SPHP Radiology Protocols

INDICATION: Cervical cancer staging. (Generally ordered by gyn-onc, rad-onc, or heme-onc).

Sag TSE T2 high-res uterus/cervix

Long Axis TSE T2 high-res uterus/cervix

Short Axis TSE T2 high-res cervix

Short Axis fat sat TSE T2 high-res cervix

Short Axis in and out of phase T1 cervix

Ax in and out of phase T1 whole pelvis

Short Axis 3D VIBE T1 (fat sat) pre cervix

Short Axis 3D VIBE T1 (fat sat) post 45 sec cervix

Short Axis 3D VIBE T1 (fat sat) post 90 sec cervix

Sag 3D VIBE T1 (fat sat) post 120 to 180 sec uterus/cervix

Short axis perpendicular to cervix/cervical canal

Long axis parallel to cervix/cervical canal

*Please provide subtraction images

example short axis plane

example long axis plane

FIGO	Definition	MR staging	Treatment
0	Carcinoma in situ	Not visible
I	Confined to cervix		Surgery
IA-1	Stromal invasion <3mm	Not visible	Surgery
IA-2	<5mm invasion <7mm width	May see small enhancing nodule	Surgery
IB-1	<4cm	Tumor visible Intact stromal ring	Surgery
IB-2	>4cm	Tumor visible Intact stromal ring	Radiation Therapy
II	Extends beyond uterus
IIA	Vaginal extension No parametrial invasion	Disruption of low signal intensity vaginal wall (upper 2/3)	Surgery if <4cm Radiation therapy if >4cm
IIB	Parametrial invasion	Complete disruption of stromal ring with tumor extending into parametrium	Radiation Therapy
III	Extends to lower 1/3 of vagina or pelvic wall invasion with hydronephrosis
IIIA	Extension to lower 1/3 of vagina	Invasion of lower 1/3 of vagina	Radiation Therapy
IIIB	Pelvic wall invasion with hydronephrosis	Extension to pelvic muscles or dilated ureter	Radiation Therapy
IV	Located outside true pelvis		Radiation Therapy
IVA	Bladder or rectal mucosa	Loss of low signal intensity in bladder or rectal wall	Radiation Therapy
IVB	Distant metastases	Adenopathy etc.	Radiation Therapy