Abbreviated T2w-only pelvic MRI for local tumor staging of cervical cancer: a pragmatic approach for time-critical and resource-limited settings

PURPOSE: To evaluate the diagnostic performance and inter-reader reliability of an abbreviated non-angulated three-plane T2-weighted pelvic MRI protocol for assessing local staging key parameters in cervical cancer. METHODS: In this retrospective single-center study, 47 patients with cervical cancer who underwent pelvic MRI between January 2023 and December 2024 were included. MRI was performed on a 1.5-T system using a simplified protocol; image interpretation was restricted to axial, sagittal, and coronal T2-weighted turbo spin-echo sequences. Two board-certified radiologists (one subspecialized in gynecological imaging, one general radiologist) independently assessed tumor size, parametrial invasion, vaginal involvement, and local T stage. A composite reference standard consisting of examination under anaesthesia, laparoscopic staging, and histopathology was used. Diagnostic performance metrics and inter-reader agreement (Cohen's κ, ICC) were calculated. RESULTS: Parametrial invasion was detected with high diagnostic accuracy, with a mean sensitivity of 94.0% and specificity of 88.6% across both readers. For vaginal invasion, mean sensitivity and specificity were 95.5% and 96.0%, respectively. Inter-reader agreement was excellent for tumor size measurements (ICC 0.946-0.992) and high for categorical variables categorical variables (κ = 0.828 for parametrial and 0.915 for vaginal invasion). Agreement between MRI and the reference standard for tumor size was good, with mean differences of 3.1-4.8 mm. The abbreviated protocol corresponded to an acquisition time of approximately 13 min compared to 21 min for the simplified institutional protocol and 30-45 min for standard multiparametric MRI. CONCLUSION: A non-angulated three-plane T2-weighted pelvic MRI protocol provides high diagnostic accuracy and inter-reader agreement for assessing local staging key parameters in early-stage to locally advanced cervical cancer without bladder or rectal involvement and may represent a feasible alternative in time-constrained or resource-limited settings.