Introduction/Background The most significant independent prognostic factor in cervical cancer (CC) affecting survival is lymph node (LN) involvement. MRI is the preferred method for visualizing locally advanced CC. The limitations of MRI in the evaluation of the metastatic lymph nodes (MLN) are related to the short axis size criterion greater than 1 cm. The objective of the study was to develop new MRI signs for MLN and to evaluate of their predictive significance.

Methodology The MRI findings of the 71 patients with histologically confirmed CC, who underwent radical surgical treatment with lymphatic dissection, were compared with the morphological features. To evaluate the predictive significance of MRI signs of MLN, monovariate regression logistic analyses was performed. To evaluate the diagnostic performance of methods and to determine the cutoff values, ROC- analysis was performed.

Results The following criteria of MLN have been developed: the size of the LN along the short axis is more than 0.65 cm; sensitivity – 51.2%, specificity – 86.2%; the configuration index is less than or equal to 1.65 (the ratio of the size of the LN along the long and short axis) – 83.7%, 94%, respectively; absence hypointense signal from LN fatty hilum 88.4%, 94.0%; the presence of spiky contour of the LN 79.1%, 94.0%; the perinodular edema of LN 76.7%, 87.1%; subcapsular edema of LN 55.8%, 86.2%; the central edema 25.6%, 98.3%; inhomogeneity of the MR signal LN 96.3%, 81.0%; the value of the LN signal intensity factor (the ratio of the LN signal intensity to the intensity of the tumor signal) 79.1%, 79.3%, median value for MLN ÷ 1.16 (1.02÷1.3); the value of the Apparent diffusion coefficient of MLN is less than 0.885 х 10^-3mm²/c 67.4%, 68.1%.

Conclusion The developed MRI signs are clinically and statistically significant factors for metastatic LN involvement (p < 0.05).