RADIOLOGY OF CANCER CERVIX BY DR KANHU CHARAN PATRO

RADIOLOGY OF CANCER CERVIX BY DR KANHU CHARAN PATRO

1. RADIOLOGY FOR ONCOLOGISTS RADIOLOGY OF CANCER CERVIX 3/21/2025 1 Dr Kanhu Charan Patro MD,DNB(Radiation Oncology),MBA,FICRO,FAROI(USA),PDCR,CEPC Clinical Director, HOD (Radiation Oncology) ISRo - I nstitute of S tereotactic R adiation o ncology Mahatma Gandhi Cancer Hospital & Research Institute, Visakhapatnam [email protected] /M- [phone]/ www.drkanhupatro.com

2. GROSS STAGING

3. THE GROSS ANATOMY

4. MRI ANATOMY

5. MRI PROTOCOL

6. MR REPORTING CHECKLIST

7. MR reporting checklist

8. GEC-ESTRO Working Group (IV) 3/21/2025 8

9. Effect of antispasmodic drug administration on MR image quality: small bowel peristalsis causes movement artefacts in MRI (a). A spasmolytic agent (e.g. NButylscopolan or Glucagon chlorhydrate ) is therefore commonly administered intravenously to inhibit bowel motion shortly before performing pelvic MRI (b). In (a) the sagittal T2w MR image is blurred due to small bowel motion and due to uterine contraction. In (b) the sagittal T2w MR image of the same patient appears with significant improvement of image quality since it is obtained after injection of Glucagon chlorhydrate . How to decrease the OAR artifact in pelvic MRI?

10. Differences resulting due to different magnet field strength: comparison between T2w sagittal MR images obtained with a high-field MR scanner (1.5 T (a)) and a low field MR scanner (0.2 T (b)). Prior to imaging intravaginal contrast (ultrasound gel) was injected in order to distend the vaginal walls and to improve visualisation of vaginal tumour extension. The impact of magnet field strength on signal intensity of tumour and intravaginal contrast is significant. The high field MR images depict the tumour with intermediate-to-high signal intensity and the low-field images of the same patient with high signal intensity. low field MR High field MR LOW FIELD MR FOR IN CANCER CERVIX

11. HOW IT LOOKS? T2 HYPERINTENSE

12. TYPES OF GROWTH

13. MEASURING THE LENGTH

14. ESTIMATING PARA INVOLVEMENT HYPOINTENSE STROMAL RING

15. PARA - EXPANSION VERSUS INVASION

16. PELVIC SIDEWALL INVASION Pelvic sidewall invasion is defined as invasion or tumor abutment within < 3 mm of the internal obturator , levator ani or piriformis muscles, or the iliac vessels

17. SACROUTERINE LIGAMENT INVASION This sagittal MRI shows a locally advanced cervical cancer (circle) with extensive invasion along the sacrouterine ligaments (arrows).

18. DWI CORRELATION

19. BLADDER AND RECTAL INVASION

20. INVASION VERSUS BULLOUS EDEMA

21. NORMAL VAGINAL WALL Sagittal T2-weighted image demonstrates a 2.6-cm cervical tumor (calipers) in the posterior cervix. No vaginal invasion or parametrial invasion can be seen

22. Vaginal involvement- The arrow head

23. VAGINAL GEL APPLICATION Stage IV Invasion of adjacent organs. Sagittal T2 weighted MRI of the pelvis reveals a large cervical tumor (asterisk) with bladder invasion. Sagittal T2 weighted MRI of the pelvis with vaginal gel demonstrates a large tumor with invasion of the posterior bladder wall (arrows) and rectal involvement (asterisk).

24. HYDRONEPHROSIS

25. RESPONSE ASSESMENT- CR

26. RESPONSE ASSESMENT- RESIDUAL

27. Nodal distribution 3/21/2025 27

28. Lymphatic drainage of pelvic organs 3/21/2025 28

29. LYMPH NODE STAGING

30. LYMPH NODE STAGING

31. When things are suspicious PET looks auspicious 3/21/2025 31

32. When things are unclear think of nuclear 3/21/2025 32

33. 3/21/2025 33 RENAL HILAR

34. 3/21/2025 34 AORTOCAVAL

35. 3/21/2025 35 Sup masentric

36. 3/21/2025 36 PARAAORITC

37. 3/21/2025 37 PARAAORITC

38. 3/21/2025 38 INFERIOR MASENTRIC

39. 3/21/2025 39

40. 3/21/2025 40 COMMON ILIAC

41. 3/21/2025 41 Presacral Common iliac

42. 3/21/2025 42 External and internal

43. 3/21/2025 43

44. 3/21/2025 44

45. 3/21/2025 45

46. SUMMARY OF INGUINAL NODES 3/21/2025 46

47. 3/21/2025 47

48. TAKE HOME MESSAGE For primary CT and MRI complementary to each other For nodal assessment PET is superior Lesion is hyperintensity Breaking of hypo ring is para involvement Compare with DWI in diagnosis and response assessment

49. Welcome to SON Group S implified O ncology N etwork Group Awareness to Education to Practice 3/21/2025 49

50. Scan through Google lens Go to free materials 3/21/2025 50