Value of diffusion-weighted MRI in diagnosis of uterine cervical cancer: a prospective study evaluating the benefits of DWI compared to conventional MR sequences in a 3T environment

Acta Radiol. 2016 Jul;57(7):869-77. doi: 10.1177/0284185115602146. Epub 2015 Sep 1.


Background: Imaging of cervical carcinoma remains challenging as local infiltration of surrounding tissues cannot always be discriminated safely. New imaging techniques, like diffusion-weighted imaging (DWI) have emerged, which could lead to a more sensitive tumor detection.

Purpose: To evaluate the benefits of DWI for determination of size, local infiltration, and tumor grading, in patients with primary and recurrent cervical cancer.

Material and methods: In this prospective, study we enrolled 50 patients with primary (n = 35) and recurrent (n = 15) tumors. All patients underwent 3T magnetic resonance imaging (MRI) including conventional (e.g. T1/T2 ± fs ± contrast) sequences and DWI (b-values of 0, 50, 400, 800 s/mm(2)). All images were analyzed by three readers with different experience levels (1, 3, 6 years), who compared image quality, tumor delineation, dimensions, local infiltration, lymph node involvement, and quantified ADC values compared to the histopathological grading.

Results: Additional use of DWI resulted in significantly better (P < 0.001) tumor delineation for the least experienced reader, but not for experienced readers. Tumor dimensions were assessed almost equally (P > 0.05) in conventional sequences and DWI. Use of DWI led to an increase in sensitivity of infiltrated adjacent tissue (from 86% to 90%) and detection of lymph node metastases (from 47% to 67%). Quantitative assessment of carcinomas showed lower ADC values (P < 0.001) with significant inverse correlations between different grading levels.

Conclusion: Our study demonstrates the overall benefits using DWI in 3T MRI resulting in a higher reader confidence, sensitivity of tissue infiltration, and tumor-grading for cervical cancer.

Keywords: Magnetic resonance (MR) diffusion; cervix; genital/reproductive; neoplasms – primary; pathology.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Diffusion Magnetic Resonance Imaging / methods*
  • Female
  • Humans
  • Lymphatic Metastasis / diagnostic imaging
  • Magnetic Resonance Imaging / methods
  • Middle Aged
  • Neoplasm Grading
  • Neoplasm Invasiveness / diagnostic imaging
  • Prospective Studies
  • Sensitivity and Specificity
  • Uterine Cervical Neoplasms / diagnostic imaging*
  • Uterine Cervical Neoplasms / pathology