Clinical Imaging Department, Hamad General Hospital, Hamad Medical Corporation, Doha, P.O Box 3050, Qatar.
Clinical Imaging Department, Hamad General Hospital, Hamad Medical Corporation, Doha, P.O Box 3050, Qatar.
Clin Radiol. 2023 Jan;78(1):47-54. doi: 10.1016/j.crad.2022.08.144. Epub 2022 Oct 8.
To assess qualitative and quantitative magnetic resonance imaging (MRI) factors that can help distinguish leiomyosarcoma (LMS) from benign degenerative leiomyoma (BDL) and leiomyoma variants (LV) and assess the interobserver agreement for the proposed quantitative factors.
Retrospective analysis of all histopathology proven cases of LV, BDL, and LMS with a preoperative MRI was performed. Twenty-seven cases were included (five LMS, three LV, and 19 BDL) with each case independently read by a pair of radiologists. Lesion size, margins, presence or absence of degeneration, necrosis, and haemorrhage were assessed on MRI along with quantitative factors such as mean T2-weighted (W) and T1W signal intensity, T1W signal heterogeneity, diffusion-weighted imaging (DWI), and apparent diffusion coefficient (ADC) ratios as well as dynamic contrast enhancement (DCE) characteristics along with the presence or absence of lymphadenopathy and extra-uterine and peritoneal spread. Mean and standard deviation for quantitative variables and frequency with percentages for qualitative variables were assessed.
Infiltrative margins were seen exclusively in the LMS group (n=1), with the remaining LMS cases showing lobulate or rounded smooth margins similar to BDL or LV. A high T2W signal <25% was seen exclusively in the BDL group (n=8). The presence of concomitant necrosis and haemorrhage was seen exclusively in the LMS group (n=2). Quantitative MRI had good inter-reader correlation but was not significantly different between the LMS, BDL, and LV groups.
LMS, BDL, and LV may have overlapping features on multiparametric MRI making differentiation difficult.
评估有助于区分平滑肌肉瘤（LMS）、良性退行性平滑肌瘤（BDL）和平滑肌瘤变异型（LV）的定性和定量磁共振成像（MRI）因素，并评估所提出的定量因素的观察者间一致性。
对所有术前 MRI 证实为 LV、BDL 和 LMS 的组织病理学病例进行回顾性分析。共纳入 27 例（5 例 LMS、3 例 LV 和 19 例 BDL），每例均由一对放射科医生独立阅读。在 MRI 上评估病变大小、边界、是否存在退行性变、坏死和出血，以及定量因素，如平均 T2 加权（W）和 T1W 信号强度、T1W 信号异质性、弥散加权成像（DWI）和表观弥散系数（ADC）比值以及动态对比增强（DCE）特征，以及是否存在淋巴结病和子宫外和腹膜扩散。评估定量变量的平均值和标准差以及定性变量的频率和百分比。
浸润性边界仅见于 LMS 组（n=1），其余 LMS 病例的边界呈分叶状或圆形光滑，类似于 BDL 或 LV。高 T2W 信号<25%仅见于 BDL 组（n=8）。同时存在坏死和出血仅见于 LMS 组（n=2）。定量 MRI 具有良好的观察者间相关性，但在 LMS、BDL 和 LV 组之间无显著差异。
LMS、BDL 和 LV 在多参数 MRI 上可能具有重叠特征，使得鉴别困难。
