Clinical application of diffusion-weighted imaging for preoperative differentiation between uterine leiomyoma and leiomyosarcoma

doi:10.1016/j.ajog.2013.12.028

American Journal of Obstetrics and Gynecology

Volume 210, Issue 4, April 2014, Pages 368.e1-368.e8

https://doi.org/10.1016/j.ajog.2013.12.028 Get rights and content

Objective

This study investigated the clinical usefulness of diffusion-weighted imaging (DWI) and the apparent diffusion coefficient (ADC) value for preoperative differentiation between uterine leiomyoma and leiomyosarcoma.

Study Design

This study included 10 lesions from 5 patients with pelvic leiomyosarcoma and 83 leiomyoma nodules from 76 patients, as identified by postoperative pathological examination (1 autopsy). All magnetic resonance examinations were performed with a 1.5-T superconductive magnetic resonance unit.

Results

The leiomyosarcoma lesions were readily apparent via DWI, presenting as an intermediate- to high-intensity area in the uterine wall. All low-intensity areas presented as leiomyoma nodules. The mean ADC value for the 10 leiomyosarcoma lesions was 0.791 ± 0.145 (×10⁻³ mm²/s), significantly lower than that of the leiomyoma nodules that presented with intermediate-intensity areas, 1.472 ± 0.285 (×10⁻³ mm²/s) (n = 41) (P < .001), and high-intensity areas (1.100 ± 0.343) (n = 9) (P = .03). Additionally, in this study, the highest ADC value for a leiomyosarcoma was 1.095, with an intermediate DWI intensity. Based on these results, we classified the patients into 2 groups: low-risk group (barely any leiomyosarcoma risk) and high-risk group. Analyses comparing the 2 groups yielded the following: sensitivity, 100%; specificity, 94.0%; positive predictive value, 66.7%; negative predictive value, 100%; and accuracy, 94.6%.

Conclusion

We suggest that this modality using a combination of signal intensity on DWI and ADC value is very effective, simple, and easy to apply clinically for differential diagnosis of leiomyosarcoma and myoma.

Section snippets

Materials and Methods

The subjects included 5 patients confirmed to have a total of 10 leiomyosarcoma lesions (5 primary lesions, one 2-cm-diameter small-intestine recurrence, one 3.9-cm-diameter sacral recurrence, one 12-cm-diameter omentum metastasis, and 2 other disseminated Douglas pouch–lesion cases of 12.7 cm and 2.7 cm) by postoperative pathological examination (4 cases) or autopsy (1 case), and 76 patients were confirmed to have a total of 83 leiomyoma nodules by postoperative pathological examination. All

Comparison between clinical images of myoma cases and leiomyosarcoma cases

The data described below are summarized in Tables 1 and 2. The 76 myoma patients had an average age of 44.6 ± 8.1 years (range, 29–75 years), while that of the 5 uterine sarcoma patients was 55 ± 4.6 years (range, 50–62 years), with a significant difference (P < .01). In addition, 5 (6.6%) of the 76 myoma patients and 2 (40%) of the 5 uterine sarcoma patients were menopausal women. In the myoma patients, the most common symptom was excessive menstruation, which was evident in 32 cases, followed

Comment

When performing surgical treatment for rapidly growing uterine tumors, clinicians should suspect the presence of uterine sarcoma, although its incidence is very low.8, 9 Preoperative differential diagnosis of uterine sarcoma has also been attempted via needle biopsy of the myometrium,¹⁰ fluorodeoxyglucose-positron emission tomography (PET),¹¹ and 3'-deoxy-3'-fluorothymidine-PET,¹² but there are problems related to invasiveness, convenience, equipment availability, and cost. MRI has been

Acknowledgment

We thank Sinya Akatani, RT, Department of Radiology, Steel Memorial Muroran Hospital, Muroran, Japan, for the measurement of ADC values used in this study.

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: The authors report no conflict of interest.

: Cite this article as: Sato K, Yuasa N, Fujita M, et al. Clinical application of diffusion-weighted imaging for preoperative differentiation between uterine leiomyoma and leiomyosarcoma. Am J Obstet Gynecol 2014;210:368.e1-8.

View full text

ResearchImagingClinical application of diffusion-weighted imaging for preoperative differentiation between uterine leiomyoma and leiomyosarcoma

Objective

Study Design

Results

Conclusion

Section snippets

Materials and Methods

Comparison between clinical images of myoma cases and leiomyosarcoma cases

Comment

Acknowledgment

Gynecol Oncol

Gynecol Oncol

Int J Obstet Gynecol

Magn Reson Imaging

Mesenchymal tumors of the uterus

Assessment of response of uterine fibroids and myometrium to embolization using diffusion-weighted echoplanar MR imaging

J Comput Assist Tomogr

Mesenchymal tumors and related lesions

FIGO staging for uterine sarcomas

Int J Obstet Gynecol

Uterine sarcoma in patients operated on for presumed leiomyoma and rapidly growing leiomyoma

Obstet Gynecol

Research
Imaging
Clinical application of diffusion-weighted imaging for preoperative differentiation between uterine leiomyoma and leiomyosarcoma