Novel approaches to diagnostic imaging of locally advanced cervical cancer

Abstract

Cervical cancer is the second most common cancer after breast cancer and the third most common cause of cancer-related death followed by breast and lung cancers among women worldwide. advances in diagnostic imaging techniques provide better assessment of regional and distant cervical cancer metastasis. the use of contrast-enhanced ultrasound is a revolutionary imaging modality; it has several advantages over ct: no radiation exposure, nephrotoxicity, obtaining real-time information, relatively low cost and ease of use. currently, the contrast agent sonoVue is widely used in ultrasound imaging of liver, kidneys and pancreas lesions, as well as for closed abdominal injuries, multiple organ failure, breast and prostate cancers, etc. However, the role of contrast-enhanced ultrasound in gynecology is not clearly established. one of the most effective tools for the detection of locally advanced cervical cancer is mRi, which is used mainly to determine the local extent of the tumor. However, the use of functional mRi techniques has not yet been included in the standards. cervical cancer tissue has been found to show significantly lower diffusion-weighted imaging (dWi) values than normal cervical tissue, thus facilitating the detection of tumor and its spread. dWi is also used for differentiating changes after biopsy from residual tumor and for identifying small lymph nodes. the pEt/ct technique combines the metabolic images of pEt with anatomical images of ct and is more accurate than high resolution ct alone, especially in determining the involvement of regional lymph nodes and distant organs. 18-Fdg-pEt/ct has been successfully used for accurate staging of the disease (especially late stage), assessment of treatment response, radiotherapy planning, and detection of disease progression. in patients with advanced stages of cervical cancer (iiBiV stage), the 18-Fdg-pEt / ct findings can determine the treatment strategy in most cases, primarily due to high sensitivity (75-100 %) and specificity (87-100 %) in the detection of lymph node metastases.