Insights into imaging · 2026
Contrast-enhanced MRI improves the diagnostic performance for vaginal fornix invasion in cervical carcinoma.
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Yang Kailan, Rong Fangfang, Chu Funing, Dong Yafeng, Zhang Hongkai, Wan Bixiao, Xu Mingzhe, Xia Qingxin, Lu Lin, Song Ho-Young, Chen Hongmin, Qu Jinrong
Аннотация
OBJECTIVE: To investigate the added diagnostic value of contrast-enhanced MRI (CE-MRI) to T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) for evaluating vaginal fornix invasion (VFI) in cervical carcinoma (CC).
MATERIALS AND METHODS: We retrospectively enrolled 149 consecutive CC patients (training cohort) and 37 external patients (validation cohort) who underwent radical hysterectomy and preoperative MRI (T2WI, DWI, and CE-MRI). Two radiologists independently assessed VFI first using T2WI + DWI, then T2WI + DWI + CE-MRI, with histopathology as reference. Diagnostic metrics were compared with the McNemar test; interobserver agreement was evaluated via the kappa statistic. Subgroup analyses and multivariate logistic regression were performed to validate CE-MRI's added value.
RESULTS: Histopathology confirmed VFI in 68/149 patients (45.6%) in the training cohort and 6/37 (16.2%) in the external validation cohort. CE-MRI clearly visualized vaginal fornix mucosal continuity and the tumor-fornix boundary, improving lesion differentiation. Interobserver agreement improved significantly from good (κ = 0.778) to excellent (κ = 0.917) with CE-MRI (Δκ = 0.139, 95% CI: 0.062-0.220, p = 0.003). CE-MRI significantly improved diagnostic accuracy and specificity for both observers (all p < 0.001), while high sensitivity remained unchanged (p > 0.05). Multivariate regression confirmed CE-MRI as an independent positive factor for accurate VFI diagnosis (OR = 4.05, 95% CI: 2.34-6.98, p < 0.001). Subgroup analysis demonstrated accuracy improvements across most clinical subgroups (all p < 0.05). Consistent results were obtained in the external validation cohort, with diagnostic accuracy significantly improved by CE-MRI (p < 0.001).
CONCLUSION: Adding CE-MRI to T2WI + DWI significantly improves the diagnostic performance for VFI in CC.
CRITICAL RELEVANCE STATEMENT: Combining CE-MRI with T2WI + DWI significantly improves diagnostic accuracy for VFI while enhancing interobserver agreement, which will minimize miss-staging of early-stage CC, optimize treatment planning, and ultimately improve patient outcomes by reducing recurrence risk and preserving fertility when appropriate.
KEY POINTS: Accurate assessment of vaginal fornix invasion is critical but remains radiologically challenging. Contrast-enhanced MRI facilitates assessing vaginal fornix mucosal continuity and superficial invasion. Combining contrast-enhanced MRI with T2WI + DWI enhances staging accuracy for cervical carcinoma management.
MATERIALS AND METHODS: We retrospectively enrolled 149 consecutive CC patients (training cohort) and 37 external patients (validation cohort) who underwent radical hysterectomy and preoperative MRI (T2WI, DWI, and CE-MRI). Two radiologists independently assessed VFI first using T2WI + DWI, then T2WI + DWI + CE-MRI, with histopathology as reference. Diagnostic metrics were compared with the McNemar test; interobserver agreement was evaluated via the kappa statistic. Subgroup analyses and multivariate logistic regression were performed to validate CE-MRI's added value.
RESULTS: Histopathology confirmed VFI in 68/149 patients (45.6%) in the training cohort and 6/37 (16.2%) in the external validation cohort. CE-MRI clearly visualized vaginal fornix mucosal continuity and the tumor-fornix boundary, improving lesion differentiation. Interobserver agreement improved significantly from good (κ = 0.778) to excellent (κ = 0.917) with CE-MRI (Δκ = 0.139, 95% CI: 0.062-0.220, p = 0.003). CE-MRI significantly improved diagnostic accuracy and specificity for both observers (all p < 0.001), while high sensitivity remained unchanged (p > 0.05). Multivariate regression confirmed CE-MRI as an independent positive factor for accurate VFI diagnosis (OR = 4.05, 95% CI: 2.34-6.98, p < 0.001). Subgroup analysis demonstrated accuracy improvements across most clinical subgroups (all p < 0.05). Consistent results were obtained in the external validation cohort, with diagnostic accuracy significantly improved by CE-MRI (p < 0.001).
CONCLUSION: Adding CE-MRI to T2WI + DWI significantly improves the diagnostic performance for VFI in CC.
CRITICAL RELEVANCE STATEMENT: Combining CE-MRI with T2WI + DWI significantly improves diagnostic accuracy for VFI while enhancing interobserver agreement, which will minimize miss-staging of early-stage CC, optimize treatment planning, and ultimately improve patient outcomes by reducing recurrence risk and preserving fertility when appropriate.
KEY POINTS: Accurate assessment of vaginal fornix invasion is critical but remains radiologically challenging. Contrast-enhanced MRI facilitates assessing vaginal fornix mucosal continuity and superficial invasion. Combining contrast-enhanced MRI with T2WI + DWI enhances staging accuracy for cervical carcinoma management.