Division of Abdominal Imaging, Department of Radiology, Beth Israel Deaconess Medical Center- Harvard Medical School, Boston, MA, USA.
Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA.
Abdom Radiol (NY). 2019 Jul;44(7):2557-2571. doi: 10.1007/s00261-019-01984-7.
Magnetic resonance imaging (MRI) of the pelvis is the most reliable imaging modality for staging, treatment planning, and follow-up of cervical cancer; and its findings may now be incorporated into the International Federation of Gynecology and Obstetrics Federation (FIGO) 2018 clinical staging of cervical cancer. It is imperative that radiologists are familiar with the imaging appearance of the different stages of cervical cancer as well as the post-treatment changes and imaging pitfalls given the respective clinical manifestations, treatment regimens, and prognosis of an accurate diagnosis. In addition to the different stages of cervical cancer, we address the imaging techniques for diagnosis, staging and treatment implications as well as the changes of the new FIGO staging system.
The use of MRI to diagnose and stage cervical cancer is steadily increasing and the new FIGO stagi ng system, previously based on clinical examination, now allows the staging or change of staging based on the imaging findings. MRI can evaluate the extent of disease because of its excellent contrast resolution for pelvic tissues and organs, high accuracy and detailed elaboration of the cervical/uterovaginal anatomy.
Relevant anatomy, including normal MRI appearance of the cervix, parametria and pelvic ligaments; different stages of cervical cancer on MRI with prognostic and therapeutic implications; MRI sequences, other imaging modalities used in the staging and follow-up, treatment of different stages and the appearance of the cervix and cervical cancer post-treatment. Since clinical implications and therapeutic strategies for cervical cancer treatment vary tremendously according to degree of tumor extension, familiarity with relevant MRI techniques and findings is essential for radiologists. It is important that radiologists interpreting pelvic MRI are aware with the different stages of cervical cancer to provide useful information regarding treatment and prognosis. Pitfalls regarding the interpretation of tumor extension can interfere with an accurate diagnosis and have significant therapeutic implications.
盆腔磁共振成像（MRI）是宫颈癌分期、治疗计划和随访最可靠的影像学方法；其结果现在可以纳入国际妇产科联合会（FIGO）2018 年宫颈癌临床分期。鉴于宫颈癌不同阶段的临床表现、治疗方案和预后，放射科医生必须熟悉宫颈癌不同阶段的影像学表现以及治疗后的变化和影像学陷阱，以便做出准确的诊断。除了宫颈癌的不同阶段，我们还讨论了诊断、分期和治疗影响的影像学技术，以及新 FIGO 分期系统的变化。
MRI 诊断和分期宫颈癌的应用稳步增加，新的 FIGO 分期系统以前基于临床检查，现在允许根据影像学发现进行分期或改变分期。MRI 可以评估疾病的范围，因为它对盆腔组织和器官具有极好的对比分辨率、高准确性和对宫颈/阴道解剖结构的详细阐述。
相关解剖学，包括宫颈、宫旁组织和骨盆韧带的正常 MRI 表现；宫颈癌的不同阶段在 MRI 上的表现及其对预后和治疗的影响；MRI 序列、用于分期和随访的其他影像学方式、不同阶段的治疗以及宫颈和宫颈癌治疗后的表现。由于宫颈癌治疗的临床意义和治疗策略根据肿瘤扩展程度而有很大差异，因此放射科医生熟悉相关的 MRI 技术和发现是必不可少的。解读盆腔 MRI 的放射科医生必须了解宫颈癌的不同阶段，以便提供有关治疗和预后的有用信息。解读肿瘤扩展的陷阱会干扰准确的诊断，并产生重大的治疗影响。
