Diffusion-weighted MRI using an endovaginal coil for evaluating early cervical cancer

Lead Research Organisation: Institute of Cancer Research
Department Name: Division of Radiotherapy and Imaging

Abstract

Magnetic resonance imaging is currently the gold standard for assessing the neck of the womb and surrounding tissues in cases of cervical or suspected cervical cancer. However, conventional techniques lack both resolution (pixel size 0.6 mm) and contrast when standard MRI pulse sequences are used. It is possible to increase the resolution of the images by placing a receiver probe close to the part under study to maximise signal and reduce noise from that region. We have previously developed an endovaginal receiver for use at 1.5T and shown significant improvement in resolution. However contrast between tumour and non-tumour tissue remains low and requires use of specialist sequences such as diffusion-weighted images which are inherently low on signal-to-noise ratio. Production of an endovaginal coil for use at a higher field strength (3.0T) would enable use of higher resolution diffusion-weighted imaging. We propose therefore to build an endovaginal device for use at 3.0T, optimize the diffusion-weighted imaging and compare the accuracy of conventional MRI techniques with and without the addition of diffusion-weighted imaging for detecting early stage cervical cancer by comparing with the tissue findings at surgery.

Technical Summary

Endovaginal T2-W magnetic resonance imaging (MRI) techniques allow precise location of small cervical cancers, but accuracy of tumour detection is reduced post cone-biopsy because of cervical distortion, haematoma and granulation tissue. The signal-to-noise ratio improvement provided by an endovaginal coil enables acquisition of Diffusion-Weighted sequences (DW-MRI), which have the potential to differentiate small tumours from post-surgical change based on water diffusion within tissues. At 1.5T, our pilot data using an endovaginal coil indicates a trend to improve sensitivity for tumour detection when DW-MRI is used in conjunction with T2-W MRI. We wish to develop this technique for use at 3.0T which offers further gains in signal-to-noise ratio leading to better resolution and thus potentially improved accuracy for tumour detection. We propose to build an endovaginal coil for use at 3.0T (addressing issues such as increased susceptibility artefacts from coil components at higher field strength), integrate it with an external pelvic array coil, optimise the DW-MRI protocol and perform a blinded comparison of T2-W MRI with and without DW-MRI against a histological gold standard in patients with Stage Ia2 and Ib1 cervical cancer.

Publications

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DeSouza NM (2016) Distortion correction of echo-planar diffusion-weighted images of uterine cervix. in Journal of magnetic resonance imaging : JMRI

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Downey K (2011) Imaging cervical cancer recent advances and future directions in Current Opinion in Oncology

 
Description Endovaginal MRI considered part of normal clinical practice at the Royal Marsden Hospital
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Influenced training of practitioners or researchers
Impact Impacts on the delivery of fertility sparing surgery to young women with cervical cancer
 
Description MRC DPFS
Amount £189,000 (GBP)
Funding ID G0802470 
Organisation Medical Research Council (MRC) 
Sector Academic/University
Country United Kingdom
Start 10/2009 
End 03/2012
 
Title Endovaginal probe for MRI of the cervix for early cervical cancer 
Description New method of imaging the cervix to visualize small tumours 
Type Of Material Technology assay or reagent 
Provided To Others? No  
Impact Better surgical decision-making for patients with early cervical cancer wishing to preseve fertility 
 
Description Transfer of technical and clinical knowledge to other sites 
Organisation University of Cambridge
Country United Kingdom 
Sector Academic/University 
PI Contribution Teaching them how to implement a new technology we have developed
Collaborator Contribution Willingness to trial the new technology in their patients
Impact Ethics approval for clinical roll out of technology in Addenbrookes Hospital
Start Year 2018
 
Description academic partnership 
Organisation Royal Marsden NHS Foundation Trust
Department Gynaecology Unit
Country United Kingdom 
Sector Hospitals 
PI Contribution linking imaging technology with surgical needs
Collaborator Contribution we have provided new imaging technology and methodology. Surgical colleagues in our cancer centre and surrounding cancer networks (St. Georges Hospital, Epsom and St Heliers Hospitals, Kingston Hospital, Mayday Hospital Croydon have provided surgical expertise
Impact Multidisciplinary Surgery, Pathology, Radiology, Engineering, Physics Altered patient management and allowed better planning of fertility sparing surgery for young women with cervical cancer
Start Year 2009
 
Title Endovaginal probe for MRI of the cervix 
Description Design and testing of an endovaginal probe for MRI of the uterine cervix 
IP Reference EP1255119 
Protection Patent application published
Year Protection Granted
Licensed No
Impact Better diagnostics for patients with early cervical cancer
 
Title Endovaginal receiver coil 
Description Endovaginal coil for imaging the cervix at 3T 
Type Diagnostic Tool - Imaging
Current Stage Of Development Initial development
Year Development Stage Completed 2010
Development Status Actively seeking support
Clinical Trial? Yes
UKCRN/ISCTN Identifier 04/Q0801/21
Impact Improved cervical cancer diagnosis and selection of patients for fertility sparing surgery 
 
Title Endovaginal coil for GE MRI scanner 
Description Ring design endovaginal coil for use with a 3T GE scanner 
Type Of Technology Detection Devices 
Year Produced 2017 
Impact Ability to scan patients with early cervical cancer at the Addenbrookes Hospital Cambridge. 
 
Description BBC London News 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Type Of Presentation Keynote/Invited Speaker
Geographic Reach Regional
Primary Audience Media (as a channel to the public)
Results and Impact BBC London News item

interest from patient groups
Year(s) Of Engagement Activity 2009
 
Description Interview for International Women in Science day for an internal blog to be reported on social media 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Postgraduate students
Results and Impact Interview for International Women in Science day for an internal blog to be reported on social media. The challenges of academic careers for women were discussed, with some potential measures ICR is taking to address them.
Year(s) Of Engagement Activity 2019