European Society of Urogenital Radiology (ESUR) Guidelines: MR Imaging of Leiomyomas

Abstract

ObjectiveThe aim of the Female Pelvic Imaging Working Group of the European Society of Urogenital Radiology (ESUR) was to develop imaging guidelines for MR work-up in patients with known or suspected uterine leiomyomas.MethodsGuidelines for imaging uterine leiomyomas were defined based on a survey distributed to all members of the working group, an expert consensus meeting at European Congress of Radiology (ECR) 2017 and a critical review of the literature.ResultsThe 25 returned questionnaires as well as the expert consensus meeting have shown reasonable homogeneity of practice among institutions. Expert consensus and literature review lead to an optimized MRI protocol to image uterine leiomyomas. Recommendations include indications for imaging, patient preparation, MR protocols and reporting criteria. The incremental value of functional imaging (DWI, DCE) is highlighted and the role of MR angiography discussed.ConclusionsMRI offers an outstanding and reproducible map of the size, site and distribution of leiomyomas. A standardised imaging protocol and method of reporting ensures that the salient features are recognised. These imaging guidelines are based on the current practice among expert radiologists in the field of female pelvic imaging and also incorporate essentials of the current published MR literature of uterine leiomyomas.Key Points• MRI allows comprehensive mapping of size and distribution of leiomyomas.• Basic MRI comprise T2W and T1W sequences centered to the uterus.• Standardized reporting ensures pivotal information on leiomyomas, the uterus and differential diagnosis.• MRI aids in differentiation of leiomyomas from other benign and malignant entities, including leiomyosarcoma.Electronic supplementary materialThe online version of this article (10.1007/s00330-017-5157-5) contains supplementary material, which is available to authorized users.

MRI of female genital tract congenital anomalies: European Society of Urogenital Radiology (ESUR) guidelines

“…Scheduling of MRI examination according to the menstrual cycle is not necessary. This agrees with the majority of authors in the literature [9].…”

“…It is recommended to achieve a moderately filled bladder, in line with previous ESUR guidelines [9][10][11].…”

“…In line with previous ESUR guidelines [9][10][11], it is recommended to fast before the examination (3-6 h) and to administer spasmolytic agents (20 mg of butylscopolamine or 1 mg glucagon (IV/IM), unless contraindicated) to reduce bowel motion artefact and obtain high-quality MR imaging.…”

MRI screening for uterine leiomyosarcoma

“…There is no exposure to radiation and there is high contrast between structures in the female pelvis. Several studies have identified features of LMS on MRI utilizing intravenous contrast and diffusion‐weighted imaging (DWI), which can identify malignant lesions by a combination of intrinsic T 2 intermediate/hyperintensity, irregular margin, low apparent diffusion coefficient (ADC) value, hemorrhage, necrosis, avid enhancement, and/or rapid growth …”

“…Several studies have identified features of LMS on MRI utilizing intravenous contrast and diffusion-weighted imaging (DWI), which can identify malignant lesions by a combination of intrinsic T 2 intermediate/hyperintensity, irregular margin, low apparent diffusion coefficient (ADC) value, hemorrhage, necrosis, avid enhancement, and/or rapid growth. [10][11][12][13][14][15][16][17][18][19][20][21][22] Based on these data, in late 2013 we created a preoperative protocol where we used MRI features to risk-stratify the appearance of fibroids in conjunction with our referring gynecologists, who used additional screening data such as total serum lactate dehydrogenase (LDH) 12 and endometrial biopsies to properly triage patients for appropriate fibroid treatment.…”