Added value of diffusion-weighted MRI in detection of cervical cancer recurrence compared with morphologic and dynamic contrast-enhanced MRI sequences

摘要

PURPOSEWe aimed to evaluate the added value of diffusion-weighted imaging (DWI) to standard magneticresonance imaging (MRI) for detecting post-treatment cervical cancer recurrence. The detectionaccuracy of T2-weighted (T2W) images was compared with that of T2W MRI combined with eitherdynamic contrast-enhanced (DCE) MRI or DWI.METHODSThirty-eight women with clinically suspected uterine cervical cancer recurrence more than sixmonths after treatment completion were examined with 1.5 Tesla MRI including T2W, DCE, andDWI sequences. Disease was confirmed histologically and correlated with MRI findings. The diagnosticperformance of T2W imaging and its combination with either DCE or DWI were analyzed.Sensitivity, positive predictive value, and accuracy were calculated.RESULTSThirty-six women had histologically proven recurrence. The accuracy for recurrence detection was80% with T2W/DCE MRI and 92.1% with T2W/DWI. The addition of DCE sequences did not significantlyimprove the diagnostic ability of T2W imaging, and this sequence combination misclassifiedtwo patients as falsely positive and seven as falsely negative. The T2W/DWI combination revealeda positive predictive value of 100% and only three false negatives.CONCLUSIONThe addition of DWI to T2W sequences considerably improved the diagnostic ability of MRI. Ourresults support the inclusion of DWI in the initial MRI protocol for the detection of cervical cancerrecurrence, leaving DCE sequences as an option for uncertain cases.