Differentiating cellular leiomyoma from uterine sarcoma and atypical leiomyoma using multi-parametric MRI

Abstract

ObjectivesTo evaluate the diagnostic performance of conventional magnetic resonance imaging (cMRI) combined with diffusion-weighted MRI (DWI) in discrimination of cellular leiomyoma, uterine sarcoma, and atypical leiomyoma.MethodsThis retrospective study enrolled 106 patients with uterine masses, including 51 cellular leiomyomas (CLs), 32 uterine sarcomas (USs) and 23 degenerated leiomyomas (LMs) confirmed by histopathologic examination. Clinical data and imaging findings were assessed. Chi-squared test for qualitative variables and one way ANOVA analysis for quantitative variables were performed. Logistic regression analysis and the receiver operating characteristic (ROC) analysis were performed to determine the cut-off point and diagnostic performances for significant numeric values or multiple models.ResultsMorphology (Odds ratio [OR] = 6.36) and margin (OR = 13.84) derived from cMRI were independent indicators for differentiating CLs from USs, and T2WI signal (OR = 0.23) were an independent indicator for differentiating CLs from degenerated LMs (all P < 0.05). The cutoff value of apparent diffusion coefficient (ADC) derived from DWI for differentiating CLs from USs was 839 ×10-6 mm2/sec and was 1239 ×10-6 mm2/sec for differentiating CLs from degenerated LMs. Compared with the use of cMRI features and ADC value alone, combination of independent indicators and ADC value achieved higher AUCs for both differentiations (all P < 0.05).ConclusionscMRI is a reliable tool for differentiating CLs from USs and atypical leiomyoma, especially degenerated LMs. The combined use of cMRI and DWI can improve the differential diagnostic performance.

Recurrence complicated with peritoneal dissemination after single-port gasless myomectomy for cellular uterine leiomyoma: A case report and literature review

“…It belongs to the category of borderline uterine tumors and has malignant potential. [ 1 – 3 ] Although in recent years, studies have pointed out that multi-parameter magnetic resonance imaging [ 4 ] and different contrast-enhanced ultrasound [ 5 ] play a certain role in the preoperative diagnosis of cellular uterine fibroids and uterine sarcoma, the current identification of the 2 mainly depends on histopathological examination and immunohistochemical markers.…”

Radiomics in Gynaecological Imaging: A State-of-the-Art Review

“…Conversely, uterine sarcomas (US) are a rare form of mesenchymal tumours, accounting for approximately 1% of gynaecological neoplasms and 3-7% of all uterine malignancies, and have a poor prognosis [134]. Currently, there are no reliable imaging criteria for distinguishing US, especially leiomyosarcomas, from LM with atypical features, including degeneration or unusual pattern of growth [135]. The final diagnosis is usually made only after the surgery, based on postoperative histopathological assessment.…”