The first pass phase of contrast material is most important to study vascularization
and perfusion of tissue and can be studied using dynamic magnetic resonance (MR) imaging.
The purpose of this prospective study was to evaluate the usefulness of pre-contrast
vs. post-contrast and fast dynamic MR imaging in the preoperative staging of cervical
carcinomas. To assess the normal onset of enhancement of the uterus and cervix 15
volunteers underwent dynamic MR imaging. Forty-two consecutive patients with invasive
cervical cancer underwent preoperative evaluation using MR imaging. The results of
the MR examinations were correlated with clinical (FIGO) staging under anesthesia
(n = 42) and with histopathological findings after operation (n = 26). The staging results of precontrast T1-weighted and T2-weighted turbo spin-echo
(TSE) MR images, pre-contrast MR images plus post-contrast enhanced (two-dimensional
fast low angle shot (FLASH 2-D) post contrast), pre-contrast MR images plus post-contrast
enhanced plus fast dynamic enhanced (single slice turbo fast low angle shot (turbo
FLASH)) MR images compared to histopathology (n = 26) were 77%, 81%, and 85%, respectively. The improvement was statistically not
significant. The result of MR staging compared to clinical staging (n = 42) with pre-contrast MR images was correct in 79% of the cases. Pre-contrast MR
images combined with post-contrast MR images did not significantly improve staging
accuracy (83%). Pre-contrast plus post-contrast plus fast dynamic MR imaging improved
staging to 91%. However, the improvement was only statistically significant for one
reader (p = 0.01), whereas the improvement of the second reader was not significant (p = 0.07). The single slice turbo FLASH images showed enhancement of all squamous cell
carcinomas (n = 32) with an average onset of 5 seconds (range 4–8 seconds during the first 45 seconds
of bolus injection of gadolinium. The normal cervix showed enhancement with an average
of 10 seconds (range 6–14 seconds). FLASH 2-D post-contrast images showed less intense
enhancement of the cervical tumors with respect to the parametria and other surrounding
structures. Fast dynamic MR imaging and to a lesser degree post-contrast MR imaging
showed a higher level of confidence than pre-contrast MR. Fast dynamic MRI compared
with clinical staging (n = 42) was correct in 91% (38/42) and to histopathology in 85% (22/26). Comparison
of clinical staging with histopathology was 85% (22/26). In conclusion, fast dynamic
MR imaging is superior to post-contrast and pre-contrast MR imaging and is at least
as good as clinical staging in the evaluation of cervical carcinoma.
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Publication history
Clin Radiol 1998;53:183–192
Identification
Copyright
© 1998 Published by Elsevier Inc.