Prätherapeutische Diagnostik des Zervixkarzinoms

Zusammenfassung

Die Magnetresonanztomografie (MRT) stellt inzwischen einen integralen Bestandteil im lokalen prätherapeutischen Staging des Zervixkarzinoms dar. Zahlreiche Veröffentlichungen der vergangenen Jahre haben die Überlegenheit der MRT im lokalen Tumorstaging gezeigt. Sie ist nicht nur die Methode der Wahl zur Therapieentscheidung und Therapieplanung, sondern auch in der Therapiekontrolle unter Strahlentherapie, im Rezidivausschluss in der Nachsorge und bei der Beurteilung tumor- bzw. therapiebedingter Komplikationen. Der Hauptgrund liegt in ihrer überragenden Abbildungsqualität der Bauch- und Beckenorgane infolge des hohen Weichteilkontrasts. In der folgenden Übersicht sollen die diagnostischen Möglichkeiten und Grenzen der MRT und der ergänzenden bildgebenden Modalitäten CT und PET bzw. PET/CT im primären Staging des Zervixkarzinoms unter Berücksichtigung der bisherigen wissenschaftlichen Erkenntnisse erörtert werden. Ebenso wird auf den aktuellen Stand im Lymphknoten-Staging und die Limitationen der bildgebenden Methoden eingegangen.

Abstract

Magnetic resonance imaging (MRI) has evolved into an integral component of the pretherapeutic local staging of cervical cancer. Many recent studies have demonstrated the superiority of MRI for this indication. It is the method of choice for therapeutic decision making and planning, monitoring of the response to radiotherapy, excluding of tumor recurrence, and assessing of patients for tumor or therapy-related complications. The superiority of MRI is mainly due to its high soft-tissue contrast that allows depiction of the abdominal and pelvic organs with excellent image quality. This article provides an overview of the diagnostic potential and limitations of MRI in the primary staging of cervical cancer and supplementary imaging modalities – CT, PET, and PET/CT – on the basis of the current scientific literature. Also included is a discussion of state-of-the-art lymph node staging and the limitations of imaging in lymph node assessment.

