Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382.
Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382.
Cancer Imaging. 2019 Sep 12;19(1):63. doi: 10.1186/s40644-019-0247-z.
Endometrial stromal sarcoma (ESS) is a rare uterine malignancy that features different prognoses for its high- and low-grade subtypes. We investigated the diagnostic accuracy of magnetic resonance (MR) imaging in diagnosing and differentiating between high- and low-grade ESS.
We retrospectively reviewed the preoperative pelvic MR images of consecutive patients who received histologically confirmed diagnoses of high-grade ESS (n = 11) and low-grade ESS (n = 9) and T2-hyperintense leiomyoma (n = 16). Two radiologists independently evaluated imaging features in T1-, T2-, and diffusion-weighted and contrast-enhanced MR images. Statistical analysis included Mann-Whitney tests and Fisher's exact test, with sensitivity, specificity and diagnostic accuracy of imaging features.
High-grade ESS was associated with significantly more extensive necrosis and hemorrhage and distinct feather-like enhancement compared with low-grade ESS (P < .05 for all). The feather-like enhancement pattern yielded a diagnostic accuracy of 95%, sensitivity of 91%, and specificity of 100% in differentiating high-grade from low-grade ESS. This imaging characteristic was significantly superior to the necrosis (80%, P = .033) or hemorrhage (75%, P = .007). Both high- and low-grade ESS demonstrated T2 hypointense bands, marginal nodules, intratumoral nodules, and worm-like intra-myometrial nodules, and their tumor apparent diffusion coefficient (ADC) values were significantly lower than those of T2-hyperintense leiomyomas (P < .001).
Diffusion-weighted MR imaging is useful in diagnosing ESS against T2-hyperintense leiomyomas, and contrast enhancement aids in further differentiating between high- and low-grade ESS.
子宫内膜间质肉瘤（ESS）是一种罕见的子宫恶性肿瘤，其高、低级别亚型具有不同的预后。我们研究了磁共振（MR）成像在诊断和区分高、低级别 ESS 中的准确性。
我们回顾性分析了连续接受组织学证实的高级别 ESS（n=11）、低级别 ESS（n=9）和 T2 高信号子宫肌瘤（n=16）患者的术前盆腔 MR 图像。两名放射科医生独立评估了 T1、T2、弥散加权和对比增强 MR 图像中的影像学特征。统计分析包括 Mann-Whitney 检验和 Fisher 确切检验，包括影像学特征的敏感性、特异性和诊断准确性。
高级别 ESS 与低级别 ESS 相比，坏死和出血更广泛，且存在明显的羽毛状强化（所有 P<0.05）。羽毛状强化模式在区分高级别和低级别 ESS 方面具有 95%的诊断准确性、91%的敏感性和 100%的特异性。这种影像学特征明显优于坏死（80%，P=0.033）或出血（75%，P=0.007）。高级别和低级别 ESS 均表现为 T2 低信号带、边缘结节、肿瘤内结节和虫样子宫内结节，其肿瘤表观扩散系数（ADC）值明显低于 T2 高信号子宫肌瘤（P<0.001）。
弥散加权 MR 成像有助于诊断 ESS 与 T2 高信号子宫肌瘤，增强对比有助于进一步区分高级别和低级别 ESS。
