Abstract
PurposeTo generate a new discrimination method to distinguish between malignant mesenchymal tumors of the uterus and T2-weighted hyperintense leiomyoma based on magnetic resonance imaging findings and clinical features.Materials and methodsData from 32 tumors of 32 patients with malignant mesenchymal tumors of the uterus and from 34 tumors of 30 patients with T2-weighted hyperintense leiomyoma were analyzed. Clinical parameters, qualitative magnetic resonance imaging features, including computed diffusion-weighted imaging, and quantitative characteristics of magnetic resonance imaging of these two tumor types were compared. Predictive values for malignant mesenchymal tumors of the uterus were calculated using variant discriminant analysis.ResultsThe T1 bright area on qualitative assessment and mean apparent diffusion coefficient value on quantitative assessment yielded the most independent magnetic resonance imaging differentiators of malignant mesenchymal tumors of the uterus and T2-weighted hyperintense leiomyoma. The classification accuracy of the variant discriminant analysis based on three selected findings, i.e., a T1 bright area, computed diffusion-weighted imaging with a b-value of 2000s/mm2 (cDWI2000), and T2-hypointense bands, was 84.8% (56/66), indicating high accuracy.ConclusionsVariant discriminant analysis using the T1 bright area, cDWI2000, and T2-hypointense bands yielded high accuracy for differentiating between malignant mesenchymal tumors of the uterus and T2-weighted hyperintense leiomyoma.
Highlights
Malignant mesenchymal tumors of the uterus (MMTUs), such as leiomyosarcoma, endometrial stromal sarcoma, undifferentiated uterine sarcoma, and smooth muscle tumorMagnetic resonance imaging (MRI) is the most important diagnostic tool for differentiating between uterine leiomyoma and sarcoma [3, 8,9,10,11,12,13,14,15,16,17,18]
This study aimed to generate a new method to distinguish MMTUs and uterine leiomyomas wherein more than 50% of the lesions show higher signal intensity than that revealed by the myometrium on T2-weighted images (T2WI) (T2-weighted hyperintense leiomyoma: T2HILM) based on the findings of muscle tumorMagnetic resonance imaging (MRI) and clinical features
The inclusion and exclusion criteria were as follows: (1) patients with MMTU, cellular leiomyoma, and degenerative leiomyoma confirmed through pathology were included; (2) patients with tumors comprising more than 50% of areas of signal intensity higher than that of the myometrium on T2WI were included; (3) patients who underwent surgery and had complete MRI data within 3 months before surgery were included; (4) patients who were pregnant or with histories of preoperative chemotherapy, radiotherapy, or hormonal therapy were excluded; and (5) patients with carcinosarcoma were excluded according to the WHO Classification of Tumours
Summary
Malignant mesenchymal tumors of the uterus (MMTUs), such as leiomyosarcoma, endometrial stromal sarcoma, undifferentiated uterine sarcoma, and smooth muscle tumorMagnetic resonance imaging (MRI) is the most important diagnostic tool for differentiating between uterine leiomyoma and sarcoma [3, 8,9,10,11,12,13,14,15,16,17,18]. High signal intensity on T2-weighted images (T2WI) is one of the characteristics of MMTUs; uterine leiomyomas may show hyperintensity due to degeneration, edema, and increased cellularity [19,20,21]. It is difficult to distinguish between MMTUs and uterine leiomyomas that show a signal intensity higher than that indicated by the myometrium on T2WI, and it is clinically very important to differentiate them. This study aimed to generate a new method to distinguish MMTUs and uterine leiomyomas wherein more than 50% of the lesions show higher signal intensity than that revealed by the myometrium on T2WI (T2-weighted hyperintense leiomyoma: T2HILM) based on the findings of MRI and clinical features
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