VALUE OF MAGNETIC-RESONANCE-IMAGING WITH AN ENDOVAGINAL RECEIVER COILIN THE PREOPERATIVE ASSESSMENT OF STAGE-I AND IIA CERVICAL NEOPLASIA

Objective To assess the value of high resolution endovaginal magnetic resonance images (MRI) of the uterine cervix in planning management of early cervical cancer. Design Prospective cross-sectional study. Sett ing Specialist gynaecological oncology unit of a postgraduate teaching hospital. Participants Thirty nine women aged 25-76 years old (mean 4 2.5 years) with invasive carcinoma Stage I or IIa of the cervix. Metho ds A ring coil was positioned endnovaginally around the cervix. Imagin g was performed on a 1.0 T HPQ Vista or 0 .5 T Asset (Picker, Highland Heights, Ohio, USA) using T-1 weighted and T-2 weighted sequences in transverse and sagittal planes with thin slices (2.5 mm) and small fie lds of view (12 cm). Tumour volumes were measured and any extension in to adjacent organs and parametrium was noted. The patients were follow ed up after treatment and the outcome related to the MRI findings. Res ults There was one false positive and one false negative result among five Stage Ia patients being assessed for residual disease after cone biopsy or LLETZ. The MRI assessment of the size and distribution of th e tumour was confirmed histologically in all 31 patients with Stage Ib or IIa disease who were treated surgically. One of these patients in whom no endocervical tumour was visible on MRI underwent radical trach electomy. Three patients had radiotherapy as primary treatment. Patien ts with Stage Ib or IIa disease who had tumour volumes > 10 cm(3) with early parametrial extension on MRI had a substantially worse prognosi s at 24 months (disease-free survival 58.3% vs 95.5%, P = 0.093). Conc lusion High resolution MRI with an endovaginal coil allows precise mea surement of tumour volume and identifies patients with small volume di sease who might be considered for more conservative therapy. This tech nique also reveals early parametrial invasion that cannot be identifie d reliably by any other method. Early parametrial invasion in women wi th large tumours appears to have a very much worse prognosis.