HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) CME Test (opens in a new window) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Jeong, Y. Y. Articles by Park, J. G. Search for Related Content PubMed PubMed Citation Articles by Jeong, Y. Y. Articles by Park, J. G. Related Collections Magnetic Resonance Imaging Obstetric/Gynecologic Radiology Computed Tomography Related Article

Uterine Cervical Carcinoma after Therapy: CT and MR Imaging Findings¹

¹ From the Department of Diagnostic Radiology, Chonnam National University Medical School, 8 Hack-Dong, Dong-Ku, Gwang-Ju 501-757, Korea. Recipient of a Certificate of Merit award for an education exhibit at the 2002 RSNA scientific assembly. Received January 2, 2003; revision requested January 24 and received February 21; accepted February 26. Address correspondence to Y.Y.J. (e-mail: yjeong@chonnam.ac.kr).

View larger version (127K): [in a new window]   Figure 1a.  Normal vaginal cuff after hysterectomy in a 46-year-old woman with stage IIA cervical carcinoma. (a) Axial T1-weighted spin-echo MR image (repetition time msec/echo time msec = 500/8) obtained through the vaginal cuff shows linear low signal intensity of the vaginal fornices (arrows). (b) Axial T2-weighted fast spin-echo MR image (3,500/78) obtained at the same level as a shows low signal intensity of the normal muscularis of the vagina (arrows). (c) Sagittal T2-weighted MR image (3,500/78) shows low signal intensity of the muscular layer of the vagina and high signal intensity of the vaginal mucosa. The uterus is absent.

View larger version (134K): [in a new window]   Figure 1b.  Normal vaginal cuff after hysterectomy in a 46-year-old woman with stage IIA cervical carcinoma. (a) Axial T1-weighted spin-echo MR image (repetition time msec/echo time msec = 500/8) obtained through the vaginal cuff shows linear low signal intensity of the vaginal fornices (arrows). (b) Axial T2-weighted fast spin-echo MR image (3,500/78) obtained at the same level as a shows low signal intensity of the normal muscularis of the vagina (arrows). (c) Sagittal T2-weighted MR image (3,500/78) shows low signal intensity of the muscular layer of the vagina and high signal intensity of the vaginal mucosa. The uterus is absent.

View larger version (188K): [in a new window]   Figure 1c.  Normal vaginal cuff after hysterectomy in a 46-year-old woman with stage IIA cervical carcinoma. (a) Axial T1-weighted spin-echo MR image (repetition time msec/echo time msec = 500/8) obtained through the vaginal cuff shows linear low signal intensity of the vaginal fornices (arrows). (b) Axial T2-weighted fast spin-echo MR image (3,500/78) obtained at the same level as a shows low signal intensity of the normal muscularis of the vagina (arrows). (c) Sagittal T2-weighted MR image (3,500/78) shows low signal intensity of the muscular layer of the vagina and high signal intensity of the vaginal mucosa. The uterus is absent.

View larger version (144K): [in a new window]   Figure 2.  Metallic attenuation after lymphadenectomy in a 48-year-old woman with stage IB cervical carcinoma. Contrast material-enhanced CT scan shows areas of metallic attenuation (arrows) in both internal iliac lymph node chains.

View larger version (177K): [in a new window]   Figure 3a.  Complete response of cervical carcinoma after radiation therapy. (a) Sagittal T2-weighted fast spin-echo MR image (3,500/90) shows a large high-signal-intensity mass (arrows) in the uterine cervix. (b) Follow-up T2-weighted fast spin-echo MR image (3,500/90) obtained 4 months later shows a complete response with reconstitution of the zonal anatomy of the cervix. Fatty replacement changes are seen in the pelvic bone marrow.

View larger version (185K): [in a new window]   Figure 3b.  Complete response of cervical carcinoma after radiation therapy. (a) Sagittal T2-weighted fast spin-echo MR image (3,500/90) shows a large high-signal-intensity mass (arrows) in the uterine cervix. (b) Follow-up T2-weighted fast spin-echo MR image (3,500/90) obtained 4 months later shows a complete response with reconstitution of the zonal anatomy of the cervix. Fatty replacement changes are seen in the pelvic bone marrow.

View larger version (121K): [in a new window]   Figure 4.  Lymphoceles and hematoma in a 39-year-old woman after hysterectomy. Contrast-enhanced CT scan shows bilateral large lymphoceles (L) in the pelvic cavity and an oval hematoma (arrows) with internal high attenuation in the lower abdominal wall. The urinary bladder (UB) filled with contrast medium is seen in the central portion of the pelvic cavity.

View larger version (126K): [in a new window]   Figure 5a.  Percutaneous drainage of a lymphocele. (a) Contrast-enhanced CT scan shows a large bilobulated lymphocele (arrows) with an enhancing wall in the pelvic cavity, an appearance suggestive of infection. (b) Follow-up CT scan obtained 4 days after percutaneous drainage without sclerotherapy shows a marked decrease in the size of the lymphocele.

