Diagnostic value of contrast-enhanced ultrasound in intravenous leiomyomatosis: a single-center experiences

Ge, Zhitong; Wang, Yahong; Wang, Ying; Song, Fang; Wang, Hongyan; Li, Jianchu

doi:10.3389/fonc.2022.963675

Cited by 6 publications

(9 citation statements)

References 31 publications

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“…In our study, the sensitivity, specificity, PPV, NPV, miss rate, misdiagnosis rate and accuracy of the “sieve hole” and “multi-track” signs for diagnosis of IVL were 29.9%, 100%, 100%, 82.2%, 70.1%, 0 and 83.5%, respectively (AUC ROC=0.649; 95%CI: 0.537-0.761). Despite the lower incidence of “sieve hole” and “multi-track” indicators observed in this investigation through conventional ultrasound in comparison to our prior study utilizing contrast-enhanced ultrasound, the former approach is more cost-effective and accessible ( 34 ). Conventional ultrasound may serve as a significant diagnostic tool for IVL due to its comparative advantages in terms of cost-effectiveness, convenience, and absence of radiation when compared to enhanced CT/MRI.…”

Section: Discussioncontrasting

confidence: 67%

Diagnostic experience of intravenous leiomyomatosis with emphasis on conventional ultrasonography imaging: a single-center study

Ge,

Wang,

Wang

et al. 2023

Front. Oncol.

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ObjectiveIntravenous leiomyomatosis (IVL) is a rare and aggressive tumor type that has the potential to extend into the inferior vena cava (IVC) and is susceptible to be misdiagnosed and neglected. Despite its clinical significance, there is a paucity of research that has focused on the specific manifestations of IVL on ultrasonography. Therefore, this study aims to systematically analyze the specific ultrasound features of IVL and augment its diagnostic accuracy.Materials and methodProspective inclusion was granted to patients admitted to our hospital between December 2016 and March 2021 for an IVC-occupying lesion. Multi-modal ultrasonography, encompassing gray-scale and color Doppler, was conducted. Lesions were categorized as IVL or non-IVL based on pathological or follow-up data. Two ultrasound sonographers with over 5 years of experience read and recorded ultrasound data for all lesions, which were subsequently comparatively analyzed to identify specific signs of IVL.ResultsA total of 284 patients diagnosed with IVC-occupying lesions were included in the study. The lesion types comprised of IVL (n=67, 23.6%), IVC thrombus (n=135, 47.5%), tumor thrombus of renal carcinoma involving the IVC (n=35, 12.4%), tumor thrombus of liver carcinoma involving the IVC (n=24, 8.5%), leiomyosarcoma of the IVC (n=14, 4.9%), and tumor thrombus of adrenocortical adenocarcinoma (n=9, 4.1%). The presence of “sieve hole” and “multi-track” signs was observed in 20 IVL lesions under the grey-scale modality, while both signs were absent in the non-IVL group (P<0.01). The study found no statistically significant differences in the presentation of “sieve hole” and “multi-track” signs under the grey-scale and color Doppler modalities in cases of intravascular lithotripsy (IVL) (P>0.05). Using these two signs as diagnostic criteria for IVL, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), miss rate, misdiagnosis rate, and accuracy were determined to be 29.9%, 100%, 100%, 82.2%, 70.1%, 0, and 83.5%, respectively (AUC ROC=0.649; 95%CI: 0.537-0.761).ConclusionIVL exhibits distinct ultrasound presentations, including “sieve hole” and “multi-track” signs, which demonstrate high specificity and accuracy as diagnostic indicators. Furthermore, these signs are corroborated by pathological evidence and effectively distinguish IVL from other lesions occupying the IVC.

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Section: Discussioncontrasting

confidence: 67%

Diagnostic experience of intravenous leiomyomatosis with emphasis on conventional ultrasonography imaging: a single-center study

Ge,

Wang,

Wang

et al. 2023

Front. Oncol.

