Lin Yenpo, Wu Ren-Chin, Huang Yen-Ling, Chen Kueian, Tseng Shu-Chi, Wang Chin-Jung, Chao Angel, Lai Chyong-Huey, Lin Gigin
Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan.
Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan.
Abdom Radiol (NY). 2022 Jun;47(6):2197-2208. doi: 10.1007/s00261-022-03431-6. Epub 2022 Mar 26.
Uterine leiomyoma, also known as uterine fibroid, is the most common gynecological tumor, affecting almost 80% of women at some point during their lives. In the same time, other fibroid-like tumors have similar clinical presentations and about 0.5% of resected tumors of which were presumed benign fibroids in the preoperative diagnosis revealed as malignant sarcomas in the final histopathological examination. Amid the emergence of nonsurgical or minimally invasive procedures for symptomatic benign uterine fibroids, such as uterine artery embolization, high-intensity-focused ultrasound, or laparoscopic myomectomy, the preoperative diagnosis of uterine tumors through imaging becomes all the more relevant. Preoperative tissue sampling is challenging because of the variable location of the myometrial mass; thus, the preoperative evaluation of size and location is increasingly performed through magnetic resonance imaging. Features in images might also be useful for examining the full spectrum of such growths, from benign fibroids to neoplasms of uncertain behavior and malignant sarcomas. Benign fibroids include usual-type leiomyomas, myomas with degeneration, and mitotically active leiomyomas. Neoplasms of uncertain behavior include smooth muscle tumors of uncertain malignant potential, leiomyomas with bizarre nuclei, and cellular leiomyomas. Malignant sarcomas comprise leiomyosarcomas, endometrial stromal sarcomas, adenosarcomas, and carcinosarcomas. The purpose of this article is to review the spectrum of MRI findings of uterine fibroid-like tumors, from benign variants, uncertain behavior to malignant sarcomas, and update the advanced imaging modalities, including diffusion-weighted imaging, positron emission tomography/computed tomography, combining texture analysis and radiomics, to tackle this important issue.
子宫平滑肌瘤，也称为子宫肌瘤，是最常见的妇科肿瘤，几乎80%的女性在其一生中的某个阶段都会受到影响。与此同时，其他类似肌瘤的肿瘤具有相似的临床表现，术前诊断为良性肌瘤的切除肿瘤中，约0.5%在最终组织病理学检查中被发现为恶性肉瘤。在出现针对有症状的良性子宫肌瘤的非手术或微创手术（如子宫动脉栓塞术、高强度聚焦超声或腹腔镜子宫肌瘤切除术）的情况下，通过影像学进行子宫肿瘤的术前诊断变得更加重要。由于子宫肌层肿块位置多变，术前组织采样具有挑战性；因此，越来越多地通过磁共振成像来进行大小和位置的术前评估。图像特征对于检查此类肿瘤的全貌也可能有用，从良性肌瘤到行为不确定的肿瘤以及恶性肉瘤。良性肌瘤包括普通型平滑肌瘤、变性肌瘤和有丝分裂活跃的平滑肌瘤。行为不确定的肿瘤包括恶性潜能不确定的平滑肌肿瘤、奇异核平滑肌瘤和富于细胞平滑肌瘤。恶性肉瘤包括平滑肌肉瘤、子宫内膜间质肉瘤、腺肉瘤和癌肉瘤。本文的目的是回顾子宫肌瘤样肿瘤的磁共振成像表现谱，从良性变体、行为不确定的肿瘤到恶性肉瘤，并更新先进的成像模式，包括扩散加权成像、正电子发射断层扫描/计算机断层扫描，结合纹理分析和放射组学，以解决这一重要问题。
