Diagnostic Value of Diffusion-Weighted Imaging with Background Body Signal Suppression (DWIBS) - A Feasibility and Interobserver Reliability Study - for the Pre-Therapeutic Loco-Regional Staging of Cervical Cancer

Q: What imaging approaches were compared in the study?

The study compared standard MRI versus standard MRI combined with diffusion-weighted imaging using background body signal suppression (DWIBS) for pre-therapeutic FIGO category assessment.

Q: How did DWIBS affect diagnostic accuracy and FIGO stage assignment?

DWIBS improved diagnostic accuracy in 7 of 32 readings and enabled additional readings to be assigned the correct major (I–IV) FIGO stages pre-therapeutically.

Q: Which aspect showed the weakest and strongest interobserver reliability?

Interobserver reliability was weakest for parametrial infiltration (k = 0.43), while it was perfect for tumor size <2 cm, vaginal lower third infiltration, infiltration of adjacent organs, and loco-regional nodal metastases (k = 1.000).

Q: What is the practical conclusion regarding using DWIBS?

Pre-therapeutic staging using standard MRI already has high diagnostic accuracy, and it can be further optimized by adding DWIBS sequences when interpretation is performed by an experienced radiologist.

Sep 24, 2026

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Cervical cancer remains a major cause of cancer-related mortality, and accurate loco-regional staging is essential at the initial diagnostic work-up. This study retrospectively evaluates 16 histopathologically proven cases (FIGO IB1–IVA) to compare standard MRI with standard MRI plus diffusion-weighted imaging using background body signal suppression (DWIBS) for correct pre-therapeutic FIGO category assessment. DWIBS increased diagnostic accuracy in select readings, improved stage assignment in additional readings, and showed interobserver reliability that was weakest for parametrial infiltration. Results support adding DWIBS when reporting is performed by experienced radiologists.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Introduction

2018 FIGO staging system and prognostic relevance

Role of MRI in loco-regional staging

Diffusion-weighted imaging and DWIBS rationale

Methods and Study Design

Patient cohort and imaging comparison

Results

Diagnostic accuracy and stage assignment changes

Interobserver reliability by evaluation domain

Conclusions

Article Diagnostic Value of Diffusion-Weighted Imaging with Background Body Signal Suppression (DWIBS) for the Pre-Therapeutic Loco-Regional Staging of Cervical Cancer: A Feasibility and Interobserver Reliability Study Stephan Schleder 1, Matthias May 2, Carsten Scholz 3, Johannes Dinkel 4, Quirin Strotzer 4, Ingo Einspieler 4, Marco Dollinger 4, Andreas G. Schreyer 5, Jochen Grassinger 6 and Andreas Schicho 4, * Citation: Schleder, S.; May, M.; Scholz, C.; Dinkel, J.; Strotzer, Q.; Einspieler, I.; Dollinger, M.; Schreyer, A.G.; Grassinger, J.; Schicho, A. Diagnostic Value of Diffusion-Weighted Imaging with Background Body Signal Suppression (DWIBS) for the Pre-Therapeutic Loco-Regional Staging of Cervical Cancer: A Feasibility and Interobserver Reliability Study. Curr. Oncol. 2023, 30, 1164–1173 . [https://doi.org/10.3390/](https://doi.org/10.3390/)[ ](https://doi.org/10.3390/)curroncol30010089 Received: 1 November 2022 Revised: 30 December 2022 Accepted: 10 January 2023 Published: 13 January 2023 Copyright: © 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ([https://](https://)[ ](https://)[creativecommons.org/licenses/by/](creativecommons.org/licenses/by/)[ ](creativecommons.org/licenses/by/)[4.0/](4.0/)) . 1 Department of Diagnostic and Interventional Radiology, Merciful Brothers Hospital St. Elisabeth, 94315 Straubing, Germany 2 Department of Urology, Merciful Brothers Hospital St. Elisabeth, 94315 Straubing, Germany 3 Department of Gynecology and Obstetrics, Merciful Brothers Hospital St. Elisabeth, 94315 Straubing, Germany 4 Department of Radiology, University Medical Center Regensburg, 93055 Regensburg, Germany 5 Department of Diagnostic and Interventional Radiology, University Hospital Brandenburg, Brandenburg Medical School Theodor Fontane, 14770 Brandenburg, Germany 6 Department of Hematology and Oncology, Merciful Brothers Hospital St. Elisabeth, 94315 Straubing, Germany * Correspondence: [andreas.schicho@ukr.de](andreas.schicho@ukr.de) Abstract: (1) Background: cervical cancer is one of the leading causes of cancer-related deaths and the fourth most common cancer among women worldwide. Magnetic resonance imaging (MRI) is the modality of choice for loco-regional staging of cervical cancer in the primary diagnostic workup beginning with at least stage IB. (2) Methods: we retrospectively analyzed 16 patients with histopathological proven cervical cancer (FIGO IB1–IVA) for the diagnostic accuracy of standard MRI and standard MRI with diffusion-weighted imaging with background body signal suppression (DWIBS) for the correct pre-therapeutic assessment of the deﬁnite FIGO category. (3) Results: In 7 out of 32 readings (22%), DWIBS improved diagnostic accuracy. With DWIBS, four (13%) additional readings were assigned the correct major (I–IV) FIGO stages pre-therapeutically. Interobserver reliability of DWIBS was weakest for parametrial inﬁltration (k = 0.43; CI-95% 0.00–1.00) and perfect for tumor size <2 cm, inﬁltration of the vaginal lower third, inﬁltration of adjacent organs and loco-regional nodal metastases (k = 1.000; CI-95% 1.00–1.00) . (4) Conclusions: the pre-therapeutic staging of cervical cancer has a high diagnostic accuracy and interobserver reliability when using standard MRI but can be further optimized with the addition of DWIBS sequences when reporting is performed by an experienced radiologist. Keywords: MRI; DWIBS; cervical cancer; staging 1. Introduction Cervical cancer is one of the leading causes of cancer-related deaths, especially in lowand middle-income countries, and the fourth most common cancer among women worldwide [1,2] . The 2018 FIGO (F²d²ration Internationale de Gyn²cologie et d'Obst²trique) system, which is the accepted standard for staging cervical cancer, incorporated results from diagnostic imagi

FAQs

What imaging approaches were compared in the study?

The study compared standard MRI versus standard MRI combined with diffusion-weighted imaging using background body signal suppression (DWIBS) for pre-therapeutic FIGO category assessment.

How did DWIBS affect diagnostic accuracy and FIGO stage assignment?

DWIBS improved diagnostic accuracy in 7 of 32 readings and enabled additional readings to be assigned the correct major (I–IV) FIGO stages pre-therapeutically.

Which aspect showed the weakest and strongest interobserver reliability?

Interobserver reliability was weakest for parametrial infiltration (k = 0.43), while it was perfect for tumor size <2 cm, vaginal lower third infiltration, infiltration of adjacent organs, and loco-regional nodal metastases (k = 1.000).

What is the practical conclusion regarding using DWIBS?

Pre-therapeutic staging using standard MRI already has high diagnostic accuracy, and it can be further optimized by adding DWIBS sequences when interpretation is performed by an experienced radiologist.

Sep 24, 2026

Uploaded by OmBimo