Multiparametric MR evaluation of uterine leiomyosarcoma and STUMP versus leiomyoma in symptomatic women planned for high frequency focussed ultrasound: accuracy of imaging parameters and interobserver agreement for identification of malignancy

Abstract

Objective: To assess accuracy of and interobserver agreement on multiparametric MR findings to distinguish uterine leiomyoma (LM) from uterine leiomyosarcoma (LMS) and soft tissue tumour of unknown malignant potential. Methods: Inclusion criteria: All females over 18 years with least one uterine mass measuring 5 cm or more in at least one of the three standard orthogonal dimensions on MR with histopathological confirmation of LM, LMS, or soft tissue tumour of unknown malignant potential (STUMP) in the 3 months following MR. Patients with LMS were drawn from a larger cohort being assessed for MR-guided focussed ultrasound (MRgFUS) suitability. Image evaluation: Assessed variables were: lesion margin, margin definition, T2 signal homogeneity, >50% of lesion with T2 signal brighter than myometrium, haemorrhage, restricted diffusion, contrast enhancement (CE), CE pattern, local lymphadenopathy and ascites. Results: 32 LM, 10 LMS and 1 STUMP were evaluated. Ill-defined (p-value = 0.0003–0.0004) or irregular (p = 0.003–0.004) lesion margin, T2 hyperintensity >50% (p = 0.001–0.004), and peripheral CE (p = 0.02–0.05) were significantly more common in LMS/STUMP than LM for both radiologists. 10/11 (Reader 2) and 11/11 (Reader 1) LMS/STUMP displayed restricted diffusion but so did 63–80% of LM. Agreement was greatest for margin characteristics (κ = 0.73–0.81). Conclusion: Irregular/ill-defined lesion margin best distinguished LMS/STUMP from LM with good interrater reliability. Advances in knowledge: Assessment of agreement regarding MR parameters distinguishing LM from LMS and STUMP has not previously been undertaken in a cohort including a large number of patients with LMS. This will help inform evaluation of females considering minimally invasive LM treatment.

Radiomics and artificial intelligence in malignant uterine body cancers: Protocol for a systematic review

“…In particular, AI-based analyses of radiological, histological and molecular features could improve the diagnostic and therapeutic pathway of UBCs. In fact, the availability of diagnostic and prognostic biomarkers is still an unmet clinical need in EC and USa [ 17 , 18 ]. More specifically, integration of multi-omic data through AI systems could bypass the conventional clinical and molecular risk classifications (ESMO risk [ 19 ] and TCGA subclasses [ 3 ]) to allow a more personalized management of EC.…”

An update on uterine artery embolization for uterine leiomyomata and adenomyosis of the uterus

“…While transvaginal ultrasound is the initial imaging test of choice, MR imaging plays a role to assess the extent of disease, exclude other pathologies and weigh possible advantages or disadvantages of UAE versus other treatment options. [36][37][38][39][40][41][42][43] Indications and contraindications UAE is indicated for the treatment of uterine leiomyomata that are causing significant symptoms such as heavy or prolonged menstrual bleeding (hypermenorrhea), pelvic pressure or pain related to identified leiomyomata, including dyspareunia (Table 1). Most females will experience a combination of symptoms.…”

“…However, MR imaging can aide in the differentiation of atypical fibroids and uterine sarcomas exist and key features exist, that are more suggestive of a uterine sarcoma. 42,43 Coffin et al seeked to determine the frequency of uterine malignancy in patients evaluated for UAE at a single institution. Uterine malignancy was rare (4/864, 0.46%), and MRI detected the majority, 3 (75%) of 4 before UAE.…”

Leiomyoma with Bizarre Nuclei: A Current Update

“…In MRI, LBN and benign uterine leiomyomas usually present as well-defined large uterine masses, while LMS usually presents as large uterine masses with ill-defined, irregular margins. 59 The MRI characteristics of different types of USMTs are shown in Figures 6 and 7 . In T1-weighted images, LBN is typically isointense to hypointense to muscle, while benign uterine leiomyomas are isointense to muscle.…”