Figure 1.

Grade 3 poorly differentiated adenosquamous carcinoma with deep cervical invasion, left parametrial invasion, invasion of lower uterine segment, and positive paraaortic lymphadenopathy. Clinical assessment was FIGO stage IIA with estimated tumor diameter of 3.5 cm, and no involvement of uterus or parametrium. Average size by CT was 2.8 cm. Lower uterine segment was considered not involved by 3 CT readers, and possibly involved by one CT reader; parametrium was considered not involved by all CT readers. By MRI, tumor size was 3.7 cm; parametrial and uterine involvement were both considered definite by 3 MRI readers, and indeterminate by one. Lymph nodes were considered involved by 3 MRI readers but by no CT readers.

A. Transverse CT image shows tumor in cervix, without visible parametrial extent.

B. Transverse T2-weighted MR image shows tumor in cervix. Low signal stroma is intact surrounding most of tumor, but there is some indistinctness at the left anterior margin (arrow) suggesting parametrial spread.

C. Sagittal T2-weighted MR image shows tumor extension into lower uterine segment (arrows).