الفهرس 
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Abstract
The aim of this study was to assess the role of non- contrast magnetic resonance sequences including the diffusion weighted images in evaluation of uterine cervical lesions. The study was carried out in an attempt to distinguish benign from malignant pathologies.
This study was conducted on 35 patients having 38 different uterine cervical lesions, referred to the MRI units of Radio-diagnosis and intervention Departments of Alexandria main university. All patients were referred from gynecology outpatient clinics of Elshatby Alexandria University Hospitals.
All patients were subjected to complete history taking.They were also subjected to general examination and Local gynecological examination.
All MR examinations were performed on a Philips Achieva 1.5 Tesla closed-configuration with a pelvic phased-array coil. All patients underwent routine pelvic MR imaging including, sagittal T2 turbo spin echo (T2 TSE), Axial oblique T2 weighted turbo spin echo (T2 TSE), Axial obliqueT1 weighted spin echo (T1 SE), Axial oblique T1 fat sat, Coronal oblique T2 weighted turbo spin echo (T2 TSE) ) Axial oblique diffusion weighted image.
The final diagnosis was achieved by applying imaging, clinical data, follow up and histopathological diagnosis of some of the examined lesions.
Receiver-operating characteristic (ROC) analysis was done to investigate the discriminatory capability of the ADC values for distinguishing between benign and malignant cervical lesions.
The lesions were studied according to site, size, signal intensity, extra- cervical extensions if present .Activity of the lesion was detected by diffusion restriction signal.
The age of the examined patients ranged from 16 to 67 years, mean age of 46.6 years.
The main complaint of the studied patients was bleeding (74.3%), followed by pelvic pain (22.9%).
Twenty two lesions were malignant (57.9 %), including 15 primary lesions in the cervix (68.2%) and 7 secondary lesions extending from the uterine body, mainly endometrial carcinoma (31.8%). Squamous cell carcinoma was detected in 11/15 primary cervical malignant lesions (73.3 %).The other 4 lesions were adenocarcinoma (26.7 %).
Sixteen benign lesions (42.1%) were detected including, nabothian cysts in 7 lesions (43.8%), fibroids in 6 lesions (37.5 %) and congenital anomalies in 3 cases (18.8%).
Three out of 35 patients were diagnosed to have more than one cervical pathology including, two cervico-isthmic fibroids with nabothian cysts and one cervical carcinoma with nabothian cysts.
The twenty two patients, who were suspected to have malignant lesions by MRI, were subjected to biopsy or surgical removal of the lesion. The remaining benign 16 lesions were diagnosed on imaging and clinical follow up basis.
In the current study, the nabothian cysts expressed T2WI hyperintense signal in all cases (100%) yet only 42.9 % of the lesions were isointense in T1WI and without any solid component. All the nabothian cysts showed high signal intensity on DWI (100%), 57.1% isointense signal in ADC map with high ADC values (ranging from 1.20-2.0 x10-3 mm2/s, mean 1.56, median1.40) and no diffusion restriction