Preoperative diagnosis of atypical pelvic leiomyoma and sarcoma: the potential role of diffusion-weighted imaging

Abstract

The objective of our study was to determine the utility of diffusion-weighted magnetic resonance (DWMR) to differentiate the atypical uterine leiomyomas and sarcomas, establishing a cut-off value of the apparent diffusion coefficient (ADC) to rule out the malignancy. We performed a diagnostic accuracy retrospective study including 10 patients with pelvic sarcomas and 17 patients with leiomyomas. Atypical morphological features in magnetic resonance (MR) studies occurred in 58.8% of the patients, leading to a significant number of indeterminate diagnoses. In contrast, ADC values were consistent for leiomyomas, sarcomas, primary tumours, recurrences, intrauterine and in the extrauterine pelvic locations. The ADC cut-off value was set in 1 (×10 mm/s). Thus, the ADC values equal or superior to 1 × 10 mm/s were always associated with a leiomyoma. The structural MR accuracy was 66.7%, reaching 100% when using DWMR with dichotomised ADC values. Diffusion-weighted imaging with the quantitative measurement of ADC may be considered a useful preoperative test for the differentiation of atypical leiomyomas from sarcomas. Impact statement What is already known on this subject? Papers reporting the utility of a diffusion-weighted MR for the diagnosis of uterine sarcomas are scarce and consist of a small series. However, the published results are consistent with our study, with the decreased ADCs in the case of malignancy. What do the results of this study add? The main differential characteristic of our study is that we selected only the atypical leiomyomas: they share sonographic and MR features with sarcomas, which often leads to an inaccurate diagnosis. This is also the first paper reporting on the role of DWMR with ADC for these types of tumours in extrauterine pelvic locations. We demonstrated a consistent relationship between dichotomised ADC values in leiomyomas/sarcomas for these particular cases and in recurrent tumours, with no overlap between both the groups, as a difference with the previous reports. What are the implications of these findings for clinical practice and/or further research? Our study can be considered as a proof of concept supporting DWMR with ADC measurement as a useful tool to enhance the diagnostic accuracy of MR, highlighting its value to rule out malignancy. Hence, DWMR seems to be a potential useful test to include in the preoperative evaluation of clinically atypical uterine tumours.

Significance of changes in inflammatory parameters following uterine artery embolization in pre‑menopausal females

“…Serious complications may appear even at 6 months post-treatment (11,13,14,31). Any alterations in inflammatory parameters, body temperature or leukocytosis, along with CRP levels and pain evaluation, should be monitored until 6 months post-embolization (11,13,14,(31)(32)(33)(34)(35)(36). CRP is an acute-phase pro-inflammatory cytokine, which is crucial in the acute phase of inflammation and increases progressively in association with the inflammatory process (11,13,14,(31)(32)(33)(34)(35)(36).…”

The Role of Magnetic Resonance Imaging in the Differential Diagnosis of Giant Rectal and Perirectal Masses

“…Giant tumors located in the rectal and perirectal regions cause compression and distortion in normal anatomic structures, so it may be difficult to determine the origin of the tumor and decide the correct diagnosis and treatment (1)(2)(3)(4)(5)(6). Masses such as rectal adenocarcinoma, sarcoma, neuroendocrine tumor, leiomyoma, ovarian mass, rectal gastrointestinal stromal tumor (GIST), prostate adenocarcinoma, lymphoma, neurogenic tumor and congenital cyst should be considered in the differential diagnosis of giant rectal and perirectal tumors (6).…”

“…Although rectoscopy-guided biopsy is the most important method for diagnosis, it is insufficient to evaluate intramural and extramural extension of the mass (1,5). Pre-operative imaging is necessary to determine the location of the mass (submucosal/intramural/extramural) and its extension, to evaluate the need for surgical approach to the patient and to decide the surgical technique to be applied (1)(2)(3)(4)(5)(6)(7). Computed tomography (CT) and magnetic resonance imaging (MRI) are used in the diagnosis and evaluation of rectal and perirectal tumors (1)(2)(3)(4)(5)(6)(7).…”

“…Pre-operative imaging is necessary to determine the location of the mass (submucosal/intramural/extramural) and its extension, to evaluate the need for surgical approach to the patient and to decide the surgical technique to be applied (1)(2)(3)(4)(5)(6)(7). Computed tomography (CT) and magnetic resonance imaging (MRI) are used in the diagnosis and evaluation of rectal and perirectal tumors (1)(2)(3)(4)(5)(6)(7). MRI is more appropriate because it does not contain radiation and has high soft tissue resolution (1)(2)(3)(4)(5).…”

“…Computed tomography (CT) and magnetic resonance imaging (MRI) are used in the diagnosis and evaluation of rectal and perirectal tumors (1)(2)(3)(4)(5)(6)(7). MRI is more appropriate because it does not contain radiation and has high soft tissue resolution (1)(2)(3)(4)(5). Diffusion-weighted imaging (DWI) may also provide important findings in use with MRI (8)(9)(10).…”