Schwartz L B, Zawin M, Carcangiu M L, Lange R, McCarthy S
Department of Obstetrics and Gynecology, New York University Medical Center, New York 10016, USA.
Fertil Steril. 1998 Sep;70(3):580-7. doi: 10.1016/s0015-0282(98)00193-9.
To evaluate if pelvic magnetic resonance imaging (MRI) is reliable for differentiating leiomyoma subtypes.
Prospective study.
Academic center.
PATIENT(S): Forty-five patients underwent MRI before surgery for leiomyomata.
INTERVENTION(S): One radiologist blinded to patient history and histologic diagnosis recorded the MRI characteristics and classification of the largest leiomyoma.
MAIN OUTCOME MEASURE(S): Comparison of MRI and histologic diagnoses.
RESULT(S): Leiomyoma subtypes were diagnosed accurately by MRI in 69% of cases. Magnetic resonance imaging had a 95% sensitivity and 72% specificity for diagnosing an uncomplicated leiomyoma and a 10% sensitivity and 100% specificity for a cellular leiomyoma. For cystic leiomyomata, the sensitivity was 80% and specificity was 98%, and for hemorrhagic leiomyomata, 100% and 86%, respectively. Magnetic resonance imaging correctly diagnosed all malignant tumors and did not incorrectly diagnose a leiomyoma as a leiomyosarcoma in any case. Ill-defined MRI margins were significantly more likely to be leiomyosarcoma, whereas well-defined margins were characteristic of benign lesions. Hemorrhagic leiomyomata were significantly more likely to be hyperintense on T1-weighted images than other subtypes.
CONCLUSION(S): Although MRI is only fairly accurate in differentiating the subtypes of benign uterine smooth muscle tumors, signal intensities and margin characteristics are useful to distinguish accurately benign from malignant tumors.
