MR Imaging of Cervical Carcinoma: A Practical Staging Approach1
Viviane Nicolet, MD,
Louis Carignan, MD,
France Bourdon, MD and
Odile Prosmanne, MD
1 From the Department of Radiology, CHUM, Hôpital Notre-Dame, 1560 Sherbrooke Est, Montréal, Québec, Canada H2L 4M1. Presented as a scientific exhibit at the 1999 RSNA scientific assembly. Received February 24, 2000; revision requested March 21 and received May 10; accepted May 11. Address correspondence to V.N. (e-mail: vnicolet@videotron.ca).
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Figure 1. MR imaging technique. Sagittal T2-weighted image shows the position of the axial 5-mm sections obtained in two sequences from the lower poles of the kidneys down to the pubis.
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Figure 2a. Lymph node evaluation. (a) T1-weighted MR image demonstrates an enlarged left common iliac lymph node (arrow) that is isointense relative to blood vessels and muscles. (b) On a T2-weighted MR image, the enlarged lymph node (arrow) is more clearly differentiated from these structures.
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Figure 2b. Lymph node evaluation. (a) T1-weighted MR image demonstrates an enlarged left common iliac lymph node (arrow) that is isointense relative to blood vessels and muscles. (b) On a T2-weighted MR image, the enlarged lymph node (arrow) is more clearly differentiated from these structures.
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Figure 3. Cervical carcinoma. Sagittal T2-weighted MR image reveals a small, posterior cervical carcinoma (arrow) disrupting the low-signal-intensity fibrous stroma.
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Figure 4. Exophytic cervical carcinoma. Sagittal T2-weighted MR image demonstrates a large, exophytic cervical mass protruding into the posterior vaginal fornix (arrow).
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Figure 5. Infiltrating cervical carcinoma. Sagittal T2-weighted MR image shows a large cervical mass infiltrating the lower myometrium and endometrium.
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Figure 6. Endocervical carcinoma. Sagittal T2-weighted MR image shows a barrel-shaped cervical carcinoma expanding the inner cervix, with preservation of the external os (arrow).
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Figure 7a. Cervical carcinoma. (a) Axial T2-weighted MR image shows a small, slightly hyperintense carcinoma posterior to and to the left of the cervix (arrow). (b, c) On consecutive axial fat-saturated T1-weighted MR images obtained shortly after intravenous injection of gadopentetate dimeglumine, the carcinoma demonstrates rapid enhancement (arrow).
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Figure 7b. Cervical carcinoma. (a) Axial T2-weighted MR image shows a small, slightly hyperintense carcinoma posterior to and to the left of the cervix (arrow). (b, c) On consecutive axial fat-saturated T1-weighted MR images obtained shortly after intravenous injection of gadopentetate dimeglumine, the carcinoma demonstrates rapid enhancement (arrow).
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Figure 7c. Cervical carcinoma. (a) Axial T2-weighted MR image shows a small, slightly hyperintense carcinoma posterior to and to the left of the cervix (arrow). (b, c) On consecutive axial fat-saturated T1-weighted MR images obtained shortly after intravenous injection of gadopentetate dimeglumine, the carcinoma demonstrates rapid enhancement (arrow).
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Figure 8a. Cervical carcinoma. (a) Axial T2-weighted MR image demonstrates a hyperintense central cervical carcinoma (arrow), in contrast to the hypointense cervical stroma. (b) On an axial fat-saturated T1-weighted MR image obtained after dynamic intravenous injection of gadopentetate dimeglumine, the carcinoma demonstrates intense enhancement (arrow).
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Figure 8b. Cervical carcinoma. (a) Axial T2-weighted MR image demonstrates a hyperintense central cervical carcinoma (arrow), in contrast to the hypointense cervical stroma. (b) On an axial fat-saturated T1-weighted MR image obtained after dynamic intravenous injection of gadopentetate dimeglumine, the carcinoma demonstrates intense enhancement (arrow).
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Figure 9. Sagittal T2-weighted MR image shows a long, infiltrating central cervical carcinoma. Such a tumor is difficult to evaluate at clinical examination alone.
