T2-weighted MRI findings predictive of parametrial involvement in patients with cervical cancer and histologically confirmed full thickness stromal invasion

Purpose: To record the T2-weighted imaging (T2WI) appearance of the cervical rim in cervical cancer patients with histologically confirmed full thickness stromal invasion and to identify any signs predictive of parametrial involvement in this particular subset of patients. Material and Methods: During a 5-year period, 30/115 patients surgically treated for early cervical cancer (FIGOparametrial invasion on histology. All patients were evaluated with pelvic MRI, preoperatively. Two expert radiologists retrospectively reviewed all MRIs. The presence of the following T2WI characteristics was recorded for each side of the cervical rim: thinning (<3 mm), complete loss of normal hypointense signal, diffuse  signal inhomogeneity, irregularity of inner and outer cervical border and peritumoural fat stranding. The above signs were evaluated alone and in combination in search for any correlation with parametrial involvement. Results: Diffuse signal inhomogeneity, shaggy inner border and small focal disruptions of the normal low T2 cervical rim were the most frequent findings on T2WI. Diffuse signal inhomogeneity and peritumoural fat stranding were the only MRI features significantly associated with parametrial invasion. Complete loss of the low T2 cervical rim was observed in approximately 25% of patients with parametrial involvement. In 4/15 patients the cervical rim appeared intact. Conclusions: Diffuse signal inhomogeneity of the cervical rim and peritumoural fat stranding were the only MRI signs significantly associated with parametrial involvement in patients with cervical cancer and full stromal invasion. An intact hypointense cervical rim does not exclude tumour extension to the parametrial fat.