Preliminary Diagnosis: Cervical cancer

I. What imaging technique is first-line for this diagnosis?

Cervical cancer is typically screened for and diagnosed using annual PAP smear and colposcopy but may be incidentally discovered on an imaging study performed for another reason. MRI of the pelvis with contrast can be used for presurgical local staging, postsurgical follow-up, or monitoring of treatment response.

II. Describe the advantages and disadvantages of this technique for diagnosis of cervical cancer.

  • MRI can reliably identify parametrial invasion, the vaginal wall, and uterine cavity for local staging.

  • The patient is not exposed to ionizing radiation.

  • MRI is relatively costly.

  • MRI is a lengthy examination that requires patient cooperation with breathing motion and movement.

  • MRI cannot be performed in a select number of patients with pacemakers and other metallic nontitanium hardware and medical devices.

III. What are the contraindications for the first-line imaging technique?

  • Patients with embedded metallic nontitanium devices, such as cardiac pacers, stents and other non-MR-approved devices may not enter the MRI suite for imaging.

  • Patients who cannot cooperate with breathing instructions and immobility may not be ideal candidates. Some patients require sedation to tolerate the examination to diagnostic quality.

  • Patients with GFR below 30 should not receive gadolinium IV contrast.

IV. What alternative imaging techniques are available?

  • Clinical examination with PAP smear and colposcopy remains the standard for diagnosis of cervical cancer.

  • In advanced cases, CT or PET scan can be used for staging and monitoring of treatment response.