Objective  To investigate the application value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) technology for cervical cancer clinical staging.

Methods  A retrospective analysis was performed on 186 patients diagnosed with cervical cancer and treated surgically at The Second Affiliated Hospital of Zhengzhou University between January 2019 and December 2021. All patients received DCE-MRI examination to evaluate clinical staging, cervical stromal invasion, uterine corpus invasion, vaginal involvement, parametrial metastases, and lymph node metastases. Postoperative pathology was used as the gold standard to confirm related criteria. The accuracy, sensitivity, and specificity of DCE-MRI in preoperative cervical cancer staging were analyzed.

Results  The clinical staging of 186 patients was consistent with surgical-pathological staging (Kappa=0.862, P<0.001), and 165 cases (88.71%) had the same clinical staging and surgical-pathological staging. DCE-MRI had an accuracy of 96.24%, a sensitivity of 86.96%, and a specificity of 97.55% in diagnosing vaginal involvement, and 97.31%, 82.35%, and 98.82% in diagnosing lymph node metastases, and 86.56%, 90.79%, and 83.63% in diagnosing deep stromal invasion, respectively.

Conclusion  DCE-MRI has a high sensitivity and specificity in the identification of vaginal involvement, lymph node metastases and deep stromal invasion, and it can be utilized as a reference for evaluating cervical cancer preoperative clinical staging.

1.Bhatla N, Berek JS, Cuello Fredes M, et al. Revised FIGO staging for carcinoma of the cervix uteri[J]. Int J Gynaecol Obstet, 2019, 145(1): 129-135. DOI: 10.1002/ijgo.12749.

2.Corrigendum to "Revised FIGO staging for carcinoma of the cervix uteri" [Int J Gynecol Obstet 145(2019) 129-135][J]. Int J Gynaecol Obstet, 2019, 147(2): 279-280. DOI: 10.1002/ijgo.12969.

3.张婷, 刘爱连, 汪禾青, 等. MRI动态增强扫描对宫颈癌的诊断价值[J]. 中华放射学杂志, 2009, 43(9): 973-977. [Zhang T, Liu AL, Wang HQ, et al. Dynamic contrast-enhanced MRI in the diagnosis of uterine cervical cancer[J]. Chinese Journal of Radiology, 2009, 43(9): 973-977.] DOI: 10.3760/cma.j.issn.1005-1201.2009.09.019.

4.王艾博, 边杰. DCE-MRI原理及临床应用情况[J].中国临床医学影像杂志, 2016, 27(6): 435-438. [Wang AB, Bian J. The principle and application in clinic of dynamic contrast enhancement magnetic resonance imaging[J]. Journal of China Clinic Medical Imaging, 2016, 27(6): 435-438.] DOI: CNKI:SUN:LYYX.0.2016-06-017.

5.Abu-Rustum NR, Yashar CM, Bean S, et al. NCCN guidelines insights: cervical cancer, version 1.2020[J]. J Natl Compr Canc Netw, 2020, 18(6): 660-666. DOI: 10.6004/jnccn.2020.0027.

6.中华人民共和国国家卫生健康委员会. 宫颈癌诊疗规范(2018年版)[J]. 肿瘤综合治疗电子杂志, 2020, 6(3): 33-43. [National Health Commission of the People's Republic of China. Guidelines for diagnosis and treatment of cervical cancer (2018 version)[J]. Journal of Multidisciplinary Cancer Management (Electronic Version), 2020, 6(3): 33-43.] DOI: 10.12151/JMCM.2020.03-06.

7.高克非, 刘富元, 冯艳玲, 等. 子宫颈癌盆腔淋巴结转移的术前CT评价[J]. 临床肿瘤学杂志, 2004, 9(6): 578-580, 585. [Gao KF, Liu FY, Feng YL, et al. The assessing by preoperative CT scan for pelvic lymph node metastases of uterine cervical carcinoma[J]. Chinese Clinical Oncology, 2004, 9(6): 578-580, 585.] DOI: 10.3969/j.issn.1009-0460.2004.06.006.

8.戴景蕊, 张洵, 蒋玲霞, 等. CT扫描对早期宫颈癌的诊断价值[J]. 中华肿瘤杂志, 2006, 28(2): 151-154. [Dai JR, Zhang X, Jiang LX, et al. Value of CT scaning in the diagnosis of early cervical carcinoma[J]. Chinese Journal of Oncology, 2006, 28(2): 151-154.] DOI: 10.3760/j.issn:0253-3766.2006.02.021.

9.Dappa E, Elger T, Hasenburg A, et al. The value of advanced MRI techniques in the assessment of cervical cancer: a review[J]. Insights Imaging, 2017, 8(5): 471-481. DOI: 10.1007/s13244-017-0567-0.

10.Matani H, Patel AK, Horne ZD, et al. Utilization of functional MRI in the diagnosis and management of cervical cancer[J]. Front Oncol, 2022, 12: 1030967. DOI: 10.3389/fonc.2022.1030967.

11.Pötter R, Tanderup K, Schmid MP, et al. MRI-Guided adaptive brachytherapy in locally advanced cervical cancer (EMBRACE-I): a multicentre prospective cohort study[J]. Lancet Oncol, 2021, 22(4): 538-547. DOI: 10.1016/S1470-2045(20)30753-1.

12.范辉健. 子宫颈癌正常大小淋巴结转移情况调查及CT影像组学预测模型的构建[D]. 广东: 南方医科大学, 2022. [Fan HJ. Investigation of normal size lymph node metastasis in cervical cancer and construction of CT radiomics prediction model[D]. Guangdong: Southern Medical University, 2022.] DOI: 10.27003/d.cnki.gojyu.2021.000706.

