PET/MR Imaging for the Evaluation of Cervical Cancer During Pregnancy

Abstract Background: To assess the diagnostic value of positron emission tomography/magnetic resonance imaging (PET/MRI) for cervical cancer propagation before surgery, especially in pregnant women.Methods: 18F Fluorodeoxyglucose (FDG)-PET/MRI was performed in seven pregnant cervical cancer patients (28 - 34 years old) at 9-18 gestational weeks. In case #5, a second PET/MRI was performed at 24 gestational weeks. Results: Of seven FDG-PET/MRI examination series in six cases (cases #1-#6), FDG-PET/MR imaging could detect cervical tumors with abnormal FDG accumulation; these tumors were confirmed with a standardized uptake value max (SUV max) titer of 4.5 - 16. A second PET/MRI examination in case #5 revealed the same SUV max titer as the first examination. In these six imaging series (cases #1-#5), there were no signs of cancer metastasis to the parametrium and lymph nodes. However, in case #6, abnormal FDG accumulation in the left parametrial lymph nodes was also detectable. Pathological examination showed lymph node metastasis in case #6. In case #7, PET/MRI could not detect any abnormal FDG accumulation in the cervix and other sites. Cone biopsy demonstrated only micro-invasive squamous cell carcinoma. After treatment for cervical cancer, all seven patients have had no recurrence of disease within the follow-up period (2.4 – 5.2 years), and their children have developed appropriately.Conclusion: PET/MRI is an effective and relatively safe imaging tool to evaluate cervical cancer progression in pregnancy.