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Does pelvic magnetic resonance imaging differentiate among the histologic subtypes of uterine leiomyomata?

Fertility and Sterility
Publication Date
DOI: 10.1016/s0015-0282(98)00193-9
  • Leiomyoma
  • Uterine Smooth Muscle Tumors
  • Cellular Leiomyoma
  • Degenerated Leiomyoma
  • Hemorrhagic Leiomyoma
  • Leiomyosarcoma
  • Pelvic Magnetic Resonance Imaging
  • Signal Intensities
  • Biology
  • Medicine


Abstract Objective: To evaluate if pelvic magnetic resonance imaging (MRI) is reliable for differentiating leiomyoma subtypes. Design: Prospective study. Setting: 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.

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