Cervical cancer is the most commonly diagnosed cancer in females in vast majority of the countries including sub-Saharan Africa, Melanesia, South America, and South-Eastern Asia. [1]. MRI is the modality of choice for benign and malignant gynaecological conditions as it has superior tissue resolution in female pelvis and reliably shows uterine and ovarian abnormalities[2]. The techniques for accurate imaging for preoperative assessment of women with early-stage cervical cancer include ultrasound and MRI [3]. However, the tumor margin delineation on conventional MR imaging techniques can be difficult due to normally collapsed vagina, hence distinguishing the anterior and posterior vaginal walls and cervix and vaginal fornices can be difficult in such conditions. By distending vagina using vaginal gel gives better tumor margin delineation on T1 and T2Wt imaging [2].This study aims to assess the impact of MRI gel technique on tumor visibility, staging accuracy, inter-observer agreement and patient tolerability.
Methods and materials
Study Design and Population
A total of 25 patients with histopathologically confirmed carcinoma cervix were included in this prospective study. All patients underwent MRI scans in two phases:
- Without Gel: Standard pelvic MRI protocol.
- With Gel: Vaginal distention achieved using 50 ml sterile gel.
MRI Protocol
MRI scans were performed using a 1.5T scanner (1.5 Tesla Philips Achieva MR scanner). The scanning protocol included:
- T2-weighted axial, sagittal and coronal images
- Diffusion-weighted imaging (DWI)
Image Assessment and Analysis
Three radiologists(R1, R2 and R3) independently scored tumor visibility on a 5-point Likert Scale, where:
1 = Poor visibility
2 = Suboptimal visibility
3 = Moderate visibility
4 = Good visibility
5 = Excellent visibility
Tumor staging was compared with the histopathological findings, which served as the reference standard.
Statistical Analysis
- Paired t-tests were used to assess the significance of visibility score differences.
- McNemar’s test was applied to compare staging accuracy.
- Cohen’s kappa coefficient was used to quantify inter-observer agreement.
Tolerability Assessment
- Patient-reported discomfort was documented through a standardized questionnaire post-examination.