Key words

MR imaging - uterus - cervix - PET - PET-CT

Literatur

• 1 Hauth E A, Stattaus J, Debatin J F. et al . Magnetresonanztomographie benigner und maligner Tumoren des weiblichen Beckens.  Fortschr Röntgenstr. 2004;  176 817-828
• 2 Hamm B. Stellenwert der MRT in der Diagnostik benigner und maligner Tumoren des Uterus.  Fortschr Röntgenstr. 1999;  170 327-337
• 3 Itoh K, Shiozawa T, Ohira S. et al . Correlation between MRI and histopathologic findings in stage I cervical carcinomas: influence of stromal desmoplastic reaction.  Int J Gynecol Cancer. 2006;  16 610-614
• 4 Soutter W P, Hanoch J, D’Arcy T. et al . Pretreatment tumour volume measurement on high-resolution magnetic resonance imaging as a predictor of survival in cervical cancer.  Bjog. 2004;  111 741-747
• 5 Sethi T K, Bhalla N K, Jena A N. et al . Magnetic resonance imaging in carcinoma cervix--does it have a prognostic relevance.  J Cancer Res Ther. 2005;  1 103-107
• 6 Narayan K, McKenzie A, Fisher R. et al . Estimation of tumor volume in cervical cancer by magnetic resonance imaging.  Am J Clin Oncol. 2003;  26 e163-e168
• 7 Sheu M H, Chang C Y, Wang J H. et al . Preoperative staging of cervical carcinoma with MR imaging: a reappraisal of diagnostic accuracy and pitfalls.  Eur Radiol. 2001;  11 1828-1833
• 8 Sahdev A, Sohaib S A, Wenaden A E. et al . The performance of magnetic resonance imaging in early cervical carcinoma: a long-term experience.  Int J Gynecol Cancer. 2007;  17 629-636
• 9 Choi S H, Kim S H, Choi H J. et al . Preoperative magnetic resonance imaging staging of uterine cervical carcinoma: results of prospective study.  J Comput Assist Tomogr. 2004;  28 620-627
• 10 Akata D, Kerimoglu U, Hazirolan T. et al . Efficacy of transvaginal contrast-enhanced MRI in the early staging of cervical carcinoma.  Eur Radiol. 2005;  15 1727-1733
• 11 Scheidler J, Heuck A, Wencke K. et al . Parametrane Infiltration beim Zervixkarzinom: Diagnostische Wertigkeit von kontrastverstärkten fettsupprimierten T 1-gewichteten SE-Sequenzen bei 1,5 Tesla.  Fortschr Röntgenstr. 1997;  166 312-316
• 12 Iwata S, Joja I, Okuno K. et al . Cervical carcinoma with full-thickness stromal invasion: efficacy of dynamic MR imaging in the assessment of parametrial involvement.  Radiat Med. 2002;  20 247-255
• 13 Desouza N M, Dina R, McIndoe G A. et al . Cervical cancer: Value of an endovaginal coil magnetic resonance imaging technique in detecting small volume disease and assessing parametrial extension.  Gynecol Oncol. 2006;  102 80-185
• 14 Bipat S, Glas A S, Velden van der J. et al . Computed tomography and magnetic resonance imaging in staging of uterine cervical carcinoma: a systematic review.  Gynecol Oncol. 2003;  91 59-66
• 15 Park W, Park Y J, Huh S J. et al . The usefulness of MRI and PET imaging for the detection of parametrial involvement and lymph node metastasis in patients with cervical cancer.  Jpn J Clin Oncol. 2005;  35 260-264
• 16 Hricak H, Gatsonis C, Coakley F V. et al . Early invasive cervical cancer: CT and MR imaging in preoperative evaluation – ACRIN/GOG comparative study of diagnostic performance and interobserver variability.  Radiology. 2007;  245 491-498
• 17 Hawighorst H, Knapstein P G, Knopp M V. et al . Uterine cervical carcinoma: comparison of standard and pharmacokinetic analysis of time-intensity curves for assessment of tumor angiogenesis and patient survival.  Cancer Res. 1998;  58 3598-3602
• 18 Rockall A G, Ghosh S, Alexander-Sefre F. et al . Can MRI rule out bladder and rectal invasion in cervical cancer to help select patients for limited EUA?.  Gynecol Oncol. 2006;  101 244-249
• 19 Kim S H, Han M C. Invasion of the urinary bladder by uterine cervical carcinoma: evaluation with MR imaging.  Am J Roentgenol. 1997;  168 393-397
• 20 Hawighorst H, Knapstein P G, Weikel W. et al . Invasives Zervixkarzinom (pT2b-pT4a) Wertigkeit der konventionellen und pharmakokinetischen Magnetresonanztomographie (MRT) im Vergleich zum Großflächenschnitt und dem histopathologischen Befund.  Radiologe. 1997;  37 130-138
• 21 Ozsarlak O, Tjalma W, Schepens E. et al . The correlation of preoperative CT, MR imaging, and clinical staging (FIGO) with histopathology findings in primary cervical carcinoma.  Eur Radiol. 2003;  13 2338-2345
• 22 Hricak H, Powell C B, Yu K K. et al . Invasive cervical carcinoma: role of MR imaging in pretreatment work-up –cost minimization and diagnostic efficacy analysis.  Radiology. 1996;  198 403-409
• 23 Hricak H, Gatsonis C, Chi D S. et al . Role of imaging in pretreatment evaluation of early invasive cervical cancer: results of the intergroup study American College of Radiology Imaging Network 6651-Gynecologic Oncology Group 183.  J Clin Oncol. 2005;  23 9329-9337
• 24 Kim S H, Kim S C, Choi B I. et al . Uterine cervical carcinoma: evaluation of pelvic lymph node metastasis with MR imaging.  Radiology. 1994;  190 807-811
• 25 Choi H J, Kim S H, Seo S S. et al . MRI for pretreatment lymph node staging in uterine cervical cancer.  Am J Roentgenol. 2006;  187 W538-W543
