation of Gynecology and Obstetrics) and evaluate neoadjuvant chemotherapy effect using magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI).Methods:(1) Evaluating staging of uterine cervical cancer with FIGO system and MRI:forty five patients with histopathological confirmed uterine cervical cancer were recruited. A;l patients underwent staging using FIGO system and MRI study before chemotherapy. The MR images were reviewed, and the uterine cervical cancers were staged according to findings on MR images. The staging of the uterine cervical cancer with FIGO system and study of MR images was evaluated with reference of histopathological findings, and agreement between the two staging methods was examined with kappa statistics.(2) Experimental group of b value:five healthy female volunteers was selected and underwent MRI and DWI of the uterine cervix, with the b value of200,400,600and800s/mm2, respectively, and the optimal b value was selected for cervical DWI based on the clarity and signal to noise ratio of image.(3) Evaluation of chemotherapy effect:twenty patients with pathological confirmed cervical cancer were reviewed. All patients underwent routine MRI sequence and DWI sequence before and after chemotherapy, changes of tumor volume and apparent diffusion coefficient (ADC) values before and after chemotherapy were noted and their relations with long term prognosis was studied, including relations of changes of tumor volume and ADC to the response and sensitivity of chemotherapy of cervical cancers. Ability of MR imaging to exhibit pelvic lymph nodes was assessed through double blind interpretation comparing MR images (T2WI sequence and DWI sequence) before and after chemotherapy. Results:(1) Taking histopathological findings as gold standard, the agreement between the two staging methods had good agreement (Kappa=0.883. P<0.05).(2) Characteristics of the uterine cervix could be e(?)bited with higher quality on DWI as b value was set600s/mm2.(3) ADC of the solid component of the cancer eleva(?)ed markedly20days (average) after the chemotherapy (P<0.01), and change of tumor volume had no statistical significance (P=0.1). Setting35%as cut off point, ADC could be assigned into two groups (equal to and more than35%, fewer than35%), and the patients with higher ADC change (≥35%) had longer survival time(P=0.0212<0.05).Conclusion:(1) MRI evaluation may improve accuracy of preoperative staging of uterine cervical cancer.(2) Change of the quantitative variable ADC of DWI may be used to evaluate the early chemotherapy effect and long term prognosis of uterine cervical cancer.(3) DWI sequence is superior to T2WI sequence in exhibition of pelvic metastatic lymph nodes.