Normal and abnormal MRI findings after abdominal radical trachelectomy (ART) for cervical cancer

Purpose: To report MRI findings after abdominal radical trachelectomy (ART) for early-stage cervical cancer. Material and Methods: During an 8-year period, 25 women (mean age: 32 years) with biopsy-proven cervical cancer stage ≤IB1, were treated with ART. Postoperative MRI was performed in 22/25 patients, 6 months after ART and every 6 months thereafter, for a total of 6-48 months (mean: 24 months). Normal MRI features of utero-vaginal anastomosis and post-ART complications were recorded by two expert radiologists. Results: The utero-vaginal anastomosis was clearly depicted on all postoperative MRIs; a vaginal neo-fornix was observed in 17/22 patients. Magnetic susceptibility artefacts caused by the metallic cerclage suture placed at the anastomosis, were more prominent on gradient-echo sequences, partially degrading image quality. Baseline postoperative MRI showed diffuse vaginal wall thickening in 14/22 patients; this gradually resolved within a year from surgery. Asymptomatic lymphoceles occurred in 4/22 patients. Two/22 patients developed symptomatic isthmic stenosis and hematosalpinges, the first 2 years after surgery. In 4/22 patients, hydrosalpinges were discovered incidentally 6 months after ART; one of these patients was diagnosed with pelvic inflammatory disease a year after surgery. Follow-up MRI revealed local tumor relapse in two patients and nodal involvement in one patient, within 2 years after ART. Conclusion: Post-ART complications observed on MR images of the pelvis include: vaginal wall thickening, lymphoceles, isthmic stenosis, hemato/hydrosalpinges and tumor recurrence. Familiarization of radiologists with the post-ART MRI appearance of utero-vaginal anastomosis is important to avoid misdiagnosis of tumor recurrence.