Fig. 15.

A 34-year-old woman with locally advanced cervical squamous cell carcinoma. Baseline pre-treatment axial and sagittal CECT (a) images demonstrate a large cervical tumour (open white arrows). Post-RT follow-up pelvic MRI performed 8 months later (b) depicts imaging findings consistent with complete response with reconstitution of the normal cervical zonal anatomy and homogeneous low T2 signal (wide black arrows) on axial and sagittal T2 TSE sequences. Note the small size and homogeneous low T2 signal without follicular activity in the right ovary (dashed white arrow) an expected post-RT finding. Follow-up pelvic MRI was performed 7 months later, axial T2 TSE images (c) reveal a heterogeneous ill-defined mass in the right parametrium that extends to the right pelvic side wall with areas of both intermediate and low T2 signal intensity which is suspicious for locally recurrent tumour (solid white arrows). In the early post RT setting immature fibrosis could have a similar appearance. DWI performed at same imaging session demonstrates restricted diffusion within this mass as low signal intensity on ADC map (black arrow in d). Subsequently whole-body PET-CT was performed (e) for the assessment of systemic disease, which depicts avid FDG uptake in the mass on fused axial FDG PET-CT image (white arrow in e). Biopsy was performed which confirmed recurrent tumour in this case involving both the central and lateral pelvic compartments