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Figure 10a. Cervical carcinoma with vaginal invasion. Sagittal (a) and axial (b) T2-weighted MR images show a posterior cervical carcinoma invading the posterior vaginal fornix (arrow).
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Figure 10b. Cervical carcinoma with vaginal invasion. Sagittal (a) and axial (b) T2-weighted MR images show a posterior cervical carcinoma invading the posterior vaginal fornix (arrow).
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Figure 11. Noninvasive cervical carcinoma. Axial T2-weighted MR image shows a cervical carcinoma (arrow) with preservation of the normal hypointense cervical stroma. This finding is a reliable indication that there is no parametrial invasion.
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Figure 12a. Cervical carcinoma with parametrial invasion. (a) Axial T2-weighted MR image shows a cervical carcinoma with disruption of the stromal ring and extension into the parametrium (arrow). (b) Axial T2-weighted MR image obtained in a different patient shows a cervical carcinoma with more extensive bilateral parametrial invasion (arrow).
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Figure 12b. Cervical carcinoma with parametrial invasion. (a) Axial T2-weighted MR image shows a cervical carcinoma with disruption of the stromal ring and extension into the parametrium (arrow). (b) Axial T2-weighted MR image obtained in a different patient shows a cervical carcinoma with more extensive bilateral parametrial invasion (arrow).
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Figure 13. Cervical carcinoma with pelvic wall invasion. Fat-saturated T1-weighted MR image obtained after intravenous injection of gadopentetate dimeglumine shows a cervical carcinoma extending posteriorly through the uterosacral ligament (arrow).
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Figure 14a. Cervical carcinoma with bladder invasion. Sagittal T2-weighted MR images obtained in two different patients demonstrate bladder wall invasion (arrow) with disruption of the normal hypointense bladder wall and a mass protruding into the lumen.
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Figure 14b. Cervical carcinoma with bladder invasion. Sagittal T2-weighted MR images obtained in two different patients demonstrate bladder wall invasion (arrow) with disruption of the normal hypointense bladder wall and a mass protruding into the lumen.
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Figure 15a. Cervical carcinoma with rectal invasion. Axial (a) and sagittal (b) T2-weighted MR images and corresponding axial contrast-enhanced T1-weighted MR image (c) show a cervical carcinoma with direct extension into the rectal wall. There is irregular thickening of the anterior rectal wall (arrow), which enhances after injection of gadopentetate dimeglumine.
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Figure 15b. Cervical carcinoma with rectal invasion. Axial (a) and sagittal (b) T2-weighted MR images and corresponding axial contrast-enhanced T1-weighted MR image (c) show a cervical carcinoma with direct extension into the rectal wall. There is irregular thickening of the anterior rectal wall (arrow), which enhances after injection of gadopentetate dimeglumine.
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Figure 15c. Cervical carcinoma with rectal invasion. Axial (a) and sagittal (b) T2-weighted MR images and corresponding axial contrast-enhanced T1-weighted MR image (c) show a cervical carcinoma with direct extension into the rectal wall. There is irregular thickening of the anterior rectal wall (arrow), which enhances after injection of gadopentetate dimeglumine.
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Figure 16. Cervical carcinoma with bladder invasion. Axial contrast-enhanced T1-weighted MR image shows a cervical carcinoma with direct extension into the bladder wall (arrow).
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Figure 17. Bullous edema sign. Sagittal T2-weighted MR image demonstrates hyperintense bullous thickening of the bladder wall (arrow). This finding is not a direct sign of tumor extension but may indicate inflammation or microscopic invasion.
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Figure 18. Lymph node. Axial T2-weighted MR image shows a slightly hyperintense lymph node (arrow) that is well differentiated from muscles and blood vessels.
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Figure 19. Ring flow artifact. Axial T2-weighted MR image demonstrates a slightly hyperintense ring flow artifact (arrows), a finding that is often seen in the iliac veins and should not be confused with adenopathy.
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Copyright © 2000 by the Radiological Society of North America.
