The utility of MRI for the preoperative differential diagnosis of uterine sarcoma and leiomyoma: a single-center study.

Abstract

Although uterine sarcoma is a rare disease, its prognosis is extremely poor;thus, it is important to differentiate it from uterine leiomyoma. In this retrospective study, we examined the association between preoperative MRI findings and postoperative pathology results in 170 patients with uterine tumors who underwent preoperative MRI examination at Fukushima Red Cross Hospital. In 4 cases of sarcoma / smooth muscle tumor of unknown malignant potential (STUMP), abnormal findings were found at a high frequency with T1-weighted imaging (T1WI) (75%), T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), and contrast enhancement (CE) (100%). In cases of ordinary leiomyoma, on the other hand, abnormal findings were less frequent. The rates of high DWI signal intensity for degenerated and cellular leiomyoma were 31% and 64%, respectively, and the CE-positive rates were 31% and 57%, respectively. Apparent Diffusion Coefficient (ADC) values appeared to be useful in differentiating degenerated leiomyoma from sarcoma. The relatively characteristic findings of uterine sarcoma on MRI images may overlap with those of degenerated leiomyoma and cellular leiomyoma, making it difficult to diagnose sarcoma on imaging alone. However, findings that distinguish sarcoma from ordinary, degenerated, and cellular leiomyoma cases are worthy of attention, to avoid overlooking sarcoma.