View larger version (116K): [in a new window]   Figure 5b.  Percutaneous drainage of a lymphocele. (a) Contrast-enhanced CT scan shows a large bilobulated lymphocele (arrows) with an enhancing wall in the pelvic cavity, an appearance suggestive of infection. (b) Follow-up CT scan obtained 4 days after percutaneous drainage without sclerotherapy shows a marked decrease in the size of the lymphocele.

View larger version (132K): [in a new window]   Figure 6a.  Rectovesical fistula in a 55-year-old woman who underwent radical hysterectomy and radiation therapy. (a) Contrast-enhanced CT scan shows a fistulous tract (arrow) between the urinary bladder (UB) and rectosigmoid junction (R). (b) Lateral image from a barium enema examination clearly shows the fistulous tract (arrows). (c) Contrast-enhanced CT scan obtained caudad to a shows a recurrent mass (arrows) in the vaginal stump.

View larger version (112K): [in a new window]   Figure 6b.  Rectovesical fistula in a 55-year-old woman who underwent radical hysterectomy and radiation therapy. (a) Contrast-enhanced CT scan shows a fistulous tract (arrow) between the urinary bladder (UB) and rectosigmoid junction (R). (b) Lateral image from a barium enema examination clearly shows the fistulous tract (arrows). (c) Contrast-enhanced CT scan obtained caudad to a shows a recurrent mass (arrows) in the vaginal stump.

View larger version (131K): [in a new window]   Figure 6c.  Rectovesical fistula in a 55-year-old woman who underwent radical hysterectomy and radiation therapy. (a) Contrast-enhanced CT scan shows a fistulous tract (arrow) between the urinary bladder (UB) and rectosigmoid junction (R). (b) Lateral image from a barium enema examination clearly shows the fistulous tract (arrows). (c) Contrast-enhanced CT scan obtained caudad to a shows a recurrent mass (arrows) in the vaginal stump.

View larger version (133K): [in a new window]   Figure 7a.  Sigmoiditis in a 77-year-old woman after radiation therapy. (a) Contrast-enhanced CT scan shows concentric edematous wall thickening of the sigmoid colon with preservation of colonic layering (arrows). There is proliferation and linear infiltration of the prerectal fat plane. (b) Frontal image from a barium enema examination shows tapered narrowing of the sigmoid colon (arrows).

View larger version (146K): [in a new window]   Figure 7b.  Sigmoiditis in a 77-year-old woman after radiation therapy. (a) Contrast-enhanced CT scan shows concentric edematous wall thickening of the sigmoid colon with preservation of colonic layering (arrows). There is proliferation and linear infiltration of the prerectal fat plane. (b) Frontal image from a barium enema examination shows tapered narrowing of the sigmoid colon (arrows).

View larger version (201K): [in a new window]   Figure 8a.  Persistent disease 4 months after radiation therapy. (a) Sagittal T2-weighted fast spin-echo MR image (3,500/75) shows an inhomogeneous high-signal-intensity mass (arrows) in the uterine cervix and invasion of the posterior wall of the urinary bladder. (b) Sagittal T2-weighted fast spin-echo MR image (3,500/75) obtained 2 months later shows that the mass (arrows) has the same signal intensity.

View larger version (186K): [in a new window]   Figure 8b.  Persistent disease 4 months after radiation therapy. (a) Sagittal T2-weighted fast spin-echo MR image (3,500/75) shows an inhomogeneous high-signal-intensity mass (arrows) in the uterine cervix and invasion of the posterior wall of the urinary bladder. (b) Sagittal T2-weighted fast spin-echo MR image (3,500/75) obtained 2 months later shows that the mass (arrows) has the same signal intensity.

View larger version (114K): [in a new window]   Figure 9a.  Central pelvic recurrence of cervical carcinoma in a 78-year-old woman 10 years after radiation therapy. (a) Contrast-enhanced CT scan shows a ringlike enhancing recurrent mass (arrows) in the uterine cervix. (b) Sagittal multiplanar reformatted image shows severe hydrometra (H).

View larger version (156K): [in a new window]   Figure 9b.  Central pelvic recurrence of cervical carcinoma in a 78-year-old woman 10 years after radiation therapy. (a) Contrast-enhanced CT scan shows a ringlike enhancing recurrent mass (arrows) in the uterine cervix. (b) Sagittal multiplanar reformatted image shows severe hydrometra (H).

View larger version (159K): [in a new window]   Figure 10a.  Central pelvic recurrence of cervical carcinoma in a 46-year-old woman after surgery. (a) Sagittal T2-weighted fast spin-echo MR image (3,500/90) shows an ill-defined inhomogeneous mass (arrows), which has high signal intensity relative to that of back muscle. Loss of low signal intensity in the wall of the urinary bladder is indicative of invasion. (b) Axial contrast-enhanced gradient-echo MR image (120/1.5) shows a central recurrent mass with an irregular, thick, enhancing wall and invasion of the right pelvic side wall (arrow). (c) Axial T2-weighted fast spin-echo MR image (4,000/104) obtained at the renal hilum shows moderate right hydronephrosis.

