• Uterine Cervical Cancer
• Magnetic Resonance Imaging
• MRI
• DWI
• Diffusion Weighted Imaging
• Cervix Uteri Cancer
• Apparent Diffusion Coefficient
• ADC

Purpose
The aims of this study are to evaluate the behaviour of the metabolic and functional parameters in cervix uteri cancer, meant as DWI/ADC, to estimate the role of DWI and ADC values in diagnosis and follow-up of the cervix uteri cancer and to assess the possible additional contribution of DWI in this clinical setting.
Materials and Methods
From July 2012 to April 2017, we retrospectively selected 36 patients with clinical suspicion of cervix uteri cancer who underwent pelvic MRI for regional staging on 3.0T- MR scanner. We divided the population into 2 groups: group A composed of 17 patients (median age 48; range 29-81 years) who underwent first staging MRI and then went directly to surgical intervention, group (B) includes 19 patients (median age 50; range 36- 70 years) who underwent pelvic MRI before (staging MRI) and after neoadjuvant chemotherapy (NAChT).
All the patients underwent 3.0T-MR scan with conventional pelvic study protocol with additional specific DWI sequences. ADC maps and specific lesions’ ADC (whole lesion and lowest ADC values) were obtained from the elaboration of the DW images.
In both groups, the ADC values were compared with the histological grading; in addition in group B, ADC values before and after NAChT were analysed.
Results
In group A, 12 squamous cell carcinomas, 3 adenocarcinomas, 1 clear cell adenocarcinoma, and 1 negative for neoplasm (according to MRI report) were included. In group B, the following histological diagnosis were present: 9 squamous cell carcinomas, 3 adenocarcinomas and 1 neuroendocrine cancer; 6 patients did not undergo surgical intervention, so the confirm of malignancy was based on biopsy.
First we analysed the performance of MRI, meant as best detection of the lesion, comparing DW and T2w images. Respectively in group A and B, the lesions were better depicted in DWI than in T2w images in 10 and 13 patients, while in 6 and 4 patients the two sequences were highly corresponding; in 1 and 2 patients the lesions were better depicted on T2w images.
No significant correlation between ADC values and histological grading was found neither in group A nor in group B.
In group A, the mean whole ADC and lowest ADC values was respectively 0.00088 s/mm2 and 0.00071 s/mm2. In group B, the mean baseline whole ADC and lowest ADC values was respectively 0.00086 s/mm2 and 0.00068 s/mm2. Regarding the post-ChT ADC value in group B, we obtained 0.00100 s/mm2 and 0.00084 s/mm2 respectively for whole ADC and lowest ADC mean values.
In group B, the results show that there is no statistically significant difference between baseline and post-ChT whole ADC values but the p-value obtained (p=0.0583) is really close to the alpha level of 0.05 indicating a trend. The presence of statistically significant difference was found between baseline and post-ChT lowest ADC values (p=0,0370), but the non-parametric approach used is definitely less robust and more prone to the case for so small samples.
Conclusions
The addition of DWI to T2W sequences considerably improved the diagnostic ability of MRI. Our results support the inclusion of DWI in the MRI protocol for the detection, staging and follow-up of cervix uteri cancer. No correlation between ADC and histological grading was found. A statistically significant difference was found only between baseline and post-ChT lowest ADC values, while for whole ADC values it is suggested only a trend. Probably with a higher sample size a difference would be detected.