Magnetic resonance imaging in the planning and monitoring of the treatment of cervical cancer

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Abstract

Cervical cancer remains one of the leading causes of cancer morbidity and mortality among the female population worldwide. The prognosis as well as the choice of therapy depends on the initial assessment of the extent of the tumor spread. The latter is mainly determined with the use of methods of radiologic diagnostics: magnetic resonance imaging (MRI), positron emission tomography and multispiral computed tomography. These methods also play one of the leading roles in assessing the treatment response. The updated classification of the International Federation of Gynecology and Obstetrics (FIGO, 2018) recognizes the value of imaging in cervical cancer, in particular MRI, before, during and after antitumor treatment. The development of medical imaging and the search for new biomarkers will increase the prognostic value in assessing the response to therapy, identifying residual tumors and relapse of the disease.

This review presents the relevant information on the possibilities and limitations, the place of MRI in the complex diagnostic algorithm at the stage of primary assessment of the tumor process, the choice of tactics and analysis of the effectiveness of cervical cancer treatment. Different data bases, including PubMed/MEDLINE, eLibrary, Scopus, NCCN, ESUR, ACR, were searched. We analyzed the studies results on the use of noninvasive imaging techniques at the stage of primary diagnosis, assessing the effectiveness of treatment and its prognosis in patients with cervical cancer. The diagnostic opportunities and limitations of MRI in the cervical cancer diagnosis are summarized in our review. Due to the high soft tissue contrast, MRI is the method of choice in assessing the response to therapy, predicting treatment and further monitoring.

Conclusion: Noninvasive imaging plays a leading role in the primary diagnosis of cervical cancer. Further research is needed to overcome the difficulties of staging, monitoring the response to therapy and detecting relapse of the disease.

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About the authors

Alina E. Solopova

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Author for correspondence.
Email: dr.solopova@mail.ru
ORCID iD: 0000-0003-4768-115X
Scopus Author ID: 24460923200
ResearcherId: P-8659-2015

Dr. Med. Sci., Leading Researcher, Radiology Department, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia; Professor, Department of Obstetrics, Gynecology and Perinatal Medicine, Sechenov University, Ministry of Health of Russia

Russian Federation, Moscow

Bova B. Bendzhenova

Botkin City Clinical Hospital, Moscow Healthcare Department

Email: dr.solopova@mail.ru
ORCID iD: 0009-0004-4744-0422

MD, obstetrician-gynecologist, Gynecological Department, Botkin City Clinical Hospital

Russian Federation, Moscow

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Supplementary files

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2. Fig. 1. MR image of the normal anatomy of the cervix (the transition zone between stratified squamous and columnar epithelium is marked) [from the archive of Sokolova A.E.]

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3. Fig. 2. Options for extended hysterectomy (classification by Qeurleu and Morrow, 2008 [31])

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4. Fig. 3. MRI scans of a patient of reproductive age with assessment of selection criteria for the possibility of organ-preserving treatment (cervical length, vertical size of the tumor, depth of stromal invasion, absence of signs of infiltration of parametric tissue, distance from the upper pole of the formation to the internal os) [from the archive of Sokolova A E.]

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5. Fig. 4. MRI scans of the patient after radical trachelectomy, without signs of relapse (A – post-contrast T1-VI in FatSat mode, B-E2-WI – both in the sagittal plane. The area of uterovaginal anastomosis without signs of infiltration, the uterine cavity is closed, data no information about outflow disturbance was received) [from the archive of Sokolova A.E.]

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6. Fig. 5. CC T1b3 (FIGO). On T2-weighted images during chemotherapy, partial response (observation interval 3 months), Partial Response, PR-RECIST 1.1. There is a decrease in tumor size and degree of infiltration of surrounding tissues. (A, C – T2-WI in the sagittal and axial planes before treatment; B, D – T2-WI in the sagittal and axial planes 3 months after treatment) [from the archive of Sokolova A.E.]

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7. Fig. 6. CC T1b3 (FIGO). On T2-weighted images during chemotherapy, complete response (observation interval 2 months), CR-RECIST 1.1. At the second time point, no MR signs of the presence of a residual tumor are detected. The involuted stroma of the cervical cervix is completely visible, the undeformed hyperintense cervical canal is preserved throughout. (A, C - T2-VI in the sagittal and axial planes before treatment; .B, D - T2-VI in the sagittal and axial planes during treatment) [from the archive of Sokolova A.E.]

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8. Fig. 7. CC T1b3. MRI scans of the patient on T2-WI during PCT, progression (observation interval 2.5 months), PD-RECIST 1.1. There is a marked increase in the predominantly exophytic tumor, the appearance of signs of invasion of the posterior parametrium, and the manifestation of small lymph nodes in the mesorectal tissue. (A, D - T2-WI in the sagittal and axial planes before treatment; B, C, E - T2-WI in the sagittal and axial planes during treatment) [from the archive of Sokolova A.E.]

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9. Fig. 8. MRI scans of local cervical cancer recurrence (area highlighted by arrow) [from the archive of Sokolova A.E.]

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10. Fig. 9. Formation of a vesicovaginal fistula against the background of tumor infiltration (between the posterior wall of the bladder and the wall of the uterovaginal anastomosis). (A - T2-WI in the sagittal plane, B, C - T2-WI in the axial plane, D - DWI with a high b-factor) [from the archive of Sokolova A.E.]

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