CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2021; 31(02): 454-467
DOI: 10.1055/s-0041-1734377
Pictorial Essay

Magnetic Resonance Imaging of Uterine Cervix: A Pictorial Essay

Foram B. Gala
1   Department of Radiology, Lifescan Imaging Centre, Mumbai, Maharashtra, India
2   Department of Radiology, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
,
Kunal B. Gala
3   Department of Radiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
,
Bharat M. Gala
1   Department of Radiology, Lifescan Imaging Centre, Mumbai, Maharashtra, India
› Author Affiliations

Abstract

Uterine cervix is the lower constricted part of uterus which is best evaluated by magnetic resonance imaging (MRI) due to its higher soft tissue and contrast resolution. The cervical cancer is a common gynecological cancer causing much morbidity and mortality especially in developing countries. Cervical carcinomas mainly occurs in reproductive age group with prognosis mainly depending on the extent of disease at the time of diagnosis, hence it is important to identify these cancerous lesions early and stage them accurately for optimal treatment. In this article, we will review the following: (1) the normal MRI anatomy of uterine cervix; (2) MRI protocol and techniques in evaluation of cervical lesions; (3) imaging of spectrum of various congenital abnormalities and pathologies affecting uterine cervix which ranges from congenital abnormalities to various benign lesions of cervix like nabothian cysts, tunnel cysts, cervicitis, cervical fibroid, and, lastly, endometriosis which usually coexists with adenomyosis; the malignant lesions include carcinoma cervix, adenoma malignum or direct extension from carcinoma endometrium or from carcinoma of vagina; (4) Accurately stage carcinoma of cervix using FIGO classification (2018); and (5) posttreatment evaluation of cervical cancers. MRI is the most reliable imaging modality in evaluation of various cervical lesions, identification of cervical tumors, staging of the cervical malignancy, and stratifying patients for surgery and radiation therapy. It also plays an important role in detection of local disease recurrence.