• 26 Bellomi M, Bonomo G, Landoni F. et al . Accuracy of computed tomography and magnetic resonance imaging in the detection of lymph node involvement in cervix carcinoma.  Eur Radiol. 2005;  15 2469-2474
• 27 Scheidler J, Hricak H, Yu K K. et al . Radiological evaluation of lymph node metastases in patients with cervical cancer. A meta-analysis.  Jama. 1997;  278 1096-1101
• 28 Harisinghani M G, Saini S, Weissleder R. et al . MR lymphangiography using ultrasmall superparamagnetic iron oxide in patients with primary abdominal and pelvic malignancies: radiographic-pathologic correlation.  Am J Roentgenol. 1999;  172 1347-1351
• 29 Bellin M F, Beigelman C, Precetti-Morel S. Iron oxide-enhanced MR lymphography: initial experience.  Eur J Radiol. 2000;  34 257-264
• 30 Keller T M, Michel S C, Frohlich J. et al . USPIO-enhanced MRI for preoperative staging of gynecological pelvic tumors: preliminary results.  Eur Radiol. 2004;  14 937-944
• 31 Rose P G, Adler L P, Rodriguez M. et al . Positron emission tomography for evaluating para-aortic nodal metastasis in locally advanced cervical cancer before surgical staging: a surgicopathologic study.  J Clin Oncol. 1999;  17 41-45
• 32 Choi H J, Roh J W, Seo S S. et al . Comparison of the accuracy of magnetic resonance imaging and positron emission tomography/computed tomography in the presurgical detection of lymph node metastases in patients with uterine cervical carcinoma: a prospective study.  Cancer. 2006;  106 914-922
• 33 Yeh L S, Hung Y C, Shen Y Y. et al . Detecting para-aortic lymph nodal metastasis by positron emission tomography of 18F-fluorodeoxyglucose in advanced cervical cancer with negative magnetic resonance imaging findings.  Oncol Rep. 2002;  9 1289-1292
• 34 Lin W C, Hung Y C, Yeh L S. et al . Usefulness of (18)F-fluorodeoxyglucose positron emission tomography to detect para-aortic lymph nodal metastasis in advanced cervical cancer with negative computed tomography findings.  Gynecol Oncol. 2003;  89 73-76
• 35 Chou H H, Chang T C, Yen T C. et al . Low value of [18F]-fluoro-2-deoxy-D-glucose positron emission tomography in primary staging of early-stage cervical cancer before radical hysterectomy.  J Clin Oncol. 2006;  24 123-128
• 36 Roh J W, Seo S S, Lee S. et al . Role of positron emission tomography in pretreatment lymph node staging of uterine cervical cancer: a prospective surgicopathologic correlation study.  Eur J Cancer. 2005;  41 2086-2092
• 37 Wright J D, Dehdashti F, Herzog T J. et al . Preoperative lymph node staging of early-stage cervical carcinoma by [18F]-fluoro-2-deoxy-D-glucose-positron emission tomography.  Cancer. 2005;  104 2484-2491
• 38 Hertel H, Kohler C, Elhawary T. et al . Laparoscopic staging compared with imaging techniques in the staging of advanced cervical cancer.  Gynecol Oncol. 2002;  87 46-51
• 39 Chung H H, Lee S, Sim J S. et al . Pretreatment laparoscopic surgical staging in locally advanced cervical cancer: preliminary results in Korea.  Gynecol Oncol. 2005;  97 468-475
• 40 Kerr I G, Manji M F, Powe J. et al . Positron emission tomography for the evaluation of metastases in patients with carcinoma of the cervix: a retrospective review.  Gynecol Oncol. 2001;  81 477-480
• 41 Belhocine T, Kridelka F, Thille A. et al . Staging of primary cervical cancers: the role of nuclear medicine.  Crit Rev Oncol Hematol. 2003;  46 275-284
• 42 Kirisits C, Potter R, Lang S. et al . Dose and volume parameters for MRI-based treatment planning in intracavitary brachytherapy for cervical cancer.  Int J Radiat Oncol Biol Phys. 2005;  62 901-911
• 43 Lindegaard J C, Tanderup K, Nielsen S K. et al . MRI-Guided 3D Optimization Significantly Improves DVH Parameters of Pulsed-Dose-Rate Brachytherapy in Locally Advanced Cervical Cancer.  Int J Radiat Oncol Biol Phys. 2008;  71 756-764
• 44 Potter R, Haie-Meder C, Van Limbergen E. et al . Recommendations from gynaecological (GYN) GEC ESTRO working group (II): concepts and terms in 3D image-based treatment planning in cervix cancer brachytherapy-3D dose volume parameters and aspects of 3D image-based anatomy, radiation physics, radiobiology.  Radiother Oncol. 2006;  78 67-77
• 45 Mayr N A, Taoka T, Yuh W T. et al . Method and timing of tumor volume measurement for outcome prediction in cervical cancer using magnetic resonance imaging.  Int J Radiat Oncol Biol Phys. 2002;  52 14-22
• 46 Potter R, Dimopoulos J, Bachtiary B. et al . 3D conformal HDR-brachy- and external beam therapy plus simultaneous Cisplatin for high-risk cervical cancer: Clinical experience with 3 year follow-up.  Radiother Oncol. 2006;  79 80-86
• 47 Lin L L, Mutic S, Malyapa R S. et al . Sequential FDG-PET brachytherapy treatment planning in carcinoma of the cervix.  Int J Radiat Oncol Biol Phys. 2005;  63 1494-1501
• 48 Xue F, Lin L L, Dehdashti F. et al . F-18 fluorodeoxyglucose uptake in primary cervical cancer as an indicator of prognosis after radiation therapy.  Gynecol Oncol. 2006;  101 147-151