La radiologia medica

, Volume 123, Issue 3, pp 209–216 | Cite as

Apparent diffusion coefficient for prediction of parametrial invasion in cervical cancer: a critical evaluation based on stratification to a Likert scale using T2-weighted imaging

  • Sungmin Woo
  • Sang Youn Kim
  • Jeong Yeon Cho
  • Seung Hyup Kim



To evaluate the value of apparent diffusion coefficient (ADC) for determining parametrial invasion (PMI) in cervical cancer, by stratifying them into subgroups based on a Likert scale using T2-weighted imaging (T2WI).

Materials and methods

This retrospective study included 87 patients with FIGO stage IA2–IIB cervical cancer who underwent preoperative MRI followed by radical hysterectomy. Radiological PMI was assessed on T2WI using a six-point Likert scale and ADC values of the tumors were measured. MRI findings were compared between patients with and without PMI. Differences in ADC according to the Likert scale were also assessed.


19 (21.8%) patients had pathological PMI. The prevalence of PMI was significantly associated with Likert scale (P < 0.001). ADC values significantly differed according to Likert scale (P < 0.001). However, only tumors with a Likert score of 0 (MRI-invisible) had significantly greater ADC than others (P < 0.001) while no significant difference was observed among tumors with Likert scores of 1–5 (P = 0.070–0.889). Patients with PMI had significantly lower ADC values than those without PMI (P = 0.034). However, no significant difference was seen between patients with and without PMI within each Likert score group (P = 0.180–0.857).


T2WI-based Likert score for radiological PMI and ADC values of the tumor were significantly associated with pathological PMI. However, the apparent association seen between ADC values and PMI may be due to contribution of high ADC values of MRI-invisible tumors rather than reflecting their relationship.


Cervical cancer Parametrial invasion Magnetic resonance imaging Diffusion-weighted imaging Apparent diffusion coefficient Likert scale 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. In addition, as this was a retrospective study we state that for this type of study formal consent is not required.


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Copyright information

© Italian Society of Medical Radiology 2017

Authors and Affiliations

  • Sungmin Woo
    • 1
  • Sang Youn Kim
    • 1
  • Jeong Yeon Cho
    • 1
    • 2
  • Seung Hyup Kim
    • 1
    • 2
  1. 1.Department of RadiologySeoul National University College of MedicineSeoulRepublic of Korea
  2. 2.Institute of Radiation Medicine and Kidney Research InstituteSeoul National University Medical Research CenterSeoulRepublic of Korea

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