Publication History

Article published online:
04 August 2021

© 2021. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 
  • References

  • 1 II: The anatomy of the uterine cervix and isthmus. Acta Radiol 1952; os-37 (Suppl. 91) 9-12
  • 2 Klüner C, Hamm B. Normal imaging findings of the uterus. In: Hamm B, Forstner R, Beinder E, eds. MRI and CT of the Female Pelvis.. Berlin, Germany: Springer 2007; 37-47
  • 3 Ferenczy A. Anatomy and histology of the cervix. In: Blaustein A, ed. Pathology of the Female Genital Tract.. New York, NY: Springer 1977; 102-3
  • 4 Agrawal G. Part I: MR of the female pelvis. Available at: https://www.appliedradiology.com/articles/part-i-mr-of-the-female-pelvis. Accessed July 22, 2021
  • 5 Johnson W, Taylor MB, Carrington BM, Bonington SC, Swindell R. The value of hyoscine butylbromide in pelvic MRI. Clin Radiol 2007; 62 (11) 1087-1093
  • 6 Camis CC, Brenna SMF, Lombardelli KVP, Maria Célia R. Djahjah: magnetic resonance imaging in the staging of cervical cancer. Radiol Bras 2007; 40: 207-215
  • 7 Okamoto Y, Tanaka YO, Nishida M, Tsunoda H, Yoshikawa H, Itai Y. MR imaging of the uterine cervix: imaging-pathologic correlation. Radiographics 2003; 23 (02) 425-445
  • 8 Keriakos NN, Darwish E. Diffusion-weighted imaging in suspicious uterine tumors; how efficient is it?. Egypt J Radiol Nucl Med 2018; 49: 838-845
  • 9 Bin Park S, Lee JH, Lee YH, Song MJ, Choi HJ. Multilocular cystic lesions in the uterine cervix: broad spectrum of imaging features and pathologic correlation. AJR Am J Roentgenol 2010; 195 (02) 517-523
  • 10 Kuang F, Yan Z, Li H, Feng H. Diagnostic accuracy of diffusion-weighted MRI for differentiation of cervical cancer and benign cervical lesions at 3.0T: Comparison with routine MRI and dynamic contrast-enhanced MRI. J Magn Reson Imaging 2015; 42 (04) 1094-1099
  • 11 Jones MA, Young RH. Endocervical type A (noncystic) tunnel clusters with cytologic atypia. A report of 14 cases. Am J Surg Pathol 1996; 20 (11) 1312-1318
  • 12 Balleyguier C, Sala E, Da Cunha T. et al. Staging of uterine cervical cancer with MRI: guidelines of the European Society of Urogenital Radiology. Eur Radiol 2011; 21 (05) 1102-1110
  • 13 Behr SC, Courtier JL, Qayyum A. Imaging of müllerian duct anomalies. Radiographics 2012; 32 (06) E233-E250
  • 14 Mueller GC, Hussain HK, Smith YR. et al. Müllerian duct anomalies: comparison of MRI diagnosis and clinical diagnosis. AJR Am J Roentgenol 2007; 189 (06) 1294-1302
  • 15 Troiano RN, McCarthy SM. Mullerian duct anomalies: imaging and clinical issues. Radiology 2004; 233 (01) 19-34
  • 16 Robbins JB, Parry JP, Guite KM. et al. MRI of pregnancy-related issues: müllerian duct anomalies. AJR Am J Roentgenol 2012; 198 (02) 302-310
  • 17 Elamparidhi P, Kumar RR, Sivaranjinie S, Sibhithran R. Mullerian agenesis associated with Turner’s syndrome. J Clin Diagn Res 2017; 11 (02) TD01-TD02
  • 18 Carrington BM, Hricak H, Nuruddin RN. Secaf E, Laros RK Jr., Hill EC. Müllerian duct anomalies: MR imaging evaluation. Radiology 1990; 176 (03) 715-720
  • 19 Segal GH, Hart WR. Cystic endocervical tunnel clusters. A clinicopathologic study of 29 cases of so-called adenomatous hyperplasia. Am J Surg Pathol 1990; 14 (10) 895-903
  • 20 Young RH, Clement PB. Pseudoneoplastic glandular lesions of the uterine cervix. Semin Diagn Pathol 1991; 8 (04) 234-249
  • 21 Sugiyama K, Takehara Y. MR findings of pseudoneoplastic lesions in the uterine cervix mimicking adenoma malignum. Br J Radiol 2007; 80 (959) 878-883
  • 22 Takatsu A, Shiozawa T, Miyamoto T. et al. Preoperative differential diagnosis of minimal deviation adenocarcinoma and lobular endocervical glandular hyperplasia of the uterine cervix: a multicenter study of clinicopathology and magnetic resonance imaging findings. Int J Gynecol Cancer 2011; 21 (07) 1287-1296
  • 23 Tiltman AJ. Leiomyomas of the uterine cervix: a study of frequency. Int J Gynecol Pathol 1998; 17 (03) 231-234
  • 24 Ueda H, Togashi K, Konishi I. et al. Unusual appearances of uterine leiomyomas: MR imaging findings and their histopathologic backgrounds. Radiographics 1999; 19 (01) S131-S145
  • 25 Stamatellos I, Stamatopoulos P, Bontis J. The role of hysteroscopy in the current management of the cervical polyps. Arch Gynecol Obstet 2007; 276 (04) 299-303
  • 26 Golan A, Ber A, Wolman I, David MP. Cervical polyp: evaluation of current treatment. Gynecol Obstet Invest 1994; 37 (01) 56-58
  • 27 Coutinho Jr. A, Bittencourt LK, Pires CE. et al. MR imaging in deep pelvic endometriosis: a pictorial essay. Radiographics 2011; 31 (02) 549-567
  • 28 Tamai K, Togashi K, Ito T, Morisawa N, Fujiwara T, Koyama T. MR imaging findings of adenomyosis: correlation with histopathologic features and diagnostic pitfalls. Radiographics 2005; 25 (01) 21-40
  • 29 Novellas S, Chassang M, Delotte J. et al. MRI characteristics of the uterine junctional zone: from normal to the diagnosis of adenomyosis. AJR Am J Roentgenol 2011; 196 (05) 1206-1213
  • 30 Ascher-Walsh CJ, Tu JL, Du Y, Blanco JS. Location of adenomyosis in total hysterectomy specimens. J Am Assoc Gynecol Laparosc 2003; 10 (03) 360-362
  • 31 Park J, Kim T, Lee H, Lee W, Chung S, Park S. Cervical endometriosis in a post-menopausal woman: a case report. J Korean Soc Menopause 2011; 17: 174-177
  • 32 Phadnis SV, Doshi JS, Ogunnaike O, Coady A, Padwick M, Sanusi FA. Cervical endometriosis: a diagnostic and management dilemma. Arch Gynecol Obstet 2005; 272 (04) 289-293
