How to differentiate benign from malignant myometrial tumours using MR imaging

Thomassin‐Naggara, Isabelle; Dechoux, Sophie; Bonneau, Claire; Morel, Audrey; Rouzier, Roman; Carette, Marie-France; Daraı̈, Émile; Bazot, Marc

doi:10.1007/s00330-013-2819-9

Cited by 149 publications

(86 citation statements)

References 15 publications

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“…However, recent studies suggest that MRI through diffusion and post-contrastographic sequences, represent emerging valuable technique for the differential diagnosis between degenerate leiomyoma and sarcomas [21,22,[25][26][27][28] .…”

Section: Discussionmentioning

confidence: 99%

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The contribution of Magnetic Resonance Imaging in the differential diagnosis between leiomyoma typical, atypical and uterine sarcomas: Personal experience

Tamburrini

Smiraglio

Caputo

et al. 2016

IJDI

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Purpose: Evaluate the role of Magnetic Resonance Imaging (MRI) in the differential diagnosis between degenerated leiomyomas, cellular leiomyomas and uterine sarcomas. Materials and methods:From February 2015 to August 2015, 42 patients were enrolled, aged between 18 and 75 years, suffering from uterine "mass" waiting for surgery and considered at risk and/or uncertain clinical and laboratory investigations and imaging. These patients were submitted to MRI exam of the pelvis that was performed by morphological study, DWI sequences and dynamic sequences post-contrastographic. Results:The analysis of MRI images of the 42 patients made possible to do a diagnosis of uterine sarcomas in 8 patients with the aid of sequences weighted in diffusion and dynamic, proving a sensitivity of 100% and a specificity of 88%. Conclusions:Based on our experience, we may consider that by morphological study with DWI sequences weighted in diffusion and dynamic post-contrastographic sequences, the MRI is a working aid in the differential diagnosis between degenerated leiomyomas and uterine sarcomas.

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Section: Discussionmentioning

confidence: 99%

“…The same appearance is shown by cellular leiomyomas and some types of degenerated leiomyomas, which then may mime sarcomas. Therefore, the differential diagnosis between myoma and sarcoma can be difficult if it is just based on conventional sequences without administration of contrast agent [19][20][21] .…”

Section: Introductionmentioning

confidence: 99%

The contribution of Magnetic Resonance Imaging in the differential diagnosis between leiomyoma typical, atypical and uterine sarcomas: Personal experience

Tamburrini

Smiraglio

Caputo

et al. 2016

IJDI

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“…Namimoto et al (9) showed that overlap in ADC values between leiomyosarcomas and ordinary leiomyomas (attributed to the "T2 blackout effect," i.e., hypointensity on DWI caused by hypointensity on T2-weighted images) could be resolved with the evaluation of tumor-myometrium contrast ratio on T2-weighted images. Thomassin-Naggara et al (12) reported that by combining the analysis of T2 signal intensity, b1000 images and ADC map, MRI achieved 92.4% accuracy in distinguishing benign and uncertain or malignant myometrial tumors. Therefore, they concluded that DWI may limit misdiagnosis of uterine sarcomas as benign leiomyomas, and should be the first criterion to help radiologists characterize a unique uterine tumor.…”

Section: Mri Featuresmentioning

confidence: 99%

Uterine sarcomas: clinical presentation and MRI features

Santos

Cunha²

2015

Diagn Interv Radiol

156

138

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Uterine sarcomas are a rare heterogeneous group of tumors of mesenchymal origin, accounting for approximately 8% of uterine malignancies. They comprise leiomyosarcoma, endometrial stromal sarcoma, undifferentiated endometrial sarcoma, and adenosarcoma. Compared with the more common endometrial carcinomas, uterine sarcomas behave more aggressively and are associated with a poorer prognosis. Due to their distinct clinical and biological behavior, the International Federation of Gynecology and Obstetrics introduced a new staging system for uterine sarcomas in 2009, categorizing uterine carcinosarcoma as a variant of endometrial carcinoma, rather than a pure sarcoma. Magnetic resonance imaging (MRI) has a developing role in the assessment of these malignancies. Features such as tumor localization, irregular or nodular margins, necrosis, rapid growth, intense contrast enhancement, and restriction at diffusion-weighted imaging can suggest the diagnosis and help differentiate from more common leiomyomas and endometrial carcinoma. MRI is therefore extremely useful in preoperative detection and staging and, consequently, in determination of appropriate management. This pictorial review aims to discuss the clinical features of uterine sarcomas, as well as their most common appearances and distinct characteristics in MRI.

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“…Thomassin-Naggara et al [32] in a retrospective study proposed a recursive partitioning model, using b 1000 signal intensity, T2 signal intensity, mean ADC, and patient age which correctly classified benign and malignant lesions in 92.4 % of cases. Adenosarcomas are usually low grade tumours and typically present as polyps.…”

Section: Uterine Sarcomasmentioning

confidence: 99%

“…They have been shown to have low ADC values in the limited studies available [33,34] . Overall studies trying to differentiate leiomyoma from sarcomas in terms of ADC values alone have been inconsistent with considerable overlap in values, ADC could be used as a adjuvant tool along with other parameters to increase the diagnostic confidence to characterize benign from malignant lesions [31][32][33][34][35][36][37] .…”

Section: Uterine Sarcomasmentioning

confidence: 99%

Diffusion weighted imaging in gynecological malignancies - present and future

Manoharan¹,

Das²,

Aggarwal³

et al. 2016

WJR

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The management of gynaecological malignancies has undergone a significant change in recent years with our improved understanding of cancer biogenetics, development of new treatment regimens and enhanced screening. Due to the rapid blooming of newer methods and techniques in gynaecology, surgery and oncology the scope and the role of imaging has also widened. Functional imaging in the form of diffusion weighted imaging (DWI) has been recently found to be very useful in assessing various tumours. Its ability to identify changes in the molecular level has dramatically changed the diagnostic approach of radiologists which was solely based on morphological criteria. It can improve the diagnostic accuracy of conventional magnetic resonance imaging, lend a hand in assessing tumour response to treatment regimens and detect tumour recurrence with better spatial resolution, negative radiation and diagnostic accuracy compared to positron emission tomography scan. The ability to quantify the diffusion has also lead to potential prediction of tumour aggressiveness and grade which directly correlate with the patient prognosis and management. Hence, it has become imperative for a radiologist to understand the concepts of DWI and its present and evolving role. In this article we present a brief description of the basics of DWI followed by its role in evaluation of female gynaecological malignancies. Core tip: With rapidly evolving strategies in the management of the gynaecological malignancies today there is an increasing role of imaging to keep up with the pace of development and develop newer techniques which help in better management of the patient. Diffusion weighted imaging (DWI) is one such modality which helps in detecting changes at the molecular level and hence can help in better diagnosis of early cancers as well as in assessing response to treatment.

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How to differentiate benign from malignant myometrial tumours using MR imaging

Cited by 149 publications

References 15 publications

The contribution of Magnetic Resonance Imaging in the differential diagnosis between leiomyoma typical, atypical and uterine sarcomas: Personal experience

The contribution of Magnetic Resonance Imaging in the differential diagnosis between leiomyoma typical, atypical and uterine sarcomas: Personal experience

Uterine sarcomas: clinical presentation and MRI features

Diffusion weighted imaging in gynecological malignancies - present and future

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