Differential Diagnosis of Uterine Leiomyoma and Uterine Sarcoma Using Magnetic Resonance Images: A Literature Review
<p>Typical images of uterine myoma in magnetic resonance images. In T1-weighted images, signals equivalent to or relatively lower than that of the normal myometrium can be observed. In T2-weighted images, signals that are clearly lower than those of the normal myometrium, with resection of almost all spherical masses with clearly defined borders, can be observed.</p> "> Figure 2
<p>MR images of degenerated leiomyoma. These images always require a differential diagnosis from sarcoma. (<b>A</b>): hyaline degeneration (T2WI), (<b>B</b>): leiomyoma with cystic change (T2WI), (<b>C</b>): cellular leiomyoma (T2WI), (<b>D</b>): red degeneration (T1WI), (<b>E</b>): myxoid degeneration (T2WI).</p> "> Figure 3
<p>Magnetic resonance image findings considered to be characteristic of (specific for) uterine sarcoma. (<b>1</b>) High signals in T2-weighted images (T2WI) (case of uterine myoma): Mass in the fundus uteri has extremely high signal intensity (SI). (<b>2</b>) High signals in T1-weighted images (T1WI) (case of uterine sarcoma): There are mottled portions of high SI suggesting hemorrhage within the mass. (<b>3</b>) Ill-defined mass borders (case of uterine sarcoma, T2WI): Mass existing in the myometrium. High signals are presented in T2WI, and at the arrow portions, borders are ill-defined.</p> "> Figure 4
<p>Magnetic resonance images of leiomyosarcoma. (<b>A</b>,<b>B</b>): T1-weighted sagittal sections, (<b>C</b>,<b>D</b>): T2-weighted sagittal sections. In the myometrium, in T2-weighted images, overall, there is high signal intensity with ill-defined borders; in T1-weighted images, there is mass accompanied by internal hemorrhage. Follow-up observation was selected for this case, with the diagnosis of uterine sarcoma 1 year thereafter.</p> "> Figure 5
<p>Magnetic resonance images of leiomyosarcoma (age, 49 years). (<b>A</b>,<b>B</b>): T2-weighted images sagittal sections, (<b>C</b>): T1-weighted axial section, (<b>D</b>): contrast T1 fat-suppression axial section. In the myometrium, heterogeneous high signals are presented with T2-weighted images, and with T1-weighted images, there is confirmation of mass showing faint high signals considered to be hemorrhage. In the contrast T1 fat-suppression image (<b>D</b>), a poorly contrasted area considered to be necrosis is found, while in (<b>B</b>), the fundus uteri side shows extremely thin myometrium, together with finding a portion considered to be extraserosal exposure, with ill-defined tumor borders (arrow).</p> "> Figure 6
<p>Magnetic resonance images of low-grade endometrial stromal sarcoma (age, 41 years). (<b>A</b>): T2-weighted sagittal section, (<b>B</b>): T1-weighted axial section, (<b>C</b>): T1-weighted axial section, (<b>D</b>): dynamic MRI contrast sagittal section. Within the uterine posterior wall myometrium, in T2-weighted images, there are mild high signals, with slow deep dyeing in the dynamic contrast-enhanced magnetic resonance imaging, with a finding of mass accompanied with internal necrosis. The T1-weighted images of C present faint high signals.</p> "> Figure 7
<p>Magnetic resonance images of low-grade endometrial stromal sarcoma. (<b>A</b>): T2-weighted sagittal section, (<b>B</b>): T1-weighted sagittal section, (<b>C</b>): T2-weighted axial section, (<b>D</b>): diffusion-weighted image. Within the uterine posterior wall myometrium, in T2-weighted images, there are relatively high signals, and in T1-weighted images, a mass with ill-defined borders presenting low signals is observed. In (<b>A</b>) and (<b>C</b>), a low-signal band exists in the high-signal mass, presenting a “worm-like” finding that suggests that the low-grade endometrial stromal sarcoma is penetrating the normal myometrium while interposing itself intratumorally. Reduced diffusion is shown in (<b>D</b>).</p> ">
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