View larger version (146K): [in a new window]   Figure 10b.  Central pelvic recurrence of cervical carcinoma in a 46-year-old woman after surgery. (a) Sagittal T2-weighted fast spin-echo MR image (3,500/90) shows an ill-defined inhomogeneous mass (arrows), which has high signal intensity relative to that of back muscle. Loss of low signal intensity in the wall of the urinary bladder is indicative of invasion. (b) Axial contrast-enhanced gradient-echo MR image (120/1.5) shows a central recurrent mass with an irregular, thick, enhancing wall and invasion of the right pelvic side wall (arrow). (c) Axial T2-weighted fast spin-echo MR image (4,000/104) obtained at the renal hilum shows moderate right hydronephrosis.

View larger version (138K): [in a new window]   Figure 10c.  Central pelvic recurrence of cervical carcinoma in a 46-year-old woman after surgery. (a) Sagittal T2-weighted fast spin-echo MR image (3,500/90) shows an ill-defined inhomogeneous mass (arrows), which has high signal intensity relative to that of back muscle. Loss of low signal intensity in the wall of the urinary bladder is indicative of invasion. (b) Axial contrast-enhanced gradient-echo MR image (120/1.5) shows a central recurrent mass with an irregular, thick, enhancing wall and invasion of the right pelvic side wall (arrow). (c) Axial T2-weighted fast spin-echo MR image (4,000/104) obtained at the renal hilum shows moderate right hydronephrosis.

View larger version (117K): [in a new window]   Figure 11.  Pelvic recurrence of cervical carcinoma in a 42-year-old woman after surgery. Contrast-enhanced CT scan shows a heterogeneously enhancing mass in the pelvic cavity with invasion of the left posterolateral pelvic wall (arrows) and destruction of the sacrum.

View larger version (38K): [in a new window]   Figure 12.  Lymphatic pathways of spread of cervical carcinoma. Coronal (left) and sagittal (right) drawings of the abdomen and pelvis show the primary nodes (blue) and secondary nodes (green).

View larger version (118K): [in a new window]   Figure 13a.  Lymph node metastases. (a) Obturator node metastasis in a 32-year-old woman who underwent radical hysterectomy. Contrast-enhanced CT scan shows a peripherally enhancing low-attenuation mass (arrows) attached to the left ilium. (b) Paraaortic node metastases in a 55-year-old woman who underwent radiation therapy. CT scan shows conglomerate enlarged lymph nodes (arrows) in the portacaval space.

View larger version (131K): [in a new window]   Figure 13b.  Lymph node metastases. (a) Obturator node metastasis in a 32-year-old woman who underwent radical hysterectomy. Contrast-enhanced CT scan shows a peripherally enhancing low-attenuation mass (arrows) attached to the left ilium. (b) Paraaortic node metastases in a 55-year-old woman who underwent radiation therapy. CT scan shows conglomerate enlarged lymph nodes (arrows) in the portacaval space.

View larger version (123K): [in a new window]   Figure 14a.  Distant metastases. (a) Hepatic metastases in a 64-year-old woman who underwent radiation therapy. Portal venous phase CT scan shows multiple variably enhancing masses in the liver. (b) Lung metastases in a 41-year-old woman who underwent radiation therapy. Chest CT scan shows multiple nodular lesions (arrows) in the right lower lung. (c) Bone metastases in a 35-year-old woman who underwent radical hysterectomy. Contrast-enhanced CT scan shows multiple conglomerate lymph nodes (arrows) in the paraaortic space and irregular destruction (arrowhead) of the lumbar spine. There is marked hydronephrosis in the left pelvocaliceal system with cortical thinning.

View larger version (89K): [in a new window]   Figure 14b.  Distant metastases. (a) Hepatic metastases in a 64-year-old woman who underwent radiation therapy. Portal venous phase CT scan shows multiple variably enhancing masses in the liver. (b) Lung metastases in a 41-year-old woman who underwent radiation therapy. Chest CT scan shows multiple nodular lesions (arrows) in the right lower lung. (c) Bone metastases in a 35-year-old woman who underwent radical hysterectomy. Contrast-enhanced CT scan shows multiple conglomerate lymph nodes (arrows) in the paraaortic space and irregular destruction (arrowhead) of the lumbar spine. There is marked hydronephrosis in the left pelvocaliceal system with cortical thinning.

View larger version (118K): [in a new window]   Figure 14c.  Distant metastases. (a) Hepatic metastases in a 64-year-old woman who underwent radiation therapy. Portal venous phase CT scan shows multiple variably enhancing masses in the liver. (b) Lung metastases in a 41-year-old woman who underwent radiation therapy. Chest CT scan shows multiple nodular lesions (arrows) in the right lower lung. (c) Bone metastases in a 35-year-old woman who underwent radical hysterectomy. Contrast-enhanced CT scan shows multiple conglomerate lymph nodes (arrows) in the paraaortic space and irregular destruction (arrowhead) of the lumbar spine. There is marked hydronephrosis in the left pelvocaliceal system with cortical thinning.