Current imaging strategies for the evaluation of uterine cervical cancer

Table 1 Uterine cervical cancer classification system (as proposed by the International Federation of Gynecology and Obstetrics, 2009)

Stage	Sub-stage	Sub-stage
(description)	(description)	(description)
In situ
I	IA	IA1
Tumor confined to the cervix (may extend to the uterine corpus)	Miscroscopic tumor: Depth of invasion ≤ 5 mm, horizontal spread ≤ 7 mm	Depth of invasion ≤ 3 mm, horizontal spread ≤ 7 mm
		IA2
		Depth of invasion > 3 mm and ≤ 5 mm, horizontal spread ≤ 7 mm
	IB	IB1
	Macroscopically visible tumor	Lesion of maximal diameter ≤ 4 cm
		IB2
		Lesion of maximal diameter > 4 cm
II	IIA	IIA1
Cervical carcinoma extends to the upper vagina or parametrium	Cervical cancer extents to the upper 2/3 of the vagina	Lesion of maximal diameter ≤ 4 cm
		IIA2
		Lesion of maximal diameter > 4 cm
	IIB
	Tumor invades parametrial space (uni- and/or bilateral)
III	IIIA
Cervical cancer invades pelvic sidewall and/or lower 1/3 vagina and/or causes hydronephrosis	Tumor invades lower 1/3 of vagina
	IIIB
	Tumor invades pelvic wall and/or ureter causing hydronephrosis
IV	IVA
Cervical cancer invades adjacent pelvic organs and/or extending distally (beyond the pelvis)	Bladder and/or rectal mucosa invasion
	IVB
	Distant metastasis, peritoneal or paraaortic node involvement

Table 2 Magnetic resonance imaging protocol for cervical cancer staging

Sequence	Plane	Technical characteristics	Utility
T2-W TSE (mandatory)	Axial (renal hilum-pubis)	TR/TE: 3500/90, NSA: 2, SL/G: 4.5/1, Matrix: 340 × 350, FOV: 38	Tumor detection and morphology, evaluation of pelvic tissues, lymph node status
	Sagittal	TR/TE: 3500/90, NSA: 3, SL/G: 3.5/1.2, Matrix: 348 × 276, FOV: 25
	Axial oblique (perpendicular to cervical axis)	TR/TE: 3900/125, NSA: 6, SL/G: 4/0.4, Matrix: 256 × 176, FOV: 18
T1-W TSE (mandatory)	Axial (renal hilum-pubis)	TR/TE: 400/13, NSA: 1, SL/G: 6/2, Matrix: 300 × 205, FOV: 36	Pelvic anatomy, lymph nodes, bone marrow, haemorrhage
DWI-EPI (mandatory)	Axial	TR/TE: 3000/68,	Tumor detection, lymph nodes, post-treatment evaluation
		NSA: 12, SL/G: 6/1
		Matrix: 124 × 174
		FOV: 35
DCE (optional)	Sagittal; one native, post contrast images every 17 s, total acquisition time about 3 min	TR/TE/FA: 15/4.2/45°, NSA: 2, Matrix: 228 × 75, FOV:17	Small tumor detection, tumor borders, endocervical extent
T2-W TSE FS (optional)	Axial	TR/TE: 1650/70, NSA: 2, SL/G: 4.5/1, Matrix: 288 × 250, FOV: 35	Parametrial plexus, fluid, bone marrow evaluation

T2-W: T2-weighted; T1-W: T1-weighted; T2-FS: T2-fat-suppressed; DCE: Dynamic contrast-enhanced; TR (ms): Repetition time; TE (ms): Echo time; FA (°): Flip angle; NSA: Number of signal acquisitions; SL (mm): Slice thickness; G (mm): Interslice gap; FOV (cm): Field of view (right-left).