Accurate evaluation of tumor extent in cervical cancer is critical to make clinical decision, including fertility-sparing surgical options such as radical trachelectomy [1]. Diffusion weighted imaging (DWI) can improve diagnostic performances in respect of local invasion in cervical cancer [2]. One of the major drawbacks of DWI in the evaluation of cervical cancer lies in the high signal intensity of endocervical canal even on DWI with a b-value of 1000 s/mm². Computed DWI is a mathematical technique that makes it possible to obtain higher b-value images with a good signal-to-noise ratio from acquired lower b-value images [3]. The purpose of this study was to evaluate the utility of computed DWI in cervical cancer and investigate the optimal b-value using computed DWI with multiple b-values.This retrospective study involved 80 patients with cervical cancer in the FIGO stage IB, IIA or IIB pathologically confirmed by surgery or biopsy. MR studies were performed using 3.0 T MR units (MAGNETOM Skyra and MAGNETOM Trio; Siemens Healthcare, Erlangen, Germany) and a 1.5 T MR unit (MAGNETOM Avanto; Siemens Healthcare, Erlangen, Germany) with a multichannel phased array coil. Sagittal DWI with b-values of 0, 100, 500 and 1000 s/mm² was obtained using single-shot echo-planar imaging sequence. Computed DWI with b-values of 800, 1000, 1300, 1600 and 2000 s/mm² (cDWI₈₀₀, cDWI₁₀₀₀, cDWI₁₃₀₀, cDWI₁₆₀₀, cDWI₂₀₀₀) were generated from all measured DWI (mDWI) data using an in-house script written with MATLAB® (R2013b, The MathWorks, Natick, MA, USA) (Figure 1). Qualitatively, computed DWI was evaluated in terms of tumor conspicuity, background signal suppression and total image quality by two radiologists independently with reference to mDWI with b-value of 1000 s/mm². Tumor conspicuity and total image quality were scored on a 5-point scale, and background signal suppression was scored on a 4-point scale. The signal intensity of endocervical canal was also assessed in 25 out of 80 cases in which the endocervical canal was preserved from tumor invasion. The b-value at which the signal of the endocervical canal was suppressed was recorded. Quantitatively, the signal intensities of tumor, myometrium, endocervical canal, endometrium, and gluteal subcutaneous fat were measured and represented as contrast ratios (CR). The signal intensity of each region indicated above was measured by placing ROIs, and the same ROIs were applied to all the DWI sets. In statistical analysis, interobserver agreement on the qualitative analysis was assessed by weighted kappa test with quadratic weighting, and the CRs for each b-value were compared using Friedman test.There were good inter-observer agreements between the two readers for tumor conspicuity (κ=0.68), background signal suppression (κ=0.66), and total image quality (κ=0.61). Regarding tumor conspicuity and total image quality, significantly higher scores were obtained at cDWI₁₃₀₀ and cDWI₁₆₀₀ compared to cDWI₈₀₀, cDWI₁₀₀₀ and cDWI₂₀₀₀ (p<0.01) (Table 1). Background signal suppression was the worst at cDWI₂₀₀₀. The signal intensity of the endocervical canal was suppressed in 24 of 25 cases with the increase of b-value (Table 2). Quantitatively, the CRs of tumor to myometrium, tumor to cervix and tumor to endometrium increased with higher b-values, while the CRs of tumor to fat decreased and there were statistically significant difference (p<0.01) (Figure 2).This stydy might be the first report on the utility of computed DWI with b-values above 1000 s/mm² for the evaluation of cervical cancer. Our results showed that b-values of 1300 and 1600 s/mm² were optimal for the visualization of cervical cancer with respect to the contrast between tumor and background using computed DWI. In addition, the signal suppression of the endocervical canal with higher b-values would improve visualization of cervical tumor. If computed DWI was introduced into clinical settings, this tool may help to determine the indication of fertility-sparing surgery such as trachelectomy.Computed DWI with b-values of 1300 or 1600　s/mm² was significantly superior to computed DWI with b-values of 800, 1000 or 2000　s/mm² in terms of tumor conspicuity and total image quality. Computed DWI with b-values of 1300 or 1600 s/mm²　may thus be recommended for the clinical evaluation of the extent of cervical cancer.