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. 2022 Oct 6:12:1005191.
doi: 10.3389/fonc.2022.1005191. eCollection 2022.

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

Cong Wang  1 , Xianying Zheng  1 , Zuofu Zhou  1 , Yuequan Shi  1 , Qin Wu  1 , Kaiwu Lin  1
Affiliations

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

Cong Wang et al. Front Oncol. .

Abstract

Objectives: To 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.

Methods: This 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.

Results: Morphology (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).

Conclusions: cMRI 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.

Keywords: atypical leiomyoma; diffusion-weighted MRI; magnetic resonance imaging; uterine leiomyoma; uterine sarcoma.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart showing the patient enrollment process.
Figure 2
Figure 2
A 43-year-old woman with a cellular leiomyoma. A mass was located in the uterine anterior wall (arrow) with a clear margin, showing isointensity on T1WI (A) and hyperintensity on T2WI images (B). This mass showed high signal intensity on diffusion-weighted MR image (C) with a low ADC value (ADC = 985 ×10-6 mm2/sec) (D).
Figure 3
Figure 3
A 49-year-old woman with a uterine sarcoma. A mass was found in the uterine-side wall (arrow) with an unclear margin, showing heterogeneous iso-to-hyperintensity on T1WI (A) and heterogeneous hyperintensity on T2WI images (B). The tumor showed high signal intensity on diffusion-weighted MR image (C) with a low ADC value (ADC = 736 × 10-6 mm2/sec) (D).
Figure 4
Figure 4
A 56-year-old woman with a hydropic degeneration leiomyoma. The mass was detected in the uterine right wall (arrow) with isointensity on T1WI (A) and heterogenous iso-to-hyperintensity on T2WI images (B). The tumor showed high signal intensity on diffusion-weighted MR image (C) with a high ADC value (ADC = 1339 × 10-6 mm2/sec) (D).
Figure 5
Figure 5
ROC curves showing the diagnostic performances of cMRI, ADC and the combination of cMRI and ADC in differentiating CLs from degenerated LMs (A) and USs (B).
See this image and copyright information in PMC

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