HIGH-RESOLUTION MR-IMAGING OF STAGE-I CERVICAL NEOPLASIA WITH A DEDICATED TRANSVAGINAL COIL - MR FEATURES AND CORRELATION OF IMAGING AND PATHOLOGICAL FINDINGS

OBJECTIVE. The purposes of this study were to assess the appearance of stage 1 neoplasia of the cervix by high-resolution MR imaging with an enveloping transvaginal receiver coil and to correlate the imaging fi ndings with the pathologic findings. SUBJECTS AND METHODS. Fifteen pat ients (25-73 years old; mean, 40 years old) with clinical stage I dise ase were examined with a 37-mm-diameter ring design solenoid receiver coil placed around the cervix. Axial 2.5-mm contiguous slices were obt ained with a field of view of 10-15 cm on a 1.0-T HPQ Vista scanner wi th T1-weighted (660/20 msec [TR/TE]) and T2- weighted (2500/80 msec) s pin-echo sequences and dynamic gradient-echo sequences during injectio n of gadopentetate dimeglumine (0.1 mmol/kg). Ten patients subsequentl y underwent Wertheim's hysterectomy, two underwent radiotherapy, two u nderwent extended cone biopsy for microinvasive disease, and one under went a punch biopsy. For seven of 10 patients who had a hysterectomy, the widths of the tumor and the residual stroma were measured at eight radial points on the transverse images and at corresponding points on the histologic specimens at 5, 10, 15, 20, and 25 mm from the ectocer vix. We then compared the widths of the tumor and the stroma on images and histologic specimens at each of these 40 points. Tumor volumes we re calculated from the MR imaging and pathologic data and compared. Fo r the other three patients, detailed MR imaging-pathology correlation was not possible because of multifocal tumor distribution (two patient s) and insufficient detailed pathologic data (one patient). RESULTS. T hree carcinoma types were recognized. Squamous carcinoma (nine cases) was seen as a centrally expanding intermediate-signal-intensity mass, whereas oat (small)-cell carcinoma (one case) and clear cell carcinoma (one case) showed a multifocal distribution. For patients who had a r adical hysterectomy, we noted good agreement between the widths of the tumor and the stroma determined by MR imaging and histology. Tumor vo lumes were determined to be 0 -28.2 cm(3) by MR imaging and 0-18.4 cm( 3) by pathology. We observed tumor extension into the immediate parame trium in four patients by MR imaging; one of these cases was not confi rmed at surgery. Parametrial extension was not underestimated by MR im aging in any case. CONCLUSION. High-resolution imaging of the cervix w ith a transvaginal coil provides accurate assessment of the intra- and extracervical extents of tumors in clinical stage 1 cervical neoplasi a.