  • 33 Ata B, Ates U, Usta T, Attar E. Cervical endometriosis, a case presenting with intractable spotting. MedGenMed 2005; 7 (02) 64
  • 34 Wang S, Li XC, Lang JH. Cervical endometriosis: clinical character and management experience in a 27-year span. Am J Obstet Gynecol 2011; 205 (05) 452.e1-452.e5
  • 35 Szyfelbein WM, Baker PM, Bell DA. Superficial endometriosis of the cervix: A source of abnormal glandular cells on cervicovaginal smears. Diagn Cytopathol 2004; 30 (02) 88-91
  • 36 Bennett GL, Slywotzky CM, Cantera M, Hecht EM. Unusual manifestations and complications of endometriosis–spectrum of imaging findings: pictorial review. AJR Am J Roentgenol 2010; 194 (Suppl. 06) WS34-WS46
  • 37 Steinkeler JA, Woodfield CA, Lazarus E, Hillstrom MM. Female infertility: a systematic approach to radiologic imaging and diagnosis. Radiographics 2009; 29 (05) 1353-1370
  • 38 Guven S, Ilıca T, Yılmaz A, Alanbay I. A case of asymptomatic postmenopausal hematometra mimicking endometrial carcinoma. Gynecol Obstet Reprod Med 2007; 13: 67-69 ISSN 1300–4751
  • 39 Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68 (06) 394-424
  • 40 Patel S, Liyanage SH, Sahdev A, Rockall AG, Reznek RH. Imaging of endometrial and cervical cancer. Insights Imaging 2010; 1 (05/06) 309-328
  • 41 Bhatla N, Berek JS, Cuello Fredes M. et al. Revised FIGO staging for carcinoma of the cervix uteri. Int J Gynaecol Obstet 2019; 145 (01) 129-135
  • 42 Zand KR, Reinhold C, Abe H, Maheshwari S, Mohamed A, Upegui D. Magnetic resonance imaging of the cervix. Cancer Imaging 2007; 7: 69-76
  • 43 Rockall AG, 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 (02) 244-249
  • 44 Delgado G, Bundy BN, Fowler WC Jr. et al. A prospective surgical pathological study of stage I squamous carcinoma of the cervix: a Gynecologic Oncology Group Study. Gynecol Oncol 1989; 35 (03) 314-320
  • 45 Inoue T. Prognostic significance of the depth of invasion relating to nodal metastases, parametrial extension, and cell types. A study of 628 cases with Stage IB, IIA, and IIB cervical carcinoma. Cancer 1984; 54 (12) 3035-3042
  • 46 Trattner M, Graf AH, Lax S. et al. Prognostic factors in surgically treated stage ib-iib cervical carcinomas with special emphasis on the importance of tumor volume. Gynecol Oncol 2001; 82 (01) 11-16
  • 47 Yang WT, Lam WW, Yu MY, Cheung TH, Metreweli C. Comparison of dynamic helical CT and dynamic MR imaging in the evaluation of pelvic lymph nodes in cervical carcinoma. AJR Am J Roentgenol 2000; 175 (03) 759-766
  • 48 Atri M, Zhang Z, Dehdashti F. et al. Utility of PET-CT to evaluate retroperitoneal lymph node metastasis in advanced cervical cancer: Results of ACRIN6671/GOG0233 trial. Gynecol Oncol 2016; 142 (03) 413-419
  • 49 Choi HJ, Ju W, Myung SK, Kim Y. Diagnostic performance of computer tomography, magnetic resonance imaging, and positron emission tomography or positron emission tomography/computer tomography for detection of metastatic lymph nodes in patients with cervical cancer: meta-analysis. Cancer Sci 2010; 101 (06) 1471-1479
  • 50 National Comprehensive Cancer Network. Cervical cancer 2018. Available at: https://www2.tri-kobe.org/nccn/guideline/archive/gynecological2018/english/cervical.pdf.
  • 51 Bhatla N, Aoki D, Sharma DN, Sankaranarayanan R. Cancer of the cervix uteri. Int J Gynaecol Obstet 2018; 143 (Suppl. 02) 22-36
  • 52 Chai Y, Wang T, Wang J. et al. Radical hysterectomy with adjuvant radiotherapy versus radical radiotherapy for FIGO stage IIB cervical cancer. BMC Cancer 2014; 14: 63
  • 53 Marin F, Plesca M, Bordea CI, Moga MA, Blidaru A. Types of radical hysterectomies : from Thoma Ionescu and Wertheim to present day. J Med Life 2014; 7 (02) 172-176
  • 54 Ramirez PT, Pareja R, Rendón GJ, Millan C, Frumovitz M, Schmeler KM. Management of low-risk early-stage cervical cancer: should conization, simple trachelectomy, or simple hysterectomy replace radical surgery as the new standard of care?. Gynecol Oncol 2014; 132 (01) 254-259
  • 55 Bourgioti C, Chatoupis K, Moulopoulos LA. Current imaging strategies for the evaluation of uterine cervical cancer. World J Radiol 2016; 8 (04) 342-354
  • 56 Papadopoulou I, Stewart V, Barwick TD. et al. Post-radiation therapy imaging appearances in cervical carcinoma. Radiographics 2016; 36 (02) 538-553
  • 57 Mahajan M, Kuber R, Chaudhari K, Chaudhari P, Ghadage P, Naik R. MR imaging of carcinoma cervix. Indian J Radiol Imaging 2013; 23 (03) 247-252
  • 58 Ki EY, Byun SW, Park JS, Lee SJ, Hur SY. Adenoma malignum of the uterine cervix: report of four cases. World J Surg Oncol 2013; 11: 168
  • 59 Peppercorn PD, Jeyarajah AR, Woolas R. et al. Role of MR imaging in the selection of patients with early cervical carcinoma for fertility-preserving surgery: initial experience. Radiology 1999; 212 (02) 395-399
  • 60 Freeman SJ, Aly AM, Kataoka MY, Addley HC, Reinhold C, Sala E. The revised FIGO staging system for uterine malignancies: implications for MR imaging. Radiographics 2012; 32 (06) 1805-1827
  • 61 Bourgioti C, Chatoupis K, Panourgias E. et al. Endometrial vs. cervical cancer: development and pilot testing of a magnetic resonance imaging (MRI) scoring system for predicting tumor origin of uterine carcinomas of indeterminate histology. Abdom Imaging 2015; 40 (07) 2529-2540