Jung Jae Park MD, Presenter: Nothing to Disclose

Chan Kyo Kim MD, PhD, Abstract Co-Author: Nothing to Disclose

Sung Yoon Park, Abstract Co-Author: Nothing to Disclose

Byung Kwan Park MD, Abstract Co-Author: Nothing to Disclose

With the use of T2-weighted imaging (T2WI), prediction of parametrial invasion in cervical cancer may be limited due to peritumoral edema or inflammation. The aim of our study was to retrospectively investigate the utility of fused T2WI and high b-value diffusion-weighted imaging (DWI) at 3T for evaluating parametrial invasion in cervical cancer.

Between January 2010 and December 2012, 152 consecutive patients (median, 51 years; range, 26–80 years) with biopsy-proven cervical cancer who received radical hysterectomy underwent pretreatment MR imaging at 3T (i.e., T2WI and DWI). DWI was obtained using a STIR single-shot echo-planar imaging technique with background suppression. Fusion of high b-value DWI (1000 s/mm2) to T2WI (fused T2-DWI) was performed using a dedicated image processing workstation (AZE Virtual Place). Two radiologists independently evaluated the presence of parametrial invasion on T2WI, fused T2-DWI, and combined T2WI and fused T2-DWI (T2 + fused T2-DWI), and the results were compared with histopathological findings. Statistical analysis was performed using receiver operating characteristics (ROC) curve analysis, McNemar’s test and weighted kappa statistics.

Parametrial invasion was pathologically identified in 37 patients (24.3%). For predicting parametrial invasion, fused T2-DWI and T2 + fused T2-DWI showed better specificity, accuracy and predictive positive value than T2WI alone for both readers (all P < 0.05), but the sensitivity was not significantly different between each imaging method for both readers (all P > 0.05). The area under the curve (AUC) for predicting parametrial invasion of T2WI, fused T2-DWI, and T2 + fused T2-DWI were 0.912, 0.951 and 0.976 for reader 1 and 0.890, 0.932, and 0.968 for reader 2, respectively: all pairwise comparisons were significantly different (all P < 0.05). Inter-reader agreement was good for T2WI (κ = 0.78) and excellent for fused T2-DWI and T2 + fused T2-DWI (κ = 0.83 for both).

Fused T2-DWI can improve the diagnostic performance for the prediction of parametrial invasion in cervical cancer as compared with T2WI alone.

Fusion of high b-value diffusion-weighted imaging (1000 s/mm2) to T2-weighted imaging (T2WI) can provide incremental diagnostic value for predicting parametrial invasion in cervical cancer by decreasing false positive rate compared with T2WI alone.

Park, J, Kim, C, Park, S, Park, B, Parametrial Invasion in Cervical Cancer: Utility of Fused T2-Weighted and High B-Value Diffusion-Weighted Imaging at 3T.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14005925.html