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Figure 4.1. Normal cervical anatomy in a woman of reproductive age.

T2W1 in (a) the sagittal plane and (b) the coronal plane,the latter providing a true transaxial image through the cervix. The endocervical lumen can be seen as a high signal intensity structure (black asterisk) surrounded by the cervical mucosa (white asterisk). The predominantly fibrous portion of the cervical stroma returns a low signal intensity and is discerned as a low signal intensity ring (long white arrow) immediately adjacent to the mucosa, while the outer cervix has an increased proportion of smooth muscle resulting in intermediate signal intensity (short white arrow). The cervix is surrounded by parametrium laterally and anteriorly (P in (b)) which is composed of fat, connective tissue, numerous blood vessels and lymphatics. The intra-organ anatomy of the uterus is well seen in (a) with the endometrial cavity (E), the junctional zone ofthe inner myometrium (J) and the outer myometrium (M). The pelvic floor formed by the levator ani muscular plate is well illustrated in (b) (black arrows). Bladder (B); urethra (U); ischioanal fossa; (IAF) obturator internus muscle (O).

Figure 4.2. T1b cervical cancer.

T2W (a) sagittal and (b) transaxial images demonstrating a small predominantly endocervical tumour in a postmenopausal patient. The mass is of high signal intensity (arrows) but is of lower signal intensity than the endocervical secretions seen cranial to the lesion. There is slight distension of the endocervical canal. Note the preservation of normal cervical tissue around the tumour indicating that it is confined. After the menopause the junctional anatomy of the uterus is lost and the cervix is often of low signal intensity throughout. The patient has a small Nabothian cyst (asterisk in (a)). (c), (d) Sagittal and off-axis coronal T2-weighted images in a different patient demonstrating a larger T1b endocervical tumour (T) which is confined. The tumour exceeds 4cm in its longest diameter (craniocaudal) making it a radiological T1b2 tumour.

Figure 4.3. T2a cervical cancer.

Sagittal T2W1 in which the tumour (T) can be seen extending to the anterior vaginal fornix (open arrowhead)

with altered high signal intensity in the adjacent vaginal wall; contrast this with the uninvolved vagina more caudally (arrow). There is haemorrhage (H) within the vagina which is distended superiorly.

Figure 4.4 T2b N0/N1 cervical tumour with parametrial extension.

Off-axis transaxial T2W1 demonstrating a high signal intensity tumour mass (T) involving the left cervix and extending from the endocervical canal throughout the entire cervical stroma with lobulated tumour extending beyond the lateral cervical margin and bulging into the parametrium (short arrows). There is also one left-sided posterior pelvic lymph node (long arrow) which, while small, has the same signal intensity as the tumour proper and both by its position and signal intensity is highly suspicious for an involved node.

Figure 4.5. T2b cervical cancer with parametrial vascular engulfment.

Transaxial T2W1 in which the cervix is entirely replaced by high signal intensity tumour (T) which engulfs a parametria! vessel (arrow), identified as an area of signal void due to flowing blood.

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