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“…It is proposed that cystic tumors are venous leiomyomas, with no vascular function, which is responsible for the delay in blood supply in cystic tumors compared with that in solid tumors. The 'sieve hole sign' and the 'multi-track sign' are reported to be the specific signs of IVL in CEUS diagnosis (34).…”

Section: Imaging Manifestationsmentioning

confidence: 99%

Update on clinical characteristics and molecular insights for uterine intravenous leiomyomatosis (Review)

Zhou,

Qi,

Zhao

et al. 2023

Oncol Lett

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Intravenous leiomyomatosis (IVL) is a rare benign disease, which typically develops along vascular vessels and extends to the inferior vena cava and right atrium of the heart. In the early stages of the disease, the clinical manifestations and the results of imaging examinations are not uniform among patients. Thus, a high rate of misdiagnosis and missed diagnosis is common. When the tumor extends along the venous system to the pelvic floor vein or through the inferior vena cava involving the right atrium of the heart or the pulmonary artery, severe symptoms occur, such as ascites, dyspnea, heart failure and even sudden mortality. Improving the understanding of IVL to identify and evaluate this disease in its early stages is important. Complete tumor resection remains the primary treatment option for IVL. The recurrence rate of the disease varies depending on multiple factors, such as type of surgical procedure performed. Therefore, long-term follow-up is necessary for patients with IVL. The review of recent findings on the molecular and clinicopathological characterization of IVL is important to understand the pathogenesis of IVL. In the present study, the clinical manifestations, pathogenesis, differential diagnosis, treatment and prognosis of IVL are summarized in order to provide a single source of insightful information on IVL.

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“…Some scholars believe that contrast-enhanced ultrasound has higher diagnostic accuracy, while others tend to recommend advanced chest and abdominal computed tomography scan, gynecological ultrasound, and MRI if necessary as better surveillance methods according to different clinical conditions. [ 12 , 13 ] Both of our patients were initially diagnosed with unspecified pelvic space-occupying lesions by ultrasound, and MRI referred to only diverticula, endometriosis, and inflammation in case 1. This urges radiologists to enhance the thorough understanding of IVL’s imaging diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…[10] Since a preoperative definite diagnosis could not be made by virtue of clinical symptoms and imaging analysis, the number of IVL cases remains underestimated due to its relatively insidious onset. [11][12][13] Following reasons such as asymptomatic IVL patients, undiagnosed early IVL patients, unreported limited lesions, etc, cause the morbidity to be underrated. Case 1, which was undiagnosed preoperatively, turned out to be an incidental IVL patient.…”

Section: Discussionmentioning

confidence: 99%

Different clinical diagnosis end up in the same pathological diagnosis of intravascular leiomyomatosis: Two case reports

Tan,

Han,

Wang

et al. 2024

Medicine

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Rationale: Intravascular/intravenous leiomyomatosis (IVL) is a peculiar variant of uterine leiomyoma that is classified as a histologically benign smooth muscle tumor with a biological behavior similar to that of a malignant tumor. It is characterized by the proliferation of leiomyomas spreading along the uterine and extrauterine venous circulation. Patient concerns: Herein, we present 2 cases of IVL who had completely different clinical manifestations to stress the need for constant vigilance of IVL diagnosis and the understanding of uterine leiomyoma heterogenicity. Case 1 was registered for fever without specific triggering factors, irregular menstruation and clinically diagnosed uterine diverticula, while no information about fibroids was mentioned. Case 2 was characterized by an aggressively growing abdominal mass. With a large space-occupying lesion in the right abdominopelvic cavity and no imaging evidence of involvement of the iliac vein or above vein, the patient was initially diagnosed with multiple myomata. Diagnoses: Both patients’ diagnoses were confirmed as IVL by histopathology. To our knowledge, the mass of case 1 is the minimum IVL in the English literature. Interventions: Subtotal hysterectomy with bilateral salpingectomy was performed on the former, while total hysterectomy with bilateral salpingectomy was performed on the latter. Outcomes: Both patients were comfortable, and no relapse occurred. Lessons: Two cases in the study showed 2 different proceeding stages of the same disease and corroborated multiple pathogeneses, which have been mentioned in the available literature on IVL. Our work provides both supplement for clinical data to facilitate further research and better understanding of special types of fibroids to clinicians.

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Diagnostic value of contrast-enhanced ultrasound in intravenous leiomyomatosis: a single-center experiences

Cited by 6 publications

References 31 publications

Diagnostic experience of intravenous leiomyomatosis with emphasis on conventional ultrasonography imaging: a single-center study

Diagnostic experience of intravenous leiomyomatosis with emphasis on conventional ultrasonography imaging: a single-center study

Update on clinical characteristics and molecular insights for uterine intravenous leiomyomatosis (Review)

Different clinical diagnosis end up in the same pathological diagnosis of intravascular leiomyomatosis: Two case reports

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