Role of T2-weighted and Diffusion-weighted Imaging in Cervical Malignancy in Developing Countries

Hari Soekersi, Ignatius Irawan Hidayat, Annisa Fitriani Zeindadinanda, Viola Stephanie Warokko


Cervical cancer is the second most common gynecologic malignancy in Asia and is the leading cause of death in women in developing countries. The cervical cancer stage will significantly affect the prognosis and management. Based on the International Federation of Gynecology and Obstetrics (FIGO) 2018 classification of cervical cancer, magnetic resonance imaging (MRI) has a crucial role in determining cervical cancer staging. This study aimed to evaluate the role of T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) sequences in assessing cervical carcinoma, with the pathological diagnosis being taken as the standard for cervical cancer diagnosis. This study was conducted on seven patients diagnosed with cervical cancer from pathological examination in January 2020 to March 2021 in the Department of Radiology Dr. Hasan Sadikin General Hospital Bandung. We detect the presence of locoregional lesions and extensions of cervical carcinoma using MRI with T2WI and DWI sequences in patients who have previously been diagnosed histopathologically. This study involved seven cervical cancer patients. Pelvic MRI with T2WI and DWI sequences was performed. The imaging results in these patients show that one patient has stage IB1 cervical cancer, four patients have stage IIB, one patient has stage IIIA, and one has stage IIIC1 cervical cancer. This study concluded that T2WI and DWI sequences in MRI are essential and sufficient for diagnosing cervical cancer.


Cervical malignancy; diffusion-weighted imaging; magnetic resonance imaging; T2-weighted imaging

Full Text:



Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424.

Mansoori B, Khatri G, Rivera-Colón G, Albuquerque K, Lea J, Pinho DF. Multimodality imaging of uterine cervical malignancies. AJR Am J Roentgenol. 2020;215(2):292–304.

Anderson DM, Lee J, Elkas JC. Cervical and vaginal cancer. In: Berek JS, Berek DL, editors. Berek and Novak’s gynecology. 16th Edition. Philadelphia: Wolters Kluwer; 2020. p. 1038–76.

Bell DJ, Pannu HK. Radiological assessment of gynecologic malignancies. Obstet Gynecol Clin North Am. 2011r;38(1):45–68, vii.

Sala E, Rockall AG, Freeman SJ, Mitchell DG, Reinhold C. The added role of MR imaging in treatment stratification of patients with gynecologic malignancies: what the radiologist needs to know. Radiology. 2013;266(3):717–40.

Bourgioti C, Chatoupis K, Rodolakis A, Antoniou A, Tzavara C, Koutoulidis V, et al. Incremental prognostic value of MRI in the staging of early cervical cancer: a prospective study and review of the literature. Clin Imaging. 2016;40(1):72–8.

Salvo G, Odetto D, Pareja R, Frumovitz M, Ramirez PT. Revised 2018 International Federation of Gynecology and Obstetrics (FIGO) cervical cancer staging: a review of gaps and questions that remain. Int J Gynecol Cancer. 2020;30(6):873–8.

Bhatla N, Berek JS, Cuello Fredes M, Denny LA, Grenman S, Karunaratne K, et al. Revised FIGO staging for carcinoma of the cervix uteri. Int J Gynaecol Obstet. 2019;145(1):129–35.

Abd elsalam SM, Mokhtar O, Adel L, Hassan R, Ibraheim M, Kamal A. Impact of diffusion weighted magnetic resonance imaging in diagnosis of cervical cancer. Egypt J Radiol Nucl Med. 2020;51:23.

Kumar R, Narayanan GS, Vishwanthan B, Narayanan S, Mandal S. A prospective comparative dosimetric study between diffusion weighted MRI (DWI) & T2-weighted MRI (T2W) for target delineation and planning in cervical cancer brachytherapy. Rep Pract Oncol Radiother. 2020;25(6):1011–6.

Šarenac T, Mikov M. Cervical cancer, different treatments and importance of bile acids as therapeutic agents in this disease. Front Pharmacol. 2019;10:484.

Adams TS, Rogers LJ, Cuello MA. Cancer of the vagina: 2021 update. Int J Gynaecol Obstet. 2021;155(Suppl 1):19–27.

Baral SK, Biswas P, Kaium MA, Islam MA, Dey D, Saber MA, et al. A comprehensive discussion in vaginal cancer based on mechanisms, treatments, risk factors and prevention. Front Oncol. 2022;12:883805.

Sachan PL, Singh M, Patel ML, Sachan R. A study on cervical cancer screening using pap smear test and clinical correlation. Asia Pac J Oncol Nurs. 2018;5(3):337–41.

Lim AW, Landy R, Castanon A, Hollingworth A, Hamilton W, Dudding N, et al. Cytology in the diagnosis of cervical cancer in symptomatic young women: a retrospective review. Br J Gen Pract. 2016;66(653):e871–9.

McGraw SL, Ferrante JM. Update on prevention and screening of cervical cancer. World J Clin Oncol. 2014;5(4):744–52.

Knoth J, Pötter R, Jürgenliemk-Schulz IM, Haie-Meder C, Fokdal L, Sturdza A, et al. Clinical and imaging findings in cervical cancer and their impact on FIGO and TNM staging – An analysis from the EMBRACE study. Gynecol Oncol. 2020:159(1):136–41.

Perucho JAU, Chiu KWH, Wong EMF, Tse KY, Chu MMY, Chan LWC, et al. Diffusion-weighted magnetic resonance imaging of primary cervical cancer in the detection of sub-centimetre metastatic lymph nodes. Cancer Imaging. 2020;20(1):27.

Harry VN, Persad S, Bassaw B, Parkin D. Diffusion-weighted MRI to detect early response to chemoradiation in cervical cancer: a systematic review and meta-analysis. Gynecol Oncol Rep. 2021;38:100883.

Bollineni VR, Kramer G, Liu Y, Melidis C, deSouza NM. A literature review of the association between diffusion-weighted MRI derived apparent diffusion coefficient and tumour aggressiveness in pelvic cancer. Cancer Treat Rev. 2015;41(6):496–502.

Kuang F, Yan Z, Li H, Feng H. Diagnostic accuracy of diffusion-weighted MRI for differentiation of cervical cancer and benign cervical lesions at 3.0T: comparison with routine MRI and dynamic contrast-enhanced MRI. J Magn Reson Imaging. 2015;42(4):1094–9.

Dappa E, Elger T, Hasenburg A, Düber C, Battista MJ, Hötker AM. The value of advanced MRI techniques in the assessment of cervical cancer: a review. Insights Imaging. 2017;8(5):471–81.

Patel-Lippmann K, Robbins JB, Barroilhet L, Anderson B, Sadowski EA, Boyum J. MR imaging of cervical cancer. Magn Reson Imaging Clin N Am. 2017;25(3):635–49.

Sarabhai T, Schaarschmidt BM, Wetter A, Kirchner J, Aktas B, Forsting M, et al. Comparison of 18F-FDG PET/MRI and MRI for pre-therapeutic tumor staging of patients with primary cancer of the uterine cervix. Eur J Nucl Med Mol Imaging. 2018;45(1):67–76.


pISSN 2301-9123 | eISSN 2460-5441

Visitor since 19 October 2016: 

Free counters!

Global Medical and Health Communication is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.