nach oben

Abdominal Radiology

Erschienen in:

27.06.2019 | Pelvis

T2 hyperintense myometrial tumors: can MRI features differentiate leiomyomas from leiomyosarcomas?

verfasst von: Gisela Rio, Mariana Lima, Rui Gil, Mariana Horta, Teresa Margarida Cunha

Erschienen in: Abdominal Radiology | Ausgabe 10/2019

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To establish MRI features that help differentiate atypical leiomyomas and leiomyomas with degeneration that show hyperintensity on T2WI from leiomyosarcomas.

Methods and materials

This retrospective study evaluated 41 women who performed MRI before undergoing hysterectomy and had histologically proven atypical leiomyomas, leiomyomas with degeneration or leiomyosarcomas (21 leiomyomas; 20 leiomyosarcomas); only patients with T2 hyperintense myometrial tumors were included. The association between MRI features (contours; free pelvic fluid; intra-tumoral hemorrhagic areas, T2 heterogeneity; T2 dark areas; flow voids; restriction on diffusion-weighted images; signal intensity and heterogeneity after contrast administration; unenhanced areas, localization of unenhanced areas; necrosis; cystic areas) and the histology (leiomyoma vs. leiomyosarcoma) were calculated using Fisher’s exact test. For those features that showed a significant association, a univariate linear regression was performed.

Results

Five MRI features demonstrated a significant correlation with malignant histology: irregular borders (p = 0.03); “T2 dark” areas (p = 0.02); presence of central necrosis (p = 0.01); presence of high signal on b1000 DWI (p < 0.001); ADC value lower than 0.82 × 10⁻³ mm²/s; hyperenhancement of the tumor relative to the myometrium on post-contrast images (p = 0.02); and type 3 enhancing curve on DCE. Two of these features demonstrated a significant result predicting a malignant histology: lobulated contours and central necrosis [F(3;34) = 8,95; p < 0.001; R² = 0.506].

Conclusion

The presence of lobulated borders, T2 dark areas, necrosis, hyperintensity relative to the myometrium after contrast administration, central necrosis, presence of high signal on b1000 DWI, ADC value lower than 0.82 × 10⁻³ mm²/s and type 3 enhancing curve on DCE can help distinguish between leiomyoma and leiomyosarcoma. The association of lobulated borders and central necrosis can help predict a malignant histology.

Bolan C, Caserta MP (2016) MR imaging of atypical fibroids. Abdom Radiol (NY) 41 (12):2332-2349. https://doi.org/10.1007/s00261-016-0935-0 CrossRef

Ryan GL, Syrop CH, Van Voorhis BJ (2005) Role, epidemiology, and natural history of benign uterine mass lesions. Clin Obstet Gynecol 48 (2):312-324CrossRefPubMed

Rha SE, Byun JY, Jung SE, Lee SL, Cho SM, Hwang SS, Lee HG, Namkoong SE, Lee JM (2003) CT and MRI of uterine sarcomas and their mimickers. AJR Am J Roentgenol 181 (5):1369-1374. https://doi.org/10.2214/ajr.181.5.1811369 CrossRefPubMed

Arleo EK, Schwartz PE, Hui P, McCarthy S (2015) Review of Leiomyoma Variants. AJR Am J Roentgenol 205 (4):912-921. https://doi.org/10.2214/ajr.14.13946 CrossRefPubMed

Schwartz LB, Zawin M, Carcangiu ML, Lange R, McCarthy S (1998) Does pelvic magnetic resonance imaging differentiate among the histologic subtypes of uterine leiomyomata? Fertil Steril 70 (3):580-587CrossRefPubMed

Owen C, Armstrong AY (2015) Clinical management of leiomyoma. Obstet Gynecol Clin North Am 42 (1):67-85. https://doi.org/10.1016/j.ogc.2014.09.009 CrossRefPubMed

Ueda H, Togashi K, Konishi I, Kataoka ML, Koyama T, Fujiwara T, Kobayashi H, Fujii S, Konishi J (1999) Unusual appearances of uterine leiomyomas: MR imaging findings and their histopathologic backgrounds. Radiographics 19 Spec No:S131-145. https://doi.org/10.1148/radiographics.19.suppl_1.g99oc04s131

Cornfeld D, Israel G, Martel M, Weinreb J, Schwartz P, McCarthy S (2010) MRI appearance of mesenchymal tumors of the uterus. Eur J Radiol 74 (1):241-249. https://doi.org/10.1016/j.ejrad.2009.03.005 CrossRefPubMed

Tanaka YO, Nishida M, Tsunoda H, Okamoto Y, Yoshikawa H (2004) Smooth muscle tumors of uncertain malignant potential and leiomyosarcomas of the uterus: MR findings. J Magn Reson Imaging 20 (6):998-1007. https://doi.org/10.1002/jmri.20207 CrossRefPubMed

10.