13.中华医学会放射学分会宫颈癌专家组. 宫颈癌磁共振检查及诊断规范专家共识[J]. 肿瘤影像学, 2017, 26(4): 250-254. [Cervical Cancer Expert Group of Chinese Society of Radiology. Expert consensus on MRI examination and diagnosis of cervical cancer[J]. Oncoradiology, 2017, 26(4): 250-254.] DOI: 10.3969/j.issn.1008-617X.2017.04.002.

14.黄道煌, 秦添, 杜坤, 等. DCE-MRI定量参数与宫颈癌临床分期及预后的相关性[J]. 湖南师范大学学报(医学版), 2021, 18(4): 156-159. [Huang DH, Qin T, Du K, et al. Correlation between quantitative parameters of DCE-MRI and clinical stage, prognosis of cervical cancer[J]. Journal of Hunan Normal University (Medical Science), 2021, 18(4): 156-159.] DOI: 10.3969/j.issn.1673-016X.2021.04.045.

15.Brix G, Schreiber W, Hoffmann U, et al. Methodological approaches to quantitative evaluation of microcirculation in tissues with dynamic magnetic resonance tomography[J]. Radiologe, 1997, 37(6): 470-480. DOI: 10.1007/s001170050241.

16.何斌, 杨海香, 吴芹. 动态增强MRI技术对宫颈癌术前分期的诊断价值[J]. 江西医药, 2020, 55(2): 211-212, 217. [He B, Yang HX, Wu Q. The diagnostic value of dynamic contrast-enhanced MRI in preoperative staging of cervical cancer[J]. Jiangxi Medical Journal, 2020, 55(2): 211-212, 217.] DOI: 10.3969/j.issn.1006-2238.2020.02.040.

17.王洁茹, 李梅莲, 温凤玲, 等. 磁共振动态增强检查对宫颈癌的诊断价值[J]. 深圳中西医结合杂志, 2021, 31(21): 86-88. [Wang JR, Li ML, Wen FL, et al. The diagnostic value of dynamic enhanced magnetic resonance examination for cervical cancer[J]. Shenzhen Journal of Integrated Traditional Chinese and Western Medicine, 2021, 31(21): 86-88.] DOI: 10.16458/j.cnki.1007-0893.2021.21.034.

18.Baliyan V, Das CJ, Sharma R, et al. Diffusion weighted imaging: technique and applications[J]. World J Radiol,  2016, 8(9): 785-798. DOI: 10.4329/wjr.v8.i9.785.

19.苏兰芳, 刘越雄, 万江花, 等. 动态增强MRI与DWI在中老年宫颈癌分期诊断中的价值比较[J]. 中国老年学杂志, 2022, 42(7): 1587-1590. [Su LF, Liu YX, Wan JH, et al. The value of dynamic contrast-enhanced MRI and DWI in the staging of cervical cancer in middle-aged and elderly patients[J]. Chinese Journal of Gerontology, 2022, 42(7): 1587-1590.] DOI: 10.3969/j.issn.1005-9202.2022.07.015.

20.练伟, 潘佳. 动态对比增强MRI、磁共振弥散加权成像联合应用在宫颈癌患者分期诊断中的价值[J]. 影像研究与医学应用, 2021, 5(18): 86-87. [Lian W, Pan J. The value of combined application of dynamic contrast-enhanced MRI and diffusion-weighted imaging in the staging of cervical cancer[J]. Journal of Imaging Research and Medical Applications, 2021, 5(18): 86-87.] DOI: 10.3969/j.issn.2096-3807.2021.18.041.

21.Liu Y, Liu H, Bai X, et al. Differentiation of metastatic from non-metastatic lymph nodes in patients with uterine cervical cancer using diffusion-weighted imaging[J]. Gynecol Oncol, 2011, 122(1): 19-24. DOI: 10.1016/j.ygyno.2011.03.023.

22.曹伟学, 伍振宇. 磁共振扩散加权成像(DWI)、MR动态增强扫描诊断宫颈癌的临床价值研究[J]. 现代医用影像学, 2021, 30(7): 1310-1312. [Cao WX, Wu ZY. The clinical value of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced MR scanning in the diagnosis of cervical cancer[J]. Modern Medical Imageology, 2021, 30(7): 1310-1312.] https://d.wanfangdata.com.cn/periodical/ChlQZXJpb2RpY2FsQ0hJTmV3UzIwMjMwODMxEhB4ZHl5eXh4MjAyMTA3MDM3GghhMTFzOXN4Yw%3D%3D.

23.Bai Z, Shi J, Yang Z, et al. Quantitative kinetic parameters of primary tumor can be used to predict pelvic lymph node metastasis in early-stage cervical cancer[J]. Abdom Radiol (NY), 2021, 46(3): 1129-1136. DOI: 10.1007/s00261-020-02762-6.

24.Yang W, Qiang JW, Tian HP, et al. Multi-parametric MRI in cervical cancer: early prediction of response to concurrent chemoradiotherapy in combination with clinical prognostic factors[J]. Eur Radiol, 2018, 28(1): 437-445. DOI: 10.1007/s00330-017-4989-3.

25.Zhang Q, Guo J, Ouyang H, et al. Added-value of dynamic contrast-enhanced MRI on prediction of tumor recurrence in locally advanced cervical cancer treated with chemoradiotherapy[J]. Eur Radiol, 2022, 32(4): 2529-2539. DOI: 10.1007/s00330-021-08279-w.