Diagnostic accuracy of 3.0T diffusion‐weighted MRI for patients with uterine carcinosarcoma: Assessment of tumor extent and lymphatic metastasis

Huang, Yu‐Ting; Chang, Chun-Bi; Yeh, Chi-Ju; Lin, Gigin; Huang, Huei-Jean; Wang, Chun‐Chieh; Lu, Kuan-Ying; Ng, Koon‐Kwan; Yen, Tzu‐Chen; Lai, Chyong-Huey

doi:10.1002/jmri.25981

Cited by 9 publications

(6 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Hence, the ADC values of ESS are not indicative of the aggressiveness of ESS. The results of our study are in line with those of other studies on uterine sarcomas such as leiomyosarcomas or STUMP [4], carcinosarcomas [24, 38], and ESS [16, 39], which also showed lower ADC values for ESS than for the myometrium.…”

Section: Discussionsupporting

confidence: 92%

“…Uterine leiomyosarcomas or smooth muscle tumors with uncertain malignant potential (STUMP) exhibit pocket-like central nonenhanced areas that correlate with areas of coagulative necrosis [4, 20]. By contrast, carcinosarcomas demonstrate prolonged tumoral enhancement exceeding that of the myometrium [21–24]. Leiomyomas with hyaline degeneration contain numerous bands of hyalinized collagen interlacing viable cells and the necrotic focus to support the structure [25], and entire leiomyoma tumors exhibit scattered nonenhanced areas on CE MR imaging [4].…”

Section: Discussionmentioning

confidence: 99%

“…Notably, intratumoral T2 hyperintensity is characteristic not only of ESS but also of benign degenerative leiomyomas, leiomyosarcomas or STUMP [30], and carcinosarcomas [21–23]. The T1-weighted hyperintensity observed in high-grade ESS, which represents hemorrhage [19], has also been observed in leiomyosarcomas or STUMP [20] and carcinosarcomas [23, 24]. The worm-like or marginal nodules in ESS were once considered invasive features representing intra-lymphatic or intravascular involvement [15]; however, in our study, they appeared in both high-grade and low-grade ESS and showed no statistically significant difference between the two groups.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Utility of diffusion-weighted and contrast-enhanced magnetic resonance imaging in diagnosing and differentiating between high- and low-grade uterine endometrial stromal sarcoma

et al. 2019

Self Cite

View full text Add to dashboard Cite

Background Endometrial stromal sarcoma (ESS) is a rare uterine malignancy that features different prognoses for its high- and low-grade subtypes. We investigated the diagnostic accuracy of magnetic resonance (MR) imaging in diagnosing and differentiating between high- and low-grade ESS. Methods We retrospectively reviewed the preoperative pelvic MR images of consecutive patients who received histologically confirmed diagnoses of high-grade ESS (n = 11) and low-grade ESS (n = 9) and T2-hyperintense leiomyoma (n = 16). Two radiologists independently evaluated imaging features in T1-, T2-, and diffusion-weighted and contrast-enhanced MR images. Statistical analysis included Mann-Whitney tests and Fisher’s exact test, with sensitivity, specificity and diagnostic accuracy of imaging features. Results High-grade ESS was associated with significantly more extensive necrosis and hemorrhage and distinct feather-like enhancement compared with low-grade ESS (P < .05 for all). The feather-like enhancement pattern yielded a diagnostic accuracy of 95%, sensitivity of 91%, and specificity of 100% in differentiating high-grade from low-grade ESS. This imaging characteristic was significantly superior to the necrosis (80%, P = .033) or hemorrhage (75%, P = .007). Both high- and low-grade ESS demonstrated T2 hypointense bands, marginal nodules, intratumoral nodules, and worm-like intra-myometrial nodules, and their tumor apparent diffusion coefficient (ADC) values were significantly lower than those of T2-hyperintense leiomyomas (P < .001). Conclusions Diffusion-weighted MR imaging is useful in diagnosing ESS against T2-hyperintense leiomyomas, and contrast enhancement aids in further differentiating between high- and low-grade ESS.

show abstract

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Utility of diffusion-weighted and contrast-enhanced magnetic resonance imaging in diagnosing and differentiating between high- and low-grade uterine endometrial stromal sarcoma

et al. 2019

Self Cite

View full text Add to dashboard Cite

show abstract

“…The presence of cervical stromal invasion and nodal enlargement at presentation are more common in patients with UCS than in those with EC (47). Preoperative DWI is useful to assess the deep myometrial or cervical stromal invasion in patients with uterine UCS; however, its limited diagnostic performance in detecting the adnexal invasion and lymphatic spread requires further improvement (53).…”

Section: Uterine Carcinosarcomamentioning

confidence: 99%

Current Status of Magnetic Resonance Imaging in Patients with Malignant Uterine Neoplasms: A Review

Huang

et al. 2019

Korean J Radiol

Self Cite

View full text Add to dashboard Cite

In this study, we summarize the clinical role of magnetic resonance imaging (MRI) in the diagnosis of patients with malignant uterine neoplasms, including leiomyosarcoma, endometrial stromal sarcoma, adenosarcoma, uterine carcinosarcoma, and endometrial cancer, with emphasis on the challenges and disadvantages. MRI plays an essential role in patients with uterine malignancy, for the purpose of tumor detection, primary staging, and treatment planning. MRI has advanced in scope beyond the visualization of the many aspects of anatomical structures, including diffusion-weighted imaging, dynamic contrast enhancement-MRI, and magnetic resonance spectroscopy. Emerging technologies coupled with the use of artificial intelligence in MRI are expected to lead to progressive improvement in case management of malignant uterine neoplasms.

show abstract

“…Magnetic Resonance Imaging as an imaging tool for both diagnostic accuracy and assessment of disease extent has been studied with varying results. 7 Histologically, diagnosis of carcinosarcoma depends on the demonstration of high-grade malignant epithelial and mesenchymal components typically with a sharp demarcation, 8 for which sample may not always be adequate preoperatively.…”

Section: Bpkmchmentioning

confidence: 99%

Carcinosarcoma of the Uterus: An Elusive Diagnosis

Bhattarai¹,

Pariyar²,

Neupane³

et al. 2020

Nep. J. Cancer

View full text Add to dashboard Cite

Introduction: Carcinosarcoma or Malignant Mixed Mullerian Tumor (MMMT) of the uterus is a rare malignant tumor comprising both carcinomatous and sarcomata’s components. Worldwide it accounts for two to five percentages of all uterine malignancies. However, there is a paucity of reports in Nepalese literature. Case report: A 62 year’s postmenopausal woman with diabetes and hypertension presented with urinary symptoms for two months and passage of fleshy mass per vagina for two days. Ultrasound was inconclusive, whereas, Magnetic Resonance Imaging (MRI) showed an endo-cervical mass. Pre-operative biopsy of the masssuggested leiomyosarcoma. Abdominal hysterectomy with bilateral salpingo-oophorectomy and pelvic andpara-aortic lymphadenectomy was performed. Per-operatively, an atrophic uterus, a dimple in the funds, andballooning of the lower uterine segment and vagina were noted. The cut section showed an exophytic polypoidalmass with base in the fundus. Histopathology revealed Stage IA carcinosarcoma with aggressive mitotic figures. Immunohistochemistry confirmed the diagnosis of carcinosarcoma with a heterogonous rhabdomyosarcomatouscomponent. Adjuvant chemotherapy and radiation therapy was advised. Conclusion: The preoperative diagnosis of carcinosarcoma or MMMT was difficult and might be missed on biopsy as well. Owing to its aggressive nature and higher rates of post-surgical recurrence, carcinosarcoma accounts for around one-fifth of deaths due to uterine malignancies. Surgery is the primary treatment modality, yet much study is needed before evidence-based adjuvant management for improving its outcome is established.

show abstract

Diagnostic accuracy of 3.0T diffusion‐weighted MRI for patients with uterine carcinosarcoma: Assessment of tumor extent and lymphatic metastasis

Abstract: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018.

Cited by 9 publications

References 34 publications

Utility of diffusion-weighted and contrast-enhanced magnetic resonance imaging in diagnosing and differentiating between high- and low-grade uterine endometrial stromal sarcoma

Utility of diffusion-weighted and contrast-enhanced magnetic resonance imaging in diagnosing and differentiating between high- and low-grade uterine endometrial stromal sarcoma

Current Status of Magnetic Resonance Imaging in Patients with Malignant Uterine Neoplasms: A Review

Carcinosarcoma of the Uterus: An Elusive Diagnosis

Contact Info

Product

Resources

About