. Sato K, Yuasa N, Fujita M, Fukushima Y (2014) Clinical application of diffusion-weighted imaging for preoperative differentiation between uterine leiomyoma and leiomyosarcoma. Am J Obstet Gynecol 210 (4):368 e361-368 e368. https://doi.org/10.1016/j.ajog.2013.12.028

11.

Namimoto T, Yamashita Y, Awai K, Nakaura T, Yanaga Y, Hirai T, Saito T, Katabuchi H (2009) Combined use of T2-weighted and diffusion-weighted 3-T MR imaging for differentiating uterine sarcomas from benign leiomyomas. Eur Radiol 19 (11):2756-2764. https://doi.org/10.1007/s00330-009-1471-x CrossRefPubMed

12.

Tamai K, Koyama T, Saga T, Morisawa N, Fujimoto K, Mikami Y, Togashi K (2008) The utility of diffusion-weighted MR imaging for differentiating uterine sarcomas from benign leiomyomas. Eur Radiol 18 (4):723-730.. https://doi.org/10.1007/s00330-007-0787-7 CrossRefPubMed

13.

Lakhman Y, Veeraraghavan H, Chaim J, Feier D, Goldman DA, Moskowitz CS, Nougaret S, Sosa RE, Vargas HA, Soslow RA, Abu-Rustum NR, Hricak H, Sala E (2017) Differentiation of Uterine Leiomyosarcoma from Atypical Leiomyoma: Diagnostic Accuracy of Qualitative MR Imaging Features and Feasibility of Texture Analysis. Eur Radiol 27 (7):2903-2915. https://doi.org/10.1007/s00330-016-4623-9 CrossRefPubMed

14.

Thomassin-Naggara I, Dechoux S, Bonneau C, Morel A, Rouzier R, Carette MF, Darai E, Bazot M (2013) How to differentiate benign from malignant myometrial tumours using MR imaging. Eur Radiol 23 (8):2306-2314. https://doi.org/10.1007/s00330-013-2819-9 CrossRefPubMed

15.

Sahdev A, Sohaib SA, Jacobs I, Shepherd JH, Oram DH, Reznek RH (2001) MR imaging of uterine sarcomas. AJR Am J Roentgenol 177 (6):1307-1311. https://doi.org/10.2214/ajr.177.6.1771307 CrossRefPubMed

16.

Tasaki A, Asatani MO, Umezu H, Kashima K, Enomoto T, Yoshimura N, Aoyama H (2015) Differential diagnosis of uterine smooth muscle tumors using diffusion-weighted imaging: correlations with the apparent diffusion coefficient and cell density. Abdom Imaging 40 (6):1742-1752. https://doi.org/10.1007/s00261-014-0324-5 CrossRefPubMed

17.

Rigby AS (2000) Statistical methods in epidemiology. v. Towards an understanding of the kappa coefficient. Disabil Rehabil 22 (8):339-344

18.

Wallach EE, Vlahos NF (2004) Uterine myomas: an overview of development, clinical features, and management. Obstet Gynecol 104 (2):393-406. https://doi.org/10.1097/01.aog.0000136079.62513.39 CrossRefPubMed

19.

Stewart EA (2015) Clinical practice. Uterine fibroids. N Engl J Med 372 (17):1646-1655. https://doi.org/10.1056/nejmcp1411029 CrossRefPubMed

20.

Pron G (2015) Magnetic Resonance-Guided High-Intensity Focused Ultrasound (MRgHIFU) Treatment of Symptomatic Uterine Fibroids: An Evidence-Based Analysis. Ont Health Technol Assess Ser 15 (4):1-86PubMedPubMedCentral

21.

Pritts EA, Vanness DJ, Berek JS, Parker W, Feinberg R, Feinberg J, Olive DL (2015) The prevalence of occult leiomyosarcoma at surgery for presumed uterine fibroids: a meta-analysis. Gynecol Surg 12 (3):165-177. https://doi.org/10.1007/s10397-015-0894-4 CrossRefPubMedPubMedCentral

22.

Pron G (2006) New uterine-preserving therapies raise questions about interdisciplinary management and the role of surgery for symptomatic fibroids. Fertil Steril 85 (1):44-45; discussion 48-50. https://doi.org/10.1016/j.fertnstert.2005.09.014

23.

Wu TI, Yen TC, Lai CH (2011) Clinical presentation and diagnosis of uterine sarcoma, including imaging. Best Pract Res Clin Obstet Gynaecol 25 (6):681-689. https://doi.org/10.1016/j.bpobgyn.2011.07.002 CrossRefPubMed

24.

Matsuda M, Ichimura T, Kasai M, Murakami M, Kawamura N, Hayashi T, Sumi T (2014) Preoperative diagnosis of usual leiomyoma, atypical leiomyoma, and leiomyosarcoma. Sarcoma 2014:498682. https://doi.org/10.1155/2014/498682 CrossRefPubMedPubMedCentral

25.

Santos P, Cunha TM (2015) Uterine sarcomas: clinical presentation and MRI features. Diagn Interv Radiol 21 (1):4-9. https://doi.org/10.5152/dir.2014.14053 CrossRefPubMed

26.

Hricak H, Tscholakoff D, Heinrichs L, Fisher MR, Dooms GC, Reinhold C, Jaffe RB (1986) Uterine leiomyomas: correlation of MR, histopathologic findings, and symptoms. Radiology 158 (2):385-391. https://doi.org/10.1148/radiology.158.2.3753623 CrossRefPubMed

27.

Murase E, Siegelman ES, Outwater EK, Perez-Jaffe LA, Tureck RW (1999) Uterine leiomyomas: histopathologic features, MR imaging findings, differential diagnosis, and treatment. Radiographics 19 (5):1179-1197. https://doi.org/10.1148/radiographics.19.5.g99se131179 CrossRefPubMed

28.

Goto A, Takeuchi S, Sugimura K, Maruo T (2002) Usefulness of Gd-DTPA contrast-enhanced dynamic MRI and serum determination of LDH and its isozymes in the differential diagnosis of leiomyosarcoma from degenerated leiomyoma of the uterus. Int J Gynecol Cancer 12 (4):354-361CrossRefPubMed

Titel: T2 hyperintense myometrial tumors: can MRI features differentiate leiomyomas from leiomyosarcomas?
verfasst von: Gisela Rio
Mariana Lima
Rui Gil
Mariana Horta
Teresa Margarida Cunha
Publikationsdatum: 27.06.2019
Verlag: Springer US
Erschienen in: Abdominal Radiology / Ausgabe 10/2019
Print ISSN: 2366-004X
Elektronische ISSN: 2366-0058
DOI: https://doi.org/10.1007/s00261-019-02097-x

Neu im Fachgebiet Radiologie

18.04.2024 | Pädiatrische Notfallmedizin | Nachrichten

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

T2 hyperintense myometrial tumors: can MRI features differentiate leiomyomas from leiomyosarcomas?

Abstract

Purpose

Methods and materials

Results

Conclusion

Neu im Fachgebiet Radiologie

Fünf Dinge, die im Kindernotfall besser zu unterlassen sind

Wie toxische Männlichkeit der Gesundheit von Männern schadet

Studie bestätigt Potenzial von KI in der Radiologie

Quantitative Angiografie könnte IVUS-Alternative darstellen

Update Radiologie

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Abstract

Purpose

Methods and materials

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 10/2019

Appendiceal endosalpingiosis: clinical presentation and imaging appearance of a rare condition of the appendix

Reducing radiation dose for multi-phase contrast-enhanced dual energy renal CT: pilot study evaluating prior iterative reconstruction

2D shear wave elastography: measurement acquisition and reliability criteria in noninvasive assessment of liver fibrosis

Pictorial review on abdominal applications of ferumoxytol in MR imaging

Comparison of MR imaging features of uterine neuroendocrine carcinoma and uterine malignant lymphoma

Superparamagnetic iron-oxide-enhanced diffusion-weighted magnetic resonance imaging for the diagnosis of intrapancreatic accessory spleen

Neu im Fachgebiet Radiologie

Fünf Dinge, die im Kindernotfall besser zu unterlassen sind

Wie toxische Männlichkeit der Gesundheit von Männern schadet

Studie bestätigt Potenzial von KI in der Radiologie

Quantitative Angiografie könnte IVUS-Alternative darstellen

Update Radiologie