Differential Diagnosis of Uterine Leiomyoma and Uterine Sarcoma Using Magnetic Resonance Images: A Literature Review
Abstract
:1. Introduction
2. MR Imaging Sequences Required for Evaluation
- T2-weighted images (T2WI) (sagittal, axial section)
- T1-weighted images (T1WI) (sagittal, axial section)
- Diffusion-weighted image (DWI) (sagittal or axial section) and apparent diffusion coefficient (ADC) map
- Optional: Gadolinium contrast-enhanced images including fat-suppression T1W1 and dynamic MRI
3. Procedures for the Interpretation of MR images
- In the T2WI, ascertain the mass signals. Are there mass signals in intermediate to high-signal areas? Typical uterine myoma is presented as low signals [3].
- In the T2WI, examine the mass borders. If the borders are ill-defined, this suggests infiltrative growth into the periphery, and sarcoma is suspected [3].
- Ascertain the contrast effect of the mass. While sarcoma shows a strong contrast effect from an early stage, in some cases, the contrast effect is insufficient, with an area presumed to be necrosis [4].
4. Modality of Evaluation Images
5. MR Image Findings
6. MR Images of Uterine Sarcoma
6.1. Characteristic MR Image Findings for Uterine Sarcoma
6.2. Leiomyosarcoma
6.3. Endometrial Stromal Sarcoma (ESS)
7. Differentiating between Uterine Myoma and Sarcoma
8. Update on Differential Diagnosis of Uterine Myoma and Sarcoma
9. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Ordinary Leiomyoma | Degenerated Leiomyoma | Cellular Leiomyoma | Leiomyosarcoma | |
---|---|---|---|---|
Number | Multiple | Multiple | Multiple | Single |
Well-Delinecated Margins | Yes | Yes | Yes | − |
Endometrial Thinkening | No | – | − | Yes |
Ascites | – | – | – | Yes |
T2-Weighted Images | Hypointense | Hypo or Hyper Intense (Depending on the Type of Degeneration) | Intermediate Hypersignal | Hyperintense |
T1-Weighted Images | Isosignal | Hypo or Hyper Intense (Depending on the Type of Degeneration) | Inosignal | Hypersignal |
Diffusion-Weighted Images | Isosignal | Isosignal | Hypersignal | Hypersignal |
ADC value <1.23 × 10−3 mm2/s | – | – | + | + |
T1-Weighted Post-Gadolinium Chelate | Hypovascular heterogeneous | Hypovascular Heterogeneous | Homogeneous Progressive Filling-In | Early Heterogenous progressive fillng-in |
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Suzuki, A.; Aoki, M.; Miyagawa, C.; Murakami, K.; Takaya, H.; Kotani, Y.; Nakai, H.; Matsumura, N. Differential Diagnosis of Uterine Leiomyoma and Uterine Sarcoma Using Magnetic Resonance Images: A Literature Review. Healthcare 2019, 7, 158. https://doi.org/10.3390/healthcare7040158
Suzuki A, Aoki M, Miyagawa C, Murakami K, Takaya H, Kotani Y, Nakai H, Matsumura N. Differential Diagnosis of Uterine Leiomyoma and Uterine Sarcoma Using Magnetic Resonance Images: A Literature Review. Healthcare. 2019; 7(4):158. https://doi.org/10.3390/healthcare7040158
Chicago/Turabian StyleSuzuki, Ayako, Masato Aoki, Chiho Miyagawa, Kosuke Murakami, Hisamitsu Takaya, Yasushi Kotani, Hidekatsu Nakai, and Noriomi Matsumura. 2019. "Differential Diagnosis of Uterine Leiomyoma and Uterine Sarcoma Using Magnetic Resonance Images: A Literature Review" Healthcare 7, no. 4: 158. https://doi.org/10.3390